Journal of Clinical and Diagnostic Research, ISSN - 0973 - 709X

Users Online : 15457

AbstractMaterial and MethodsResultsDiscussionConclusionReferencesDOI and Others
Article in PDF How to Cite Citation Manager Readers' Comments (0) Audio Visual Article Statistics Link to PUBMED Print this Article Send to a Friend
Advertisers Access Statistics Resources

Dr Mohan Z Mani

"Thank you very much for having published my article in record time.I would like to compliment you and your entire staff for your promptness, courtesy, and willingness to be customer friendly, which is quite unusual.I was given your reference by a colleague in pathology,and was able to directly phone your editorial office for clarifications.I would particularly like to thank the publication managers and the Assistant Editor who were following up my article. I would also like to thank you for adjusting the money I paid initially into payment for my modified article,and refunding the balance.
I wish all success to your journal and look forward to sending you any suitable similar article in future"



Dr Mohan Z Mani,
Professor & Head,
Department of Dermatolgy,
Believers Church Medical College,
Thiruvalla, Kerala
On Sep 2018




Prof. Somashekhar Nimbalkar

"Over the last few years, we have published our research regularly in Journal of Clinical and Diagnostic Research. Having published in more than 20 high impact journals over the last five years including several high impact ones and reviewing articles for even more journals across my fields of interest, we value our published work in JCDR for their high standards in publishing scientific articles. The ease of submission, the rapid reviews in under a month, the high quality of their reviewers and keen attention to the final process of proofs and publication, ensure that there are no mistakes in the final article. We have been asked clarifications on several occasions and have been happy to provide them and it exemplifies the commitment to quality of the team at JCDR."



Prof. Somashekhar Nimbalkar
Head, Department of Pediatrics, Pramukhswami Medical College, Karamsad
Chairman, Research Group, Charutar Arogya Mandal, Karamsad
National Joint Coordinator - Advanced IAP NNF NRP Program
Ex-Member, Governing Body, National Neonatology Forum, New Delhi
Ex-President - National Neonatology Forum Gujarat State Chapter
Department of Pediatrics, Pramukhswami Medical College, Karamsad, Anand, Gujarat.
On Sep 2018




Dr. Kalyani R

"Journal of Clinical and Diagnostic Research is at present a well-known Indian originated scientific journal which started with a humble beginning. I have been associated with this journal since many years. I appreciate the Editor, Dr. Hemant Jain, for his constant effort in bringing up this journal to the present status right from the scratch. The journal is multidisciplinary. It encourages in publishing the scientific articles from postgraduates and also the beginners who start their career. At the same time the journal also caters for the high quality articles from specialty and super-specialty researchers. Hence it provides a platform for the scientist and researchers to publish. The other aspect of it is, the readers get the information regarding the most recent developments in science which can be used for teaching, research, treating patients and to some extent take preventive measures against certain diseases. The journal is contributing immensely to the society at national and international level."



Dr Kalyani R
Professor and Head
Department of Pathology
Sri Devaraj Urs Medical College
Sri Devaraj Urs Academy of Higher Education and Research , Kolar, Karnataka
On Sep 2018




Dr. Saumya Navit

"As a peer-reviewed journal, the Journal of Clinical and Diagnostic Research provides an opportunity to researchers, scientists and budding professionals to explore the developments in the field of medicine and dentistry and their varied specialities, thus extending our view on biological diversities of living species in relation to medicine.
‘Knowledge is treasure of a wise man.’ The free access of this journal provides an immense scope of learning for the both the old and the young in field of medicine and dentistry as well. The multidisciplinary nature of the journal makes it a better platform to absorb all that is being researched and developed. The publication process is systematic and professional. Online submission, publication and peer reviewing makes it a user-friendly journal.
As an experienced dentist and an academician, I proudly recommend this journal to the dental fraternity as a good quality open access platform for rapid communication of their cutting-edge research progress and discovery.
I wish JCDR a great success and I hope that journal will soar higher with the passing time."



Dr Saumya Navit
Professor and Head
Department of Pediatric Dentistry
Saraswati Dental College
Lucknow
On Sep 2018




Dr. Arunava Biswas

"My sincere attachment with JCDR as an author as well as reviewer is a learning experience . Their systematic approach in publication of article in various categories is really praiseworthy.
Their prompt and timely response to review's query and the manner in which they have set the reviewing process helps in extracting the best possible scientific writings for publication.
It's a honour and pride to be a part of the JCDR team. My very best wishes to JCDR and hope it will sparkle up above the sky as a high indexed journal in near future."



Dr. Arunava Biswas
MD, DM (Clinical Pharmacology)
Assistant Professor
Department of Pharmacology
Calcutta National Medical College & Hospital , Kolkata




Dr. C.S. Ramesh Babu
" Journal of Clinical and Diagnostic Research (JCDR) is a multi-specialty medical and dental journal publishing high quality research articles in almost all branches of medicine. The quality of printing of figures and tables is excellent and comparable to any International journal. An added advantage is nominal publication charges and monthly issue of the journal and more chances of an article being accepted for publication. Moreover being a multi-specialty journal an article concerning a particular specialty has a wider reach of readers of other related specialties also. As an author and reviewer for several years I find this Journal most suitable and highly recommend this Journal."
Best regards,
C.S. Ramesh Babu,
Associate Professor of Anatomy,
Muzaffarnagar Medical College,
Muzaffarnagar.
On Aug 2018




Dr. Arundhathi. S
"Journal of Clinical and Diagnostic Research (JCDR) is a reputed peer reviewed journal and is constantly involved in publishing high quality research articles related to medicine. Its been a great pleasure to be associated with this esteemed journal as a reviewer and as an author for a couple of years. The editorial board consists of many dedicated and reputed experts as its members and they are doing an appreciable work in guiding budding researchers. JCDR is doing a commendable job in scientific research by promoting excellent quality research & review articles and case reports & series. The reviewers provide appropriate suggestions that improve the quality of articles. I strongly recommend my fraternity to encourage JCDR by contributing their valuable research work in this widely accepted, user friendly journal. I hope my collaboration with JCDR will continue for a long time".



Dr. Arundhathi. S
MBBS, MD (Pathology),
Sanjay Gandhi institute of trauma and orthopedics,
Bengaluru.
On Aug 2018




Dr. Mamta Gupta,
"It gives me great pleasure to be associated with JCDR, since last 2-3 years. Since then I have authored, co-authored and reviewed about 25 articles in JCDR. I thank JCDR for giving me an opportunity to improve my own skills as an author and a reviewer.
It 's a multispecialty journal, publishing high quality articles. It gives a platform to the authors to publish their research work which can be available for everyone across the globe to read. The best thing about JCDR is that the full articles of all medical specialties are available as pdf/html for reading free of cost or without institutional subscription, which is not there for other journals. For those who have problem in writing manuscript or do statistical work, JCDR comes for their rescue.
The journal has a monthly publication and the articles are published quite fast. In time compared to other journals. The on-line first publication is also a great advantage and facility to review one's own articles before going to print. The response to any query and permission if required, is quite fast; this is quite commendable. I have a very good experience about seeking quick permission for quoting a photograph (Fig.) from a JCDR article for my chapter authored in an E book. I never thought it would be so easy. No hassles.
Reviewing articles is no less a pain staking process and requires in depth perception, knowledge about the topic for review. It requires time and concentration, yet I enjoy doing it. The JCDR website especially for the reviewers is quite user friendly. My suggestions for improving the journal is, more strict review process, so that only high quality articles are published. I find a a good number of articles in Obst. Gynae, hence, a new journal for this specialty titled JCDR-OG can be started. May be a bimonthly or quarterly publication to begin with. Only selected articles should find a place in it.
An yearly reward for the best article authored can also incentivize the authors. Though the process of finding the best article will be not be very easy. I do not know how reviewing process can be improved. If an article is being reviewed by two reviewers, then opinion of one can be communicated to the other or the final opinion of the editor can be communicated to the reviewer if requested for. This will help one’s reviewing skills.
My best wishes to Dr. Hemant Jain and all the editorial staff of JCDR for their untiring efforts to bring out this journal. I strongly recommend medical fraternity to publish their valuable research work in this esteemed journal, JCDR".



Dr. Mamta Gupta
Consultant
(Ex HOD Obs &Gynae, Hindu Rao Hospital and associated NDMC Medical College, Delhi)
Aug 2018




Dr. Rajendra Kumar Ghritlaharey

"I wish to thank Dr. Hemant Jain, Editor-in-Chief Journal of Clinical and Diagnostic Research (JCDR), for asking me to write up few words.
Writing is the representation of language in a textual medium i e; into the words and sentences on paper. Quality medical manuscript writing in particular, demands not only a high-quality research, but also requires accurate and concise communication of findings and conclusions, with adherence to particular journal guidelines. In medical field whether working in teaching, private, or in corporate institution, everyone wants to excel in his / her own field and get recognised by making manuscripts publication.


Authors are the souls of any journal, and deserve much respect. To publish a journal manuscripts are needed from authors. Authors have a great responsibility for producing facts of their work in terms of number and results truthfully and an individual honesty is expected from authors in this regards. Both ways its true "No authors-No manuscripts-No journals" and "No journals–No manuscripts–No authors". Reviewing a manuscript is also a very responsible and important task of any peer-reviewed journal and to be taken seriously. It needs knowledge on the subject, sincerity, honesty and determination. Although the process of reviewing a manuscript is a time consuming task butit is expected to give one's best remarks within the time frame of the journal.
Salient features of the JCDR: It is a biomedical, multidisciplinary (including all medical and dental specialities), e-journal, with wide scope and extensive author support. At the same time, a free text of manuscript is available in HTML and PDF format. There is fast growing authorship and readership with JCDR as this can be judged by the number of articles published in it i e; in Feb 2007 of its first issue, it contained 5 articles only, and now in its recent volume published in April 2011, it contained 67 manuscripts. This e-journal is fulfilling the commitments and objectives sincerely, (as stated by Editor-in-chief in his preface to first edition) i e; to encourage physicians through the internet, especially from the developing countries who witness a spectrum of disease and acquire a wealth of knowledge to publish their experiences to benefit the medical community in patients care. I also feel that many of us have work of substance, newer ideas, adequate clinical materials but poor in medical writing and hesitation to submit the work and need help. JCDR provides authors help in this regards.
Timely publication of journal: Publication of manuscripts and bringing out the issue in time is one of the positive aspects of JCDR and is possible with strong support team in terms of peer reviewers, proof reading, language check, computer operators, etc. This is one of the great reasons for authors to submit their work with JCDR. Another best part of JCDR is "Online first Publications" facilities available for the authors. This facility not only provides the prompt publications of the manuscripts but at the same time also early availability of the manuscripts for the readers.
Indexation and online availability: Indexation transforms the journal in some sense from its local ownership to the worldwide professional community and to the public.JCDR is indexed with Embase & EMbiology, Google Scholar, Index Copernicus, Chemical Abstracts Service, Journal seek Database, Indian Science Abstracts, to name few of them. Manuscriptspublished in JCDR are available on major search engines ie; google, yahoo, msn.
In the era of fast growing newer technologies, and in computer and internet friendly environment the manuscripts preparation, submission, review, revision, etc and all can be done and checked with a click from all corer of the world, at any time. Of course there is always a scope for improvement in every field and none is perfect. To progress, one needs to identify the areas of one's weakness and to strengthen them.
It is well said that "happy beginning is half done" and it fits perfectly with JCDR. It has grown considerably and I feel it has already grown up from its infancy to adolescence, achieving the status of standard online e-journal form Indian continent since its inception in Feb 2007. This had been made possible due to the efforts and the hard work put in it. The way the JCDR is improving with every new volume, with good quality original manuscripts, makes it a quality journal for readers. I must thank and congratulate Dr Hemant Jain, Editor-in-Chief JCDR and his team for their sincere efforts, dedication, and determination for making JCDR a fast growing journal.
Every one of us: authors, reviewers, editors, and publisher are responsible for enhancing the stature of the journal. I wish for a great success for JCDR."



Thanking you
With sincere regards
Dr. Rajendra Kumar Ghritlaharey, M.S., M. Ch., FAIS
Associate Professor,
Department of Paediatric Surgery, Gandhi Medical College & Associated
Kamla Nehru & Hamidia Hospitals Bhopal, Madhya Pradesh 462 001 (India)
E-mail: drrajendrak1@rediffmail.com
On May 11,2011




Dr. Shankar P.R.

"On looking back through my Gmail archives after being requested by the journal to write a short editorial about my experiences of publishing with the Journal of Clinical and Diagnostic Research (JCDR), I came across an e-mail from Dr. Hemant Jain, Editor, in March 2007, which introduced the new electronic journal. The main features of the journal which were outlined in the e-mail were extensive author support, cash rewards, the peer review process, and other salient features of the journal.
Over a span of over four years, we (I and my colleagues) have published around 25 articles in the journal. In this editorial, I plan to briefly discuss my experiences of publishing with JCDR and the strengths of the journal and to finally address the areas for improvement.
My experiences of publishing with JCDR: Overall, my experiences of publishing withJCDR have been positive. The best point about the journal is that it responds to queries from the author. This may seem to be simple and not too much to ask for, but unfortunately, many journals in the subcontinent and from many developing countries do not respond or they respond with a long delay to the queries from the authors 1. The reasons could be many, including lack of optimal secretarial and other support. Another problem with many journals is the slowness of the review process. Editorial processing and peer review can take anywhere between a year to two years with some journals. Also, some journals do not keep the contributors informed about the progress of the review process. Due to the long review process, the articles can lose their relevance and topicality. A major benefit with JCDR is the timeliness and promptness of its response. In Dr Jain's e-mail which was sent to me in 2007, before the introduction of the Pre-publishing system, he had stated that he had received my submission and that he would get back to me within seven days and he did!
Most of the manuscripts are published within 3 to 4 months of their submission if they are found to be suitable after the review process. JCDR is published bimonthly and the accepted articles were usually published in the next issue. Recently, due to the increased volume of the submissions, the review process has become slower and it ?? Section can take from 4 to 6 months for the articles to be reviewed. The journal has an extensive author support system and it has recently introduced a paid expedited review process. The journal also mentions the average time for processing the manuscript under different submission systems - regular submission and expedited review.
Strengths of the journal: The journal has an online first facility in which the accepted manuscripts may be published on the website before being included in a regular issue of the journal. This cuts down the time between their acceptance and the publication. The journal is indexed in many databases, though not in PubMed. The editorial board should now take steps to index the journal in PubMed. The journal has a system of notifying readers through e-mail when a new issue is released. Also, the articles are available in both the HTML and the PDF formats. I especially like the new and colorful page format of the journal. Also, the access statistics of the articles are available. The prepublication and the manuscript tracking system are also helpful for the authors.
Areas for improvement: In certain cases, I felt that the peer review process of the manuscripts was not up to international standards and that it should be strengthened. Also, the number of manuscripts in an issue is high and it may be difficult for readers to go through all of them. The journal can consider tightening of the peer review process and increasing the quality standards for the acceptance of the manuscripts. I faced occasional problems with the online manuscript submission (Pre-publishing) system, which have to be addressed.
Overall, the publishing process with JCDR has been smooth, quick and relatively hassle free and I can recommend other authors to consider the journal as an outlet for their work."



Dr. P. Ravi Shankar
KIST Medical College, P.O. Box 14142, Kathmandu, Nepal.
E-mail: ravi.dr.shankar@gmail.com
On April 2011
Anuradha

Dear team JCDR, I would like to thank you for the very professional and polite service provided by everyone at JCDR. While i have been in the field of writing and editing for sometime, this has been my first attempt in publishing a scientific paper.Thank you for hand-holding me through the process.


Dr. Anuradha
E-mail: anuradha2nittur@gmail.com
On Jan 2020

Important Notice

Original article / research
Year : 2021 | Month : August | Volume : 15 | Issue : 8 | Page : QC05 - QC09 Full Version

Effect of Maternal Body Mass Index on Intrapartum and Neonatal Outcome in Nulliparous Women in North Karnataka: A Prospective Cohort Study


Published: August 1, 2021 | DOI: https://doi.org/10.7860/JCDR/2021/50002.15278
Krutika Sainath Andola, Hema Sinhasane, Ravikumar Subhash Kurle, Umadevi Sainath Andola, Shruthi Sainath Andola

1. Assistant Professor, Department of Obstetrics and Gynaecology, HKE’S M.R. Medical College, Kalaburagi, Karnataka, India. 2. Associate Professor, Department of Obstetrics and Gynaecology, GIMS, Kalaburagi, Karnataka, India. 3. Assistant Professor, Department of Community Medicine, HKE’S M.R. Medical College, Kalaburagi, Karnataka, India. 4. Professor and Head, Department of Obstetrics and Gynaecology, HKE’S M.R. Medical College, Kalaburagi, Karnataka, India. 5. Assistant Professor, Department of Obstetrics and Gynaecology, KLE’s Dr Prabhahkar Kore Hospital and J.N. Medical College, Belagavi, Karnataka, India.

Correspondence Address :
Dr. Shruthi Sainath Andola,
2-907/27A/1A and1B, Andola Maternity Hospital, Gubbi Colony, Kalaburagi (Gulbarga), Belagavi-585105, Karnataka, India.
E-mail: shrutiandola@gmail.com

Abstract

Introduction: Nutrient intake and weight gain are the two main modifiable factors during pregnancy that influence maternal and infant outcome. Body Mass Index (BMI) derived from weight and height is a marker of metabolic and endocrinal status and is used to classify people from underweight to obese. Pregnancy complications related to maternal BMI is a growing problem. Both lean and obese mothers carry an increased risk of adverse perinatal outcome.

Aim: To assess the effect of maternal BMI on labour and mode of delivery, neonatal outcome and to detect the obstetric complications in relation to different BMI’s.

Materials and Methods: A prospective study was conducted in Mahadevappa Rampure Medical College, Kalaburagi, Karnataka, India, from August 2014 to July 2016 in which total of 200 primigravidas with singleton pregnancy; in labour after 28 weeks of gestation were included. BMI was calculated using the formula by Quetelet. The women were categorised into underweight, normal, overweight and obese according to World Health Organisation (WHO).

Results: Out of 200 cases, 111 (55.5%) were of normal BMI, 61 (30.5%) overweight, 16 (8.0%) obese and 12 (6.0%) underweight. Pre-eclampsia, oligohydramnios, Intrauterine Growth Restriction (IUGR), anaemia, foetal birth weight <2.5 kg, increased incidence of Neonatal Intensive Care Unit (NICU) admissions and early neonatal complications were commonly seen in underweight which was statistically significant (p<0.01). Gestational hypertension (n=5), increased incidence of caesarean sections (n=13), foetal birth weight >3.5 kg (n=5), failed spinal anaesthesia (n=2), postpartum haemorrhage (n=4), post Lower Segment Caesarean Section (LSCS) wound gape (n=2) and prolonged hospital stay (n=3) were the complications seen in obese individuals.

Conclusion: Maternal BMI showed a strong association between pregnancy complications and outcomes. Therefore, all the pregnant women need to be advised to maintain normal BMI in order to achieve a healthy outcome as both underweight and obese women carry risk for adverse pregnancy outcome.

Keywords

Nulliparity, Obesity, Pregnancy outcome, Quetelet index

India is following the trend of other developing countries that are steadily becoming both more obese and underweight (1). According to National Family Health Survey (NFHS-5) prevalence of obesity in women in Karnataka has increased to 23.3% and also the underweight women has raised to 20.7% (2). It has been observed that maternal underweight and obesity are the risk factors for outcomes such as pre-eclampsia, eclampsia, pre and post-term delivery, induction of labour, caesarean section and postpartum haemorrhage, observed in different settings (3),(4),(5). Low BMI and suboptimal weight gain during pregnancy are recognised risk factors for small for gestational age infants, while high BMI in pregnancy has been shown to be associated with longer gestation and increased risk of post-term delivery (6),(7). These results will be of high interest to the primary healthcare providers who care for women before and during pregnancy. With this background, the present study was conducted with an aim to know the effect of maternal BMI on labour and mode of delivery, to detect the obstetric complications in relation to different BMI’s.

Material and Methods

A prospective cohort study was conducted on 200 primigravidas with singleton pregnancy in labour after 28 weeks of gestation, from August 2014 to July 2016, after obtaining clearance from the Institutional Ethical Committee (M.R. Medical College IEC, Ref no: HKE’S/MRMCK/IEC/SYA/2014-37 dated 29-11-2014). Participants were enrolled in the study after obtaining informed consent at Basaveshwar Teaching and General Hospital and Sangameshwar Teaching and General Hospital attached to Mahadevappa Rampure Medical College, Kalaburagi, Karnataka, India.

Inclusion criteria: All primigravidas with singleton pregnancy with >28 weeks of gestation were included.

Exclusion criteria: Multiple pregnancy, multigravida, non ambulatory primigravida and those with congenital malformations of the foetus were excluded.

Study Procedure

In all the cases detailed history of the patient was taken including the name, age and socio-economic status according to Kuppuswamy scale (8) and presenting complaints.

Weight was measured in kilograms (kg). Patients were weighed without shoes, wearing light indoor clothes. The weighing machine used was from Equinox, an electronic personal scale CE. Model: EB 9300, Strain gauge sensor, Capacity: 150 kg, Division: 0.1 kg (0.216), Low battery/overload indication, Power: 1pc*3 V lithium cells (CR 2032). Height (in metres) was measured using a measuring scale named Bioplus-200 cm scale.

The patients were made to stand straight and erect with their back against the wall such that the ankles are together, heels, buttocks shoulders and occiput were touching the wall. The patient’s head was held in such a position that the line joining the tragus and outer canthus of eye were in a horizontal plane (Frankfurts Plane). The women were categorised into underweight, normal and obese according to WHO classification (6). The data were used to calculate Quetelet index or the BMI using the formula BMI=weight (kg)/height (in m2). Per abdomen examination was done for the fundal height, lie, presentation and position of the foetus. Foetal heart rate was recorded by sound doppler. Also, local examination including vulva, vagina, urethra was done. Per speculum examination was done for cervix and vagina and for any leak/bleeding per vaginum. Detailed per vaginal examination was done for dilatation, effacement, position of cervix, station of presenting part and adequacy of pelvis.

Gestational age was calculated from the first day in the last menstrual period. Term birth was defined as that reaching upto 37-41 weeks while pre-term birth was defined as birth before 37 completed weeks and post-term as birth after 41 weeks (4).

Neonatal data included: Birth weight was recorded on a pre zeroed electronic balance with the baby naked to the nearest 5 gm. APGAR scores were estimated at 1 and 5 minutes.

Statistical Analysis

Data was entered in Microsoft excel 20.0 and analysed by using Statistical Package for the Social Sciences (SPSS) Software package version 16.0 with the help of non parametric test Chi-square (χ2) wherever required for comparison.

Results

In the present study, 111 cases (55.5%) belong to normal BMI, 61 cases (30.5%) to overweight, 16 cases (8%) to obese and 12 cases (6%) to underweight. The Mean± Standard Deviation (SD) of BMI was 24.55±3.47 kg/m2.

Maximum number of cases in all the categories of BMI belonged to 21-30 years of age group and the mean age in the present study is 23.05±3.31 years. The p-value came out to be <0.05 making the difference statistically significant (Table/Fig 1).

In the present study, no cases belonged to Class I socio-economic status. A 43.5% belonged to Class III, of which, 50.8% were overweight; 42.0% belonged to Class V, of which, maximum no. of cases 58.4% were underweight. The p-value came out to be >0.05 which was statistically insignificant (Table/Fig 2).

Among underweight (n=12), n=2 (16.7%) were hypertensive and n=5 (31.3%) in obese. Maximum number of cases, n=2 (16.7%) each of pre-eclampsia and IUGR were found in underweight. In underweight, n=8 (66.7%) were anaemic and in obese, n=7 (43.7%) were anaemic. Among underweight, the commonest indication was oligohydramnios, n=3 (33.3%) and among obese it was cephalopelvic disproportion n=6 (37.5%). Failed spinal anaesthesia was observed in n=2 (12.5%) of obese patients.

In the present study, 91.0% were term pregnancies, 6.5% were pre-term and 2.5% were post-term. Among the pre-term, 16.7% were underweight and among post-term 3.6% were normal BMI. The p-value came out to be <0.05 which was statistically significant (Table/Fig 3).

In the present study, 19.0% were free of any complications. Gestational hypertension was seen in 18.0%, commonly in obese (31.3%) pre-eclampsia in 11.5%, commonly in underweight (16.7%). Intrauterine deaths were noted in 2.0% and all the cases belonged to patients with normal BMI accounting to 3.6%. The p-value was <0.01 which was statistically significant (Table/Fig 4).

In the present study, 65.0% underwent LSCS, 29.5% normal vaginal deliveries and 5.5% operative vaginal deliveries. 81.3% of the obese patients underwent LSCS. The p value came out as <0.01 which was statistically significant (Table/Fig 5).

In the present study, labour was complicated by meconium stained liquor in a total of 29.5% of which, maximum seen in overweight (36%). Prolonged first stage was seen in 8.0%, maximum in underweight (16.7%). The p-value came out as <0.05 being statistically significant (Table/Fig 6).

In the present study, live births were 98% and stillborn were 2%. Out of 98% live births, 16.8% had NICU admissions, of which 15% had survived and 1.6% had early neonatal deaths. Maximum number of NICU admissions was seen in newborns born to underweight (33.3%) and also early neonatal complications (25%). Early neonatal deaths were noted one each in underweight (8.3%), normal (0.9%) and obese (6.3%) (Table/Fig 7).

Mean and SD of APGAR score at one minute and 5 minute was 6.37±0.93 and 8.56±0.90, respectively. In the present study, APGAR at 1 minute were <5 in 61.0% newborns born to mothers with normal BMI, 29.9% to overweight, 6.6% to obese and 2.5% to underweight. There was no statistical significance difference of APGAR score at 1minute among the categories of BMI. In the present study, APGAR at 5 minutes were <7 in 50.0% newborns born to mothers with underweight BMI, 33.3% to normal and 16.7% to obese. There was statistical highly significant difference of APGAR score at 5 minute among the categories of BMI (Table/Fig 8).

The mean foetal weight was 2.77±0.55 kg. A 66.7% of underweight patients had newborns with birth weight <2.5kg and 31.3% of obese patients had newborns with birth weight >3.5kg. Maximum number of patients (70.5%) had newborns with birth weight of 2.5-3.5 kg (including 04 cases of stillbirth). The p-value came out to be <0.01 which was statistically significant (Table/Fig 9).

In the present study, out of 16.8% who had NICU admissions, 7.14% had early neonatal complications of which, neonatal sepsis 3.6% was found to be most common complication, commonly seen in underweight (16.7%) followed by hypoxic ischemic encephalopathy seen in 2% (Table/Fig 10).

The most common postpartum complication was post LSCS wound infection (3.5%) seen in 12.5% of obese patients, followed by prolonged hospital stay (6.0%) seen in 18.9% of obese patients. There was statistical significant difference of postpartum complications among the categories of BMI (Table/Fig 11).

Pre-eclampsia, oligohydramnios, IUGR, anaemia, foetal birth weight <2.5 kg, increased incidence of NICU admissions and early neonatal complications were commonly seen in underweight which was statistically significant (p<0.01). Gestational hypertension (n=5), increased incidence of caesarean sections (n=13), foetal birth weight >3.5 kg (n=5), failed spinal anaesthesia (n=2), postpartum haemorrhage (n=4), post LSCS wound gape (n=2) and prolonged hospital stay (n=3) were the complications seen in obese individuals.

Discussion

Obesity measured by BMI predisposes women to complicated pregnancies and increased obstetric interventions (7),(9). The mean age in the present study was 23.05±3.31 years which is comparable with other studies, Jain D et al., and El-Gilany A-H and Hammad S, (7),(9). Pre-term gestation in the present study was comparable with the Bhattacharya S et al., study among the underweight, normal and obese BMI categories but among the overweight category where the present study has 1.6% cases and Bhattacharya S et al., study had 10.8% of pre-term pregnancies (10). Gestational hypertension in the present study was comparable to the Bhattacharya S et al., among all BMI categories (10).

Pre-eclampsia in the present study was comparable to the Bhattacharya S et al., and Verma A and Shrimali L, among the normal, overweight and obese BMI categories but not among underweight (10),(11) wherein, the present study shows 16.7% cases in underweight, Bhattacharya S et al., 3.3% and Verma A and Shrimali L, 3.4% cases (10),(11). Anaemia in the present study was comparable to Verma A and Shrimali L, among the underweight, normal, overweight but not obese (11) wherein, the present study has 43.7% cases and Verma A and Shrimali L, had 9.5% cases, similarly the present study was comparable to El-Gilany AH et al study among the obese which had 45.6% cases but not comparable with other categories of BMI (11). Abruptio placenta and placenta praevia in the present study was comparable with the Bhattacharya S et al., study among all the categories of BMI (Table/Fig 12) (9),(10),(11).

Stillbirth in the present study which has 3.6% cases among normal BMI is comparable to the El-Gilany AH and Hammad S, had 0.7% cases and Bhattacharya S et al., which had 0.9% (8),(9). But the present study was not comparable to El-Gilany AH et al., and Bhattacharya S et al., among underweight, overweight and obese BMI categories as the present study has no cases in those categories (9),(10).

Foetal weight <2.5 kg in the present study was comparable to the Jain D et al., among the normal, overweight and obese BMI categories but not among the underweight (7), wherein the present study 66.7% cases of foetal weight <2.5 kg and the Jain D et al., had 80.0% cases (Table/Fig 13) (7),(9),(10).

Wound infection in the present study was comparable to the Verma A and Shrimali L, study only in the obese BMI category where the present study shows 12.5% cases and Verma A and Shrimali L who, showed 16.1% cases (11). One of the major healthcare concern in India is the rising rate of obesity, which can be considered as an important factor in the intrapartum and neonatal outcome (12). However, low and middle income countries can encounter patients at both extremes of maternal BMI which cannot be ignored as the complications weigh equally (13). Study conducted by Dalbye R et al., showed no associations between maternal BMI and neonatal outcomes though there was a gradient of risk for intrapartum caesarean section, with highest risk for women in obesity classes II and III (14).

Studies conducted by Kumar HSA and Chellamma VK, showed that among 72 (65.45%) patients between 21-30 years (15), both underweight and overweight women had adverse maternal and perinatal outcome commonest being anaemia (35%) in underweight women. Low APGAR score and NICU admissions were more frequent with obese.

High rate of caesarean sections (34.76%) and prolonged postnatal hospital stay (28.66%) were seen in obese women in the study conducted by Dahake STand Shaikh UA, which were in concordance with the present study (16).

Limitation(s)

As the present study was conducted in a single institution belonging to the backward area of North Karnataka with limited number of patients attending to the hospital. This may affect the external validity of the findings, and most of the patients do not have preconception counselling and their weight goes unrecorded.

Conclusion

The relatively limited impact of obesity on perinatal outcomes found in the present study may suggest increased awareness of healthcare providers of the potential risks of maternal and perinatal morbidity in women with increased BMI. Therefore, it is a must for all pregnant and non pregnant women to be aware of the fetomaternal complications arising due to higher and lower BMI. With proper management of pregnant women with a higher and lower BMI, improvement in awareness amongst the women and increasing their accessibility to medical facilities, maternal and perinatal morbidity and mortality can be minimised.

References

1.
Adela H. The epidemiology of obesity: A big picture. Pharmaco Economics. 2015;33(7):673-89. [crossref] [PubMed]
2.
Indian Institute for Population Sciences (IIPS) and MoHFW. National Family Health Survey -5 2019-20. Available from: http://rchiips.org/nfhs/NFHS-5_FCTS/FactSheet_KA.pdf. [Accessed on 26 December 2020].
3.
Yazdani S, Yosofniyapasha Y, Nasab BH, Mojaveri MH, Bouzari Z. Effect of maternal body mass index on pregnancy outcome and newborn weight. BMC Research Notes. 2012;5:34-38. [crossref] [PubMed]
4.
Arrowsmith S, Wray AS, Quenbyb AS. Maternal obesity and labour complications following induction of labour in prolonged pregnancy. Int J Obstet Gynecol. 2012;1:584-88. [crossref]
5.
Suvarna SK. Obesity in pregnancy: Obstetrician’s obstacle. J Obstet Gynecol India. 2019;69(3):197-202. [crossref] [PubMed]
6.
Nuttall FQ. Body mass index: Obesity, BMI, and health: A critical review. Nutr Today. 2015;50(3):117-28. [crossref] [PubMed]
7.
Jain D, Khuteta R, Chaturvedi V, Khuteta S. Effect of body mass index on pregnancy outcomes in nulliparous women delivering singleton babies: Observational study. J Obstet Gynaecol India. 2012;62(4):429-31. [crossref] [PubMed]
8.
Saleem SM, Jan SS. Modified Kuppuswamy socioeconomic scale updated for the year 2021. Indian Journal of Forensic and Community Medicine 2021;8(1):01-03. [crossref]
9.
El-Gilany AH, Hammad S. Body mass index and outcomes in Saudi Arabia. Ann Saudi Med. 2010;30(5):376-80. [crossref] [PubMed]
10.
Bhattacharya S, Campbell DM, Liston WA, and Bhattacharya S. Effect of body mass index on pregnancy outcome in nulliparous women delivering singleton babies. BMC Public Health. 2007;7:168-75. [crossref] [PubMed]
11.
Verma A, Shrimali L. Maternal body mass index and pregnancy outcome. J Clin Diagn Res. 2012;6(9):1531-33. [crossref] [PubMed]
12.
Sharma BR, Sharma R, Dogra P. A prospective study on effect of maternal BMI on fetal outcome. Int J Reprod Contracept Obstet Gynecol. 2018;7:2782-85. [crossref]
13.
Maged AM, Belal DS, Marie HM, Rashwan H, Abdelaziz S, Gabr AA, et al. Prospective study of the effect of maternal body mass index on labour progress in nulliparous women in Egypt. Int J Gynecol Obstet. 2017;139(3):329-35. [crossref] [PubMed]
14.
Dalbye R, Gunnes N, Blix E, Zhang J, Eggebo T, Tokheim LN, et al. Maternal body mass index and risk of obstetric, maternal and neonatal outcomes: A cohort study of nulliparous women with spontaneous onset of labour. Acta Obstetrica et Gynecologica Scandinavica. 2021;100(3):521-30. [crossref] [PubMed]
15.
Kumar HSA, Chellamma VK. Effect of maternal body mass index on pregnancy outcome. Int J Sci Stud. 2017;4(10):81-84.
16.
Dahake ST, Shaikh UA. Maternal early pregnancy body mass index and pregnancy outcomes among nulliparous women registered in tertiary care hospital and urban slum hospital of a metropolitan city. J Edu Health Promot. 2020;9:159. [crossref] [PubMed]

DOI and Others

10.7860/JCDR/2021/50002.15278

Date of Submission: Apr 19, 2021
Date of Peer Review: May 19, 2021
Date of Acceptance: Jun 18, 2021
Date of Publishing: Aug 01, 2021

AUTHOR DECLARATION:
• Financial or Other Competing Interests: None
• Was Ethics Committee Approval obtained for this study? Yes
• Was informed consent obtained from the subjects involved in the study? Yes
• For any images presented appropriate consent has been obtained from the subjects. No

PLAGIARISM CHECKING METHODS:
• Plagiarism X-checker: Apr 21, 2021
• Manual Googling: Jun 17, 2021
• iThenticate Software: Jul 23, 2021 (15%)

ETYMOLOGY: Author Origin

JCDR is now Monthly and more widely Indexed .
  • Emerging Sources Citation Index (Web of Science, thomsonreuters)
  • Index Copernicus ICV 2017: 134.54
  • Academic Search Complete Database
  • Directory of Open Access Journals (DOAJ)
  • Embase
  • EBSCOhost
  • Google Scholar
  • HINARI Access to Research in Health Programme
  • Indian Science Abstracts (ISA)
  • Journal seek Database
  • Google
  • Popline (reproductive health literature)
  • www.omnimedicalsearch.com