Influence of Maternal Obesity on Labor Induction: A Systematic Review and Meta-Analysis.
Jessica A Ellis, Carolyn M Brown, Brian Barger and 1 others
PMID 30648804WHAT IT FOUND
Induced labor in women with obesity ended in cesarean birth more often than in women of normal weight.
Inductions also took longer and needed higher doses or repeated doses of induction medicines.
Key findings
01Cesarean birth after labor induction was more common in women with obesity than in women of normal weight in the pooled analysis of 8 studies.
02In the 7 studies reporting prostaglandin induction outcomes, women with obesity were significantly less likely to complete cervical ripening or achieve active-phase labor.
03In all 5 studies of oxytocin induction, women with obesity had longer labor duration or required higher oxytocin doses.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
The review included only observational studies, so it cannot control for bias as well as a randomized trial. The studies defined and measured BMI at different times and used different obesity categories. Labor induction protocols varied, including prostaglandin dose, route, timing, and definitions of successful cervical ripening. The meta-analysis used a fixed-effect method because few studies were available, and the authors state it is descriptive only and cannot be generalized beyond the included studies. Odds ratios were used rather than risk ratios, and odds ratios can overstate risk when the outcome is common. The review could not separate results for first-time mothers and mothers who had given birth before. It did not examine longer-term outcomes for women or newborns. Evidence on transcervical catheters was limited to 2 studies with small samples. Some studies adjusted for other maternal factors, while others did not. Changing definitions of active labor, such as using 6 cm dilation, may affect how these older studies apply today.
Declared interests
The authors have no conflicts of interest to disclose.
The easy way to misread this
Do not conclude that labor induction itself causes more cesarean births in women with obesity. This review pooled observational studies, so it cannot separate the effect of obesity from the induction protocol or other pregnancy factors.