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Across contemporary populations, however, the obstetrical dilemma manifests substantial variability, illustrated by differences in the incidence of cephalo\u2010pelvic disproportion, obstructed labour and cesarean section. Beyond accounting for 12% of maternal mortality worldwide, obstructed labour also imposes a huge burden of maternal morbidity, in particular through debilitating birth injuries. This article explores how the double burden of malnutrition and the global obesity epidemic may be reshaping the obstetrical dilemma. First, short maternal stature increases the risk of obstructed labour, while early age at marriage also risks pregnancy before pelvic growth is completed. Second, maternal obesity increases the risk of macrosomic offspring. In some populations, short maternal stature may also promote the risk of gestational diabetes, another risk factor for macrosomic offspring. These nutritional influences are furthermore sensitive to social values relating to issues such as maternal and child nutrition, gender inequality and age at marriage. Secular trends in maternal obesity are substantially greater than those in adult stature, especially in low\u2010 and middle\u2010income countries. The association between the dual burden of malnutrition and the obstetrical dilemma is therefore expected to increase, because the obesity epidemic is emerging faster than stunting is being resolved. However, we currently lack objective population\u2010specific data on the association between maternal obesity and birth injuries. Anat Rec, 300:716\u2013731, 2017. \u00a9 2017 Wiley Periodicals, Inc.<\/jats:p>","DOI":"10.1002\/ar.23540","type":"journal-article","created":{"date-parts":[[2017,3,15]],"date-time":"2017-03-15T01:25:30Z","timestamp":1489541130000},"page":"716-731","source":"Crossref","is-referenced-by-count":76,"title":["The New \u201cObstetrical Dilemma\u201d: Stunting, Obesity and the Risk of Obstructed Labour"],"prefix":"10.1002","volume":"300","author":[{"given":"Jonathan C. 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