U.S. prepregnancy obesity rates of 25% reported

It is well established that a strong link between maternal weight and birth outcomes (both maternal and neonatal) exists. In particular, women who are overweight or obese are more likely to have adverse outcomes, and this includes the likelihood of a medical (planned or emergency) cesarean delivery.

A study published this week has highlighted the prevalence of this situation in the USA, and this is important in light of efforts being made to reduce the national cesarean rate. In 'Prepregnancy Obesity Prevalence in the United States, 2004–2005', Chu et al studied 75,403 women and found that "about one in five women who delivered were obese [and] in some state, race/ethnicity, and Medicaid status subgroups, the prevalence was as high as one-third. State-specific prevalence varied widely and ranged from 13.9 to 25.1%. Black women had an obesity prevalence about 70% higher than white and Hispanic women (black: 29.1%; white: 17.4%; Hispanic: 17.4%); however, these race-specific rates varied notably by location. Obesity prevalence was 50% higher among women whose delivery was paid for by Medicaid than by other means (e.g., private insurance, cash, HMO)." They concluded: "This prevalence makes maternal obesity and its resulting maternal morbidities (e.g., gestational diabetes mellitus) a common risk factor for a complicated pregnancy."

Why is this important?
Because if advocates of vaginal delivery want to address the escalating national cesarean rate in the U.S. (and indeed other countries), which currently stands at 31.1%, it is vital that they first address this very modern health care issue (women may have been giving birth for centuries, but they weren't the same shape and size as we see in today's society). It is not a simple fix, that is true, but these women need help and support long before they go into labor if they are to succeed in delivering their babies safely. Targeting healthy women for whom cesarean delivery is their personal preference not only ignores the problem at hand, but is grossly unfair too.