• Obesity
• Pregnancy Clinical Trials

• Obesity
• Pregnancy
• Obstetrics & Gynecology Clinical Trials
• Obstetrics & Gynecology

Planning a vaginal delivery provides optimal delivery and cost outcomes, according to a study that used a computational model to estimate the effect of induction of labor compared to expectant management of term pregnancies in obese women. They found that induction at 39 weeks of gestation minimized cesarean deliveries, stillbirths, and delivery-related health care costs.

Lisa Gill, MD, of the Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, Minnesota, USA, reported the outcomes of the study, which used a decision analysis model to evaluate the optimal timing of delivery and cost outcomes in a hypothetical cohort of 100,000 pregnancies in obese patients. The model used existing data to predict outcomes (ie, stillbirths, cesarean deliveries, and delivery-related health care costs) from routine induction at 39 weeks of gestation compared with expectant management and routine induction at 40, 41, and 42 weeks.

The data used in the model were extracted from previously published research on the likelihood of spontaneous labor, the rate of cesarean section with spontaneous and induced labor, and the risk of stillbirth by gestational age in obese patients. Study data that pertained to health care costs associated with vaginal or cesarean delivery were also extracted from previously published data.

The study found that routine induction at 39 weeks of gestation was associated with a decreased number of stillbirths, a reduction in cesarean sections, and significant cost savings when compared with delivery at 40, 41, and 42 weeks via expectant management or induction of labor.

Compared with the worst-case model of expectant management with induction at 42 weeks, 387 stillbirths as well as 10,035 cesarean deliveries were avoided by routine induction at 39 weeks, with a savings in hospital costs of $29.3 million.

Comparing outcomes of induction at 39 weeks with the 2 worse-case models of expectant management and induction at 40 or 41 weeks, more than 9000 cesarean deliveries were avoided (30,888 vs. 40,025 and 40,122, respectively).

Dr. Gill emphasized that although the study indicates a benefit of early induction of labor at 39 weeks for obese patients, she cautioned that the results are limited by the computational nature of the study and its potential for biases that may have been present in the studies that were used to develop the model. She also cited a recently published study that reported the opposite findings: that obese women induced at 39 weeks had a significant increase in cesarean delivery when compared to expectant management [Wolfe X et al. Am J Obstet Gynecol 2014].

She emphasized the need for a prospective trial to better understand the optimal timing for delivery in obese women and mentioned a trial currently under development that will help to address this question (NICHD ARRIVE; NCT01990612).

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