Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Original Article
  • Published:

Does increasing body mass index affect cerclage efficacy?

Journal of Perinatology volume 32, pages 777–779 (2012)Cite this article

Subjects

Abstract

Objective:

To study the relationship between body mass index (BMI) and gestational age (GA) at delivery in patients with cervical insufficiency (CI) undergoing cerclage.

Study Design:

We accessed a database of patients with singleton gestations undergoing cerclage (N=168) for a well-characterized history of CI, shortened cervix <2.5 cm with a history of prior preterm delivery or prolapse of membranes through the external os. Univariate and multivariate logistic regression analysis were performed to compare obstetrical outcomes between obese and normal-weight patients.

Result:

Prior preterm delivery <35 weeks in obese vs normal-weight patients was significantly higher (44% vs 9%), odds ratio=6.9 (95% CI: 2.5, 18.5), with lower mean GA at delivery (32.6±7.0 vs 37.2±3.4 weeks, P<0.001). After controlling for confounders, BMI remained significantly predictive of prematurity (coefficient: −0.12, adjusted R2=0.24), such that every additional 1 unit of BMI was associated with a 1-day reduction in GA at delivery (P=0.03).

Conclusion:

An inverse correlation exists between BMI and GA at delivery in patients with CI receiving cerclage. The findings are unexpected given the protective effect of obesity on spontaneous preterm delivery.

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on Springer Link
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

Similar content being viewed by others

References

  1. Lu GC, Rouse DJ, DuBard M, Cliver S, Kimberlin D, Hauth JC . The effect of the increasing prevalence of maternal obesity on perinatal morbidity. Am J Obstet Gynecol 2001; 185: 845–849.

    Article  CAS  Google Scholar 

  2. Robinson HE, O’Connell CM, Joseph KS, McLeod NL . Maternal outcomes in pregnancies complicated by obesity. Obstet Gynecol 2005; 106: 1357–1364.

    Article  Google Scholar 

  3. Ehrenberg HM, Dierker L, Milluzzi C, Mercer BM . Prevalence of maternal obesity in an urban center. Am J Obstet Gynecol 2002; 187: 1189–1193.

    Article  Google Scholar 

  4. Handler I . The Preterm Prediction Study: association between maternal body mass index and spontaneous and indicated preterm birth. Am J Obstet Gynecol 2005; 193: 2178–2179.

    Google Scholar 

  5. Smith G, Shah I, Pell JP, Crossley JA, Dobbie R . Maternal obesity in early pregnancy and risk of spontaneous and elective preterm deliveries: a retrospective cohort study. Am J Pub Health 2007; 97: 157–162.

    Article  Google Scholar 

  6. McDonald SD, Han Z, Mulla S, Beyene J . Overweight and obesity in mothers and risk of preterm birth and low birth weight infants: systematic review and meta-analyses. BJOG 2010; 341: 1–20.

    Google Scholar 

  7. Nohr EA, Bech BH, Vaeth M, Rasmussen K, Henriksen KM, Olsen J . Obesity, gestational weight gain, and preterm birth: a study within the Danish National Birth Cohort. Paediatr Perinatal Epidemiol 2007; 211: 5–14.

    Article  Google Scholar 

  8. Ludmir J, Sehdev HM . Anatomy and physiology of the uterine cervix. Clin Obstet Gynecol 2000; 43: 433–439.

    Article  CAS  Google Scholar 

  9. Shennan A, Jones B . The cervix and prematurity: aetiology, prediction, and prevention. Semin Fetal Neonatal Med 2004; 9: 471–479.

    Article  Google Scholar 

  10. MRC/RCOG Working Party on Cervical Cerclage. Final report of the Medical Research Council/Royal College of Obstetrician and Gynecologists multicenter randomized trial of cervical cerclage. Brit J Obstet Gynecol 1993; 100: 516–523.

    Article  Google Scholar 

  11. Berghella V, Obdio AO, To MS, Rust OA, Althuisius SM . Cerclage for short cervix on ultrasonography: meta-analysis of trials using individual patient-level data. Obstet Gynecol 2005; 106: 181–189.

    Article  Google Scholar 

  12. Althuisius SM, Dekker GA, Hummel P, van Geijn HP . Cervical incompetence prevention randomized cerclage trial: emergency cerclage with bed rest versus bed rest alone. Cervical incompetence prevention randomized cerclage trial. Am J Obstet Gynecol 2003; 189: 907–910.

    Article  Google Scholar 

  13. Rafii A, Samain E, Levardon M, Darai E, Deval B . Vaginal hysterectomy for benign disorders in obese women: a prospective study. BJOG 2005; 111: 223–227.

    Article  Google Scholar 

  14. Isik-Akbay E, Harmanli O, Panganamamula U, Akbay M, Gaugham J, Chatwani A . Hysterectomy in obese women: a comparison of abdominal and vaginal routes. Obstet Gynecol 2004; 104: 710–714.

    Article  Google Scholar 

  15. Shen CC, Hsu TY, Huang Fj, Huang EY, Huang HW, Huang HY et al. Laparoscopic-assisted vaginal hysterectomy in women of all weight and the effects of weight on complications. J Am Assoc Gynecol Laparosc 2002; 9: 468–473.

    Article  Google Scholar 

  16. Frezza EE, Shebani KO, Robertson J, Wachtel MS . Morbid obesity causes chronic increase of intraabdominal pressure. Dig Dis Sci 2007; 52 (4): 1038–1041.

    Article  Google Scholar 

  17. Pratt JH, Daikoku NH . Obesity and vaginal hysterectomy. J Reprod Med 1990; 35: 945–949.

    CAS  PubMed  Google Scholar 

  18. Rafii A, Dari E, Haab F, Samain E, Levardon M, Deval B . Body mass index and outcome of tension-free tape. J Eur Urol 2003; 43: 288–292.

    Article  Google Scholar 

  19. Skriapas K, Poulakis V, Dillenburg W, Vries R, Witzsch U, Melekos M et al. Tension-free vaginal tape in morbidly obese patients with severe urodynamic stress incontinence as last option treatment. J Eur Urol 2006; 49: 544–550.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Perinatal Diagnostic Center, Inova Alexandria Hospital, Alexandria, VA, USA

    S H Poggi & A Ghidini

  2. Department of Obstetrics and Gynecology, Georgetown University Hospital, Washington, DC, USA

    S H Poggi, N A Vyas, H J Landy & A Ghidini

  3. Department of Biomathematics and Biostatistics, Georgetown University Hospital, Washington, DC, USA

    J C Pezzullo

Authors
  1. S H Poggi
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. N A Vyas
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. J C Pezzullo
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. H J Landy
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. A Ghidini
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to S H Poggi.

Ethics declarations

Competing interests

The authors declare no conflict of interest.

Additional information

This paper was presented as a poster (Abstract #342) at the 27th Annual Meeting of the Society for Maternal Fetal Medicine.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Poggi, S., Vyas, N., Pezzullo, J. et al. Does increasing body mass index affect cerclage efficacy?. J Perinatol 32, 777–779 (2012). https://doi.org/10.1038/jp.2011.198

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/jp.2011.198

Keywords

This article is cited by

Search

Advanced search

Quick links