(661) Maternal-newborn dyadic outcomes by severity of weight gain in obese pregnancies

This retrospective cross-sectional study included all deliveries eligible for the Joint Commission’s PC-06 quality metric (term newborns without preexisting conditions) at seven hospitals within a large New York health system (2019–2024). Only each patient’s first delivery was analyzed. Among patients with pre-pregnancy obesity, gestational weight gain was categorized as appropriate (≤20 lb per 2009 Institute of Medicine guidelines) or excess ( >20 lb), and further classified as mild (21–29 lb), moderate (30–39 lb), or severe (≥40 lb). DOOR methodology grouped outcomes by delivery mode and presence of maternal or neonatal complications: (1) uncomplicated vaginal delivery, (2) uncomplicated cesarean, (3) vaginal delivery with complications, and (4) cesarean with complications. Multinomial logistic regression assessed the association between EGWG and DOOR category, adjusting for race and ethnicity, insurance, language, multiparity, and the obstetric comorbidity index (OB-CMI).

 

Results:

Among 18,907 patients, DOOR outcomes by EGWG group are shown in the Figure; regression results are in the Table. Compared to appropriate GWG, mild, moderate, and severe EGWG were each associated with increased odds of uncomplicated cesarean delivery (aORs 1.16, 1.17, and 1.18, respectively). No EGWG group showed a significant increase in the risk of cesarean with complications or vaginal delivery with complications. Risk of adverse outcomes was more strongly associated with OB-CMI and certain racial and ethnic groups.

 

Conclusion:

In patients with obesity, EGWG was linked to higher cesarean delivery rates but not to increased complications. These findings suggest that while EGWG may influence delivery mode, comorbidities and social determinants are more predictive of adverse dyadic outcomes.