Trends in maternal body mass index, macrosomia and caesarean section in first-time mothers during the pandemic: a multicentre retrospective cohort study of 12 Melbourne public hospitals

期刊论文
出版模式：

开放获取
发表日期：

2024年10月28日

查看全文

Andrew J. Goldsack,
Melvin B. Marzan,
Daniel L. Rolnik,
Anthea C. Lindquist,
Joanne M. Said,
Kirsten R. Palmer,
Penelope M. Sheehan,
Stephanie Potenza,
Natasha Pritchard,
Clare L. Whitehead,
Jolyon Ford,
Ben W. Mol,
Susan P. Walker,
Lisa Hui

摘要

Objective

To compare specific perinatal outcomes in nulliparas with a singleton infant in cephalic presentation at term, with and without exposure to the COVID-19 pandemic during pregnancy. We hypothesised that the pandemic conditions in Melbourne may have been an independent contributor to trends in maternal Body Mass Index ≥ 25 kg/m², macrosomia and caesarean section.

Design

Multi-centre retrospective cohort study and interrupted time-series analysis.

Setting

Metropolitan Melbourne, Victoria.

Population

Singleton infants ≥ 20 weeks gestational age born between 1 January 2019 and 31 March 2022.

Main outcome measures

Rates of maternal Body Mass Index ≥ 25 kg/m², macrosomia (birthweight ≥ 4000 g) and caesarean section.

Results

25 897 individuals gave birth for the first time to a singleton infant in cephalic presentation at term in the pre-pandemic cohort, and 25 298 in the pandemic-exposed cohort. Interrupted time-series analysis demonstrated no significant additional effect of the pandemic on pre-existing upward trends in maternal Body Mass Index ≥ 25 kg/m², caesarean section or macrosomia. The rate of maternal Body Mass Index ≥ 25 kg/m² was higher in the pandemic-exposed cohort compared with the pre-pandemic cohort, (45.82% vs. 44.58% respectively, p = 0.041) as was the overall rate of caesarean section (33.09% vs. 30.80%, p < 0.001). However, this increase in caesarean section was confined to individuals who had either an induction of labour or no labour. There was also a nonsignificant trend to higher rates of macrosomia in the pandemic-exposed cohort compared with the pre-pandemic cohort (8.55% vs. 7.99% respectively, p = 0.124).

Conclusions

While rates of Body Mass Index ≥ 25 kg/m², pre-labour caesarean section, and caesarean section following induction of labour were higher among pandemic-exposed nulliparas, these findings represented a continuation of pre-existing upward trends, with no significant independent contribution from the pandemic. These trends are forecast to continue, with long term implications for population health.