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Objective: Nationally, rates of obesity continue to rise, resulting in increased health concerns for women of reproductive age. Identifying the impact of maternal obesity on obstetrical outcomes is important to enhance patient care., Methods: We conducted a retrospective cohort study of 6674 women who delivered a singleton infant at ≥ 20 weeks' gestation between December 1, 2007, and March 31, 2010, at The Ottawa Hospital. Maternal pre-pregnancy BMI was used to classify women into normal, overweight, and obese (class I/II/III) categories according to WHO classifications. Obstetrical outcomes among obese women were compared with those of women with normal BMI. Multivariable regression models were used to determine adjusted odds ratios and 95% confidence intervals., Results: Compared with women with normal BMI, obese women had significantly higher rates of preeclampsia, gestational hypertension, and gestational diabetes, and these rates increased with increasing BMI (trend-test P < 0.001). There was a significant increase in rates of induction of labour in the obesity categories, from 25.3% in women with normal BMI to 42.9% in women with class III morbid obesity (aOR 1.67; 95% CI 1.43 to 1.93). Rates of primary Caesarean section rose with increasing BMI and were highest in women with class III morbid obesity (36.2% vs. 22.1% in women with normal BMI) (aOR 1.46; 95% CI 1.23 to 1.73)., Conclusion: Increasing BMI is associated with increasing rates of preeclampsia, gestational hypertension, and gestational diabetes. There is a significant increase in rates of induction of labour with increasing obesity class, and a significantly increased Caesarean section rate with higher BMI. Obstetrical care providers should counsel obese patients about the risks they face and the importance of weight loss before pregnancy.

Objectives: To compare outcomes of neonates born from women with Class III obesity with those whose mothers were of normal body weight., Methods: A retrospective cohort study of live-born singleton infants was undertaken. Maternal prepregnancy body mass index (BMI) defined matched normal and Class III obese cohorts. Multivariable regression models were used to determine adjusted relative odds ratios (aOR) and 95% confidence intervals (CI) for selected adverse neonatal outcomes., Results: Newborns exposed to maternal Class III obesity had greater risks of fetal overgrowth and low cord artery pH. Class III obesity was protective against small for gestational age and low birthweight. There was no difference in the risk of preterm delivery, meconium in the amniotic fluid or breastfeeding initiation., Conclusions: The new knowledge generated by this study provides further information on unique challenges faced by newborns of women with Class III obesity, suggesting more specialized care in the intrapartum and neonatal periods may be beneficial.

Importance: Recent evidence suggests that cannabis use during pregnancy is increasing, although population-based data about perinatal outcomes following in utero exposure remain limited.Objective: To assess whether there are associations between self-reported prenatal cannabis use and adverse maternal and perinatal outcomes.Design, Setting, and Participants: Population-based retrospective cohort study covering live births and stillbirths among women aged 15 years and older in Ontario, Canada, between April 2012 and December 2017.Exposures: Self-reported cannabis exposure in pregnancy was ascertained through routine perinatal care.Main Outcomes and Measures: The primary outcome was preterm birth before 37 weeks' gestation. Indicators were defined for birth occurring at 34 to 36 6/7 weeks' gestation (late preterm), 32 to 33 6/7 weeks' gestation, 28 to 31 6/7 weeks' gestation, and less than 28 weeks' gestation (very preterm birth). Ten secondary outcomes were examined including small for gestational age, placental abruption, transfer to neonatal intensive care, and 5-minute Apgar score. Coarsened exact matching techniques and Poisson regression models were used to estimate the risk difference (RD) and relative risk (RR) of outcomes associated with cannabis exposure and control for confounding.Results: In a cohort of 661 617 women, the mean gestational age was 39.3 weeks and 51% of infants were male. Mothers had a mean age of 30.4 years and 9427 (1.4%) reported cannabis use during pregnancy. Imbalance in measured maternal obstetrical and sociodemographic characteristics between reported cannabis users and nonusers was attenuated using matching, yielding a sample of 5639 reported users and 92 873 nonusers. The crude rate of preterm birth less than 37 weeks' gestation was 6.1% among women who did not report cannabis use and 12.0% among those reporting use in the unmatched cohort (RD, 5.88% [95% CI, 5.22%-6.54%]). In the matched cohort, reported cannabis exposure was significantly associated with an RD of 2.98% (95% CI, 2.63%-3.34%) and an RR of 1.41 (95% CI, 1.36-1.47) for preterm birth. Compared with no reported use, cannabis exposure was significantly associated with greater frequency of small for gestational age (third percentile, 6.1% vs 4.0%; RR, 1.53 [95% CI, 1.45-1.61]), placental abruption (1.6% vs 0.9%; RR, 1.72 [95% CI, 1.54-1.92]), transfer to neonatal intensive care (19.3% vs 13.8%; RR, 1.40 [95% CI, 1.36-1.44]), and 5-minute Apgar score less than 4 (1.1% vs 0.9%; RR, 1.28 [95% CI, 1.13-1.45]).Conclusions and Relevance: Among pregnant women in Ontario, Canada, reported cannabis use was significantly associated with an increased risk of preterm birth. Findings may be limited by residual confounding. [ABSTRACT FROM AUTHOR]