OBSTETRICS The risk of prelabor and intrapartum cesarean delivery among overweight and obese women: possible preventive actions Monika Hermann, MD; Camille Le Ray, MD, PhD; Be ´atrice Blondel, PhD; Franc ¸ois Goffinet, MD, PhD; Jennifer Zeitlin, MA, DSc OBJECTIVE: The purpose of this study was to investigate prelabor and intrapartum cesarean delivery in overweight and obese women by parity, previous cesarean delivery, and labor induction to assess what preventive actions might be possible. STUDY DESIGN: We modeled relative risks (RRs) and risk differences of prelabor and intrapartum cesarean delivery by prepregnancy body mass index (obese, 30 kg/m 2 ; overweight, 25-29.9 kg/m 2 ; normal weight, 18.5-24.9 kg/m 2 ) in a nationally representative sample of 12,297 French women. Models were stratified by parity and previous cesarean status. Covariates included maternal sociodemographic characteristics, medical conditions, pregnancy complications, and induction of labor. RESULTS: Risks of prelabor cesarean delivery were elevated only for obese multiparous women. This reflected not only a higher prevalence of previous cesarean delivery (26.4% vs 17.9% for normal-weight women) but also higher risks of prelabor cesarean delivery for multiparous women with no previous cesarean delivery after adjustment for medico-obstetric factors (RR, 1.82; 95% confidence interval [CI], 1.25e2.64). Obese primiparous women and multiparous women with no previous cesarean delivery had similarly increased adjusted RRs for intrapartum cesarean delivery (RR, 1.64; 95% CI, 1.36e1.98; and RR, 1.66; 95% CI, 1.15e2.39, respectively), but the risk difference was higher for primiparous women, with an absolute increase of 0.10 (95% CI, 0.05e0.14) compared with 0.02 (95% CI, 0.00e0.04) for multiparous women. Increased intrapartum cesarean delivery risks for primiparous women were related to more frequent labor induction (42.6% vs 23.8% for normal-weight women). CONCLUSION: It may be possible to reduce primary and thus repeat cesarean delivery rates among obese women by preventive actions targeting labor induction in primiparous women and prelabor cesarean deliveries in multiparous women. Further research is needed on the impact of limiting inductions on cesarean delivery risks for obese primiparous women. Key words: cesarean, obesity, uterine scar Cite this article as: Hermann M, Le Ray C, Blondel B, et al. The risk of prelabor and intrapartum cesarean delivery among overweight and obese women: possible preventive actions. Am J Obstet Gynecol 2014;211:. O verweight and obese women face increased risks of having a cesarean delivery compared with normal-weight women. 1,2 Moreover, postpartum complications, that include infections, 3,4 thromboembolic risks, 5 and related maternal death 6,7 are more common among obese women who deliver by cesarean delivery than both normal-weight women with cesarean deliveries and obese women who deliver vaginally. Pregnant women with an elevated prepregnancy body mass index (BMI) have more preexisting comorbidities and obstetric complications, which include gestational hypertension and diabetes mellitus, preeclampsia, delivery of large- for-gestational-age (LGA) infants, and fetal and neonatal death, than do normal- weight women. 1,8-10 These conditions are all associated with higher cesarean delivery rates. Cesarean deliveries are also more frequent for overweight and obese women without these complications. 11,12 These results may be due to differences in labor progression and lower response to oxytocin in obese women. 13-16 Conse- quently, obstetricians who are worried about the high likelihood of emergency cesarean deliveries during labor and their increased technical complexity in obese women may be more likely to plan pre- labor cesarean deliveries. 1 From INSERM UMR 1153, Obstetrical, Perinatal, and Pediatric Epidemiology Research Team, Center for Epidemiology and Statistics Sorbonne Paris Cité, DHU Risks in pregnancy, Paris V, René Descartes University (all authors), and Department of Obstetrics and Gynecology, Port-Royal Maternity, Groupe Hospitalier Cochin-Broca-Hôtel Dieu, Assistance Publique des Hôpitaux de Paris (Drs Hermann, Le Ray, and Goffinet), Paris, France. Received April 23, 2014; revised June 18, 2014; accepted Aug. 4, 2014. The French Ministry of Health funded the National Perinatal Survey; Inserm Unit 1153 received a grant from the Bettencourt Foundation (Coups d’élan pour la Recherche Française) in support of its research activities; Assistance PubliqueeHôpitaux de Paris provided a scholarship (M.H.). The authors report no conflict of interest. Presented in poster format at the 34th annual meeting of the Society for Maternal-Fetal Medicine, New Orleans, LA, Feb. 3-8, 2014. Corresponding author: Monika Hermann, MD. monika.hermann84@gmail.com 0002-9378/$36.00  ª 2014 Elsevier Inc. All rights reserved.  http://dx.doi.org/10.1016/j.ajog.2014.08.002 MONTH 2014 American Journal of Obstetrics & Gynecology 1.e1 Research ajog.org