Newly Published
Perioperative Medicine  |   June 2018
Maternal Body Mass Index and Use of Labor Neuraxial Analgesia: A Population-based Retrospective Cohort Study
Author Notes
  • From the Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, California (A.J.B., N.G.)
  • the University of Iowa Carver College of Medicine, Iowa City, Iowa (C.A.W.).
  • Submitted for publication October 20, 2017. Accepted for publication May 14, 2018.
    Submitted for publication October 20, 2017. Accepted for publication May 14, 2018.×
  • Research Support: This study was supported and funded internally by the Department of Anesthesia and Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, California. Dr. Butwick is supported by an award from the Eunice Kennedy Shriver National Institute of Child Health and Human Development, Rockville, Maryland (1K23HD070972).
    Research Support: This study was supported and funded internally by the Department of Anesthesia and Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, California. Dr. Butwick is supported by an award from the Eunice Kennedy Shriver National Institute of Child Health and Human Development, Rockville, Maryland (1K23HD070972).×
  • Competing Interests: The authors declare no competing interests.
    Competing Interests: The authors declare no competing interests.×
  • Correspondence: Address correspondence to Dr. Butwick: Department of Anesthesiology, Perioperative and Pain Medicine (MC:5640), Stanford University School of Medicine, 300 Pasteur Drive, Stanford, California 94305. ajbut@stanford.edu. Information on purchasing reprints may be found at www.anesthesiology.org or on the masthead page at the beginning of this issue. Anesthesiology’s articles are made freely accessible to all readers, for personal use only, 6 months from the cover date of the issue.
Article Information
Perioperative Medicine / Central and Peripheral Nervous Systems / Obstetric Anesthesia / Pain Medicine
Perioperative Medicine   |   June 2018
Maternal Body Mass Index and Use of Labor Neuraxial Analgesia: A Population-based Retrospective Cohort Study
Anesthesiology Newly Published on June 22, 2018. doi:10.1097/ALN.0000000000002322
Anesthesiology Newly Published on June 22, 2018. doi:10.1097/ALN.0000000000002322
Abstract

Background: Neuraxial labor analgesia may benefit obese women by optimizing cardiorespiratory function and mitigating complications related to emergency general anesthesia. We hypothesized that obese women have a higher rate of neuraxial analgesia compared with nonobese parturients.

Methods: Using U.S. natality data, our cohort comprised 17,220,680 deliveries, which accounts for 61.5% of 28 million births in the United States between 2009 and 2015. We examined the relationships between body mass index class and neuraxial labor analgesia, adjusting for sociodemographic, antenatal, pregnancy, and peripartum factors.

Results: The study cohort comprised 17,220,680 women; 0.1% were underweight, 12.7% were normal body mass index, 37% were overweight, and 28.3%, 13.5%, and 8.4% were obesity class I, II, and III, respectively. Rates of neuraxial analgesia by body mass index class were as follows: underweight, 59.7% (9,030/15,128); normal body mass index, 68.1% (1,487,117/2,182,797); overweight, 70.3% (4,476,685/6,368,656); obesity class I, 71.8% (3,503,321/4,881,938); obesity class II, 73.4% (1,710,099/2,330,028); and obesity class III, 75.6% (1,089,668/1,442,133). Compared to women with normal body mass index, the likelihood of receiving neuraxial analgesia was slightly increased for overweight women (adjusted relative risk, 1.02; 95% CI, 1.02 to 1.02), obese class I (adjusted relative risk, 1.04; 95% CI, 1.04 to 1.04), obese class II (adjusted relative risk, 1.05; 95% CI, 1.05 to 1.05), and obese class III (adjusted relative risk, 1.06; 95% CI, 1.06 to 1.06).

Conclusions: Our findings suggest that the likelihood of receiving neuraxial analgesia is only marginally increased for morbidly obese women compared to women with normal body mass index.