The world health organization (who) considers it a “global epidemic,” affecting both developed and developing countries [6]. In india, obesity is rapidly increasing alongside persistent undernutrition, with over 30 million obese individuals[7]. This rise, driven by urbanization, sedentary lifestyles, and dietary changes, has led to a surge in non-communicable diseases such as diabetes, hypertension, and cardiovascular disorders[8]. Of particular concern is the increasing prevalence of obesity among women of reproductive age, which is linked to adverse pregnancy outcomes including gestational diabetes, hypertensive disorders, cesarean delivery, macrosomia, and perinatal mortality[9]. It also complicates prenatal care and increases long-term health risks for both mother and child. Early recognition and management of maternal obesity, beginning preconception and continuing postpartum, are essential to improve outcomes, especially in resource-limited settings like india.[10]

METHODOLOGY

This prospective observational study was conducted over a 12-month period, from february 2024 to february 2025, in the department of obstetrics and gynaecology at kodagu institute of medical sciences (koims), madikeri. The study aimed to evaluate the impact of maternal overweight and obesity on maternal and neonatal outcomes in a tertiary care setting. Participants were selected through convenience sampling from among pregnant women attending the antenatal outpatient services.

ELIGIBILITYCRITERIA:

Women aged 18 to 35 years with singleton pregnancies at any gestational age (not in active labor) were included, provided they had documented antenatal visits and a prepregnancy body mass index (bmi) >23 kg/m². Only those willing to provide informed written consent were enrolled. Exclusion criteria comprised a prior history of chronic illnesses such as diabetes mellitus, hypertension, thrombophilia, hypothyroidism, the presence of fetal anomalies, conception via assisted reproductive technologies, or unwillingness to participate.

DATACOLLECTION

Following approval from the institutional scientific and ethical committees of koims, eligible participants were enrolled. A comprehensive clinical history was recorded, followed by physical and obstetric examination. Bmi was calculated using the standard formula:

Participants were stratified into overweight and obese categories based on bmi and followed through pregnancy, labor, and postpartum for evaluation of maternal and fetal outcomes. Maternal parameters assessed included gestational diabetes mellitus (gdm), gestational hypertension, preeclampsia, mode and timing of delivery, need for induction, postpartum hemorrhage (pph), wound infection, puerperal sepsis, and deep vein thrombosis (dvt). Fetal parameters evaluated included birth weight, macrosomia, intrauterine growth restriction (iugr), apgar scores at 1 and 5 minutes, neonatal respiratory distress, and the need for nicu admission.

STATISTICALANALYSIS:

All data were compiled and analyzed using spss software version 21. Descriptive statistics, including mean and standard deviation for continuous variables and frequencies with percentages for categorical variables, were computed. The chi-square test was used to examine associations between maternal bmi and various maternal and fetal outcomes. A p-value of <0.05 was considered statistically significant.

RESULTS

1. MATERNAL RISK ASSESMENT:

In this study, maternal obesity was demonstrably linked to a wide array of obstetric complications, underscoring its profound impact on maternal health. Gestational diabetes mellitus (gdm) was diagnosed in 16 out of 80 women (20.0%), indicating a notable predisposition toward glucose intolerance in obese gravidae. Similarly, gestational hypertension (ghtn) was identified in 21 women (26.3%), while preeclampsia was reported in 13 participants (16.3%), reflecting the well-documented correlation between increased adiposity and vascular endothelial dysfunction. The incidence of pregnancy-induced hypertension (pih), when inclusive of both ghtn and preeclampsia, affected a combined total of 34 women (42.6%), signifying a substantial hypertensive burden among the obese cohort. The necessity for induction of labor was observed in 37 cases (46.3%), suggesting a heightened likelihood of suboptimal spontaneous labor initiation, possibly due to metabolic or mechanical derangements associated with obesity. The mode of delivery further illustrated this trend, with lower segment cesarean section (lscs) performed in 34 women (42.5%), and instrumental vaginal deliveries using ventouse in 10 cases (12.6%), while only 36 women (45.0%) achieved unassisted vaginal births. Furthermore, postpartum hemorrhage (pph) was encountered in 13 women (16.3%), a finding that aligns with the known risk of uterine atony and impaired contractility in obese parturients. Post-surgical morbidities were also prevalent, with wound infections affecting 8 women (10.0%) and wound gaping noted in 2 women (2.5%), complications potentially exacerbated by impaired tissue perfusion and delayed healing commonly seen in obese individuals. Collectively, these findings reinforce the multifaceted risks maternal obesity poses to pregnancy, labor, and the puerperium, emphasizing the imperative for anticipatory guidance, early screening, and multidisciplinary management strategies in this high-risk population.

2. ASSOCIATION OF MATERNAL RISK FACTORS WITH BMI :

Among the obese group, 11 women (20.4%) developed gestational diabetes mellitus (gdm) compared to 5 women (19.2%) in the overweight group. Though the percentage is slightly higher in the obese group, both categories showed a relatively comparable incidence of gdm. Similarly, the occurrence of gestational hypertension (ghtn) was significantly more prevalent among obese women, with 17 out of 54 (31.5%) developing ghtn, while only 4 out of 26 (15.4%) overweight women were affected. This indicates a notable association between increasing bmi and hypertensive disorders during pregnancy.

When analyzing the occurrence of preeclampsia, it was observed that 8 obese women (14.8%) were diagnosed with this condition compared to 5 overweight women (19.2%). While both groups experienced preeclampsia, the slightly higher percentage in the overweight group suggests that both overweight and obesity are risk contributors, though not strictly dependent on bmi category alone.

The mode of delivery also reflected marked differences. Caesarean section (lscs) was more frequently required among obese women, with 26 cases (48.1%), as compared to 8 cases (30.8%) in the overweight group. Vaginal delivery was achieved in 20 obese women (37.0%) and 16 overweight women (61.5%), indicating that overweight mothers had a better chance of delivering vaginally. The use of instrumental delivery (vaginal-ventouse) was higher in the obese group, reported in 8 women (14.8%), whereas only 2 overweight women (7.69%) required such assistance. These trends underscore the challenges posed by higher bmi in achieving spontaneous vaginal delivery.

Postpartum complications also varied with bmi. Postpartum hemorrhage (pph) was reported in 11 obese women (20.4%), a much higher incidence compared to 2 overweight women (7.7%). This indicates that obesity may predispose to increased risk of pph. On the other hand, 43 obese women (79.6%) and 24 overweight women (92.3%) did not experience pph, showing a relatively better outcome in the overweight group.

Overall, these findings highlight that maternal obesity is associated with a higher risk of adverse pregnancy outcomes, including gestational hypertension, cesarean delivery, instrumental delivery, and postpartum hemorrhage. Though overweight women also face risks, the incidence and severity are notably more pronounced in obese pregnant women.

3. ASSOCIATION OF FOETAL RISK FACTORS WITH BMI :

Based on the analysis of fetal risk factors among obese and overweight pregnant women, several significant trends were observed. In terms of birth weight, the majority of newborns in both groups had normal weights (2.5–3.99 kg), with 77.8% in the obese group and a higher 92.3% in the overweight group. Notably, macrosomia (birth weight ≥ 4 kg) was found exclusively in the obese group, affecting 13% of cases, while no macrosomic babies were born to overweight mothers. Low birth weight (<2.5 kg) was slightly more common in the obese group (9.3%) than in the overweight group (7.7%). Regarding apgar scores at 1 minute, 46.3% of neonates born to obese mothers had a score of 8, and 51.9% scored 7, whereas 73.1% of neonates born to overweight mothers scored 8 and only 23.1% scored 7, indicating better immediate neonatal condition in the overweight group. At 5 minutes, an apgar score of 9 was observed in 76.9% of babies from overweight mothers compared to 55.6% in the obese group, again suggesting better neonatal adaptation among the overweight group. Macrosomia was noted in 16.7% (9 out of 54) of obese mothers and none in the overweight group, reaffirming the association between obesity and increased fetal size. Respiratory distress syndrome (rds) was significantly higher in neonates born to obese mothers (40.7%) than in those born to overweight mothers (19.2%). Intrauterine growth restriction (iugr) was seen in 11.1% of the obese group and 7.7% of the overweight group. These findings collectively indicate that maternal obesity poses greater risks for adverse fetal outcomes, including macrosomia, lower apgar scores, increased incidence of respiratory distress, and iugr, compared to being overweight.

CONCLUSION

Based on the findings of the present study, among the fetal risk factors, a low apgar score at 1 minute (p = 0.050) and macrosomia showed a statistically significant association with maternal overweight and obesity, whereas maternal risk factors such as gestational diabetes, hypertension, preeclampsia, and delivery-related complications were not significantly associated. The study concludes that maternal obesity poses a notable risk for adverse neonatal outcomes, underlining the importance of weight optimization during pregnancy.

Conflicts of interests: The authors declare no conflicts of interest.

Author contribution: All authors have contributed in the manuscript.

Author funding: Nill

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