ROLE OF MATERNAL PRE-CONCEPTION BMI AND GESTATIONAL WEIGHT GAIN IN PREDICTING EMERGENCY CESAREAN DELIVERY

Abstract

Background: Maternal pre-pregnancy body mass index (BMI) and gestational weight gain (GWG) may influence labor progression and the likelihood of operative delivery. This study evaluated their association with emergency cesarean delivery among women undergoing a trial of labor.

Methods: A hospital-based observational cohort study was conducted at the Department of Obstetrics and Gynecology, Pakistan Ordnance Factories Hospital, Wah Cantt, from 10 January 2024 to 05 October 2025. A total of 400 women undergoing a trial of labor were included. Pre-pregnancy BMI was categorized as underweight, normal weight, overweight, or obese, while GWG was classified as inadequate, adequate, or excessive according to Institute of Medicine recommendations. The primary outcome was emergency cesarean delivery. Associations were assessed using multivariable binary logistic regression, with adjusted odds ratios (aORs) and 95% confidence intervals (CIs) reported.

Results: Emergency cesarean delivery occurred in 154 (38.5%) women. The emergency cesarean rate increased progressively across BMI categories, from 22.2% in underweight women and 29.4% in women with normal BMI to 44.0% in overweight and 72.2% in obese women. Compared with normal BMI, overweight and obesity were independently associated with emergency cesarean delivery (aOR 1.72, 95% CI 1.05–2.82; and aOR 3.84, 95% CI 2.03–7.27, respectively). Each 1 kg/m² increase in BMI was associated with higher odds of emergency cesarean delivery (aOR 1.09, 95% CI 1.04–1.14). Excessive GWG was also independently associated with emergency cesarean delivery compared with adequate GWG (aOR 2.31, 95% CI 1.43–3.73). Nulliparity and induction of labor were additional independent predictors.

Conclusion: Higher pre-pregnancy BMI and excessive gestational weight gain were independently associated with emergency cesarean delivery among women undergoing a trial of labor. Early assessment of maternal BMI and appropriate monitoring of gestational weight gain may help identify women at increased risk of emergency operative delivery.