Women who are obese before pregnancy have a higher risk of
caesarean section than normal weight women. We investigated the combined effect of pre-pregnancy weight and
gestational weight gain on pre-labour and intrapartum
caesarean section risk. We collected data on 22,763 singleton, term, live deliveries in 2003-2014 from the Icelandic Maternal and Child Health Study (
ICE-MCH), based on Icelandic registries. These were the Icelandic Medical Birth Registry and the Saga Maternal and Child Health Database. Pre-pregnancy body mass index was categorised into underweight, normal weight,
overweight and obese.
Gestational weight gain was classified according to the Institute of Medicine´s recommendation into below, within and above the recommended range. Logistic regression models, adjusted for maternal and gestational characteristics, were used to calculate adjusted odds ratios (AOR) and 95% confidence intervals (CI) for the risk of
caesarean section. Obese women had a higher risk of pre-labour (AOR 1.56, 95% CI 1.34-1.81) and intrapartum
caesarean section (AOR 1.92, 95% CI 1.70-2.17) than normal weight women in all categories of
gestational weight gain.
Gestational weight gain above the recommended range, compared to within the range, increased the risk of intrapartum
caesarean section among normal weight (AOR 1.46, 95% CI 1.23-1.73) and
overweight women (AOR 1.291, 95% CI 1.04-1.60).
Gestational weight gain below the recommended range, compared to within the range, increased the risk of pre-labour
caesarean section (AOR 1.64, 95% CI 1.20-2.25), but only among
overweight women. Women who are obese before pregnancy have a high risk of
caesarean section regardless of
gestational weight gain. However, women who are normal weight or
overweight before pregnancy and
gain weight above the recommended range during pregnancy may also have an increased risk of
caesarean section.