{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,20]],"date-time":"2026-08-20T07:24:52Z","timestamp":1787210692992,"version":"build-2736575974"},"reference-count":35,"publisher":"Wiley","license":[{"start":{"date-parts":[[2026,8,20]],"date-time":"2026-08-20T00:00:00Z","timestamp":1787184000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"},{"start":{"date-parts":[[2026,8,20]],"date-time":"2026-08-20T00:00:00Z","timestamp":1787184000000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["obgyn.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Intl J Gynecology &amp;amp; Obste"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>The relationship between pre\u2010pregnancy body mass index (BMI) and obstetric anal sphincter injury (OASI) is not well established. OASI is a major obstetric complication, contributing to postpartum morbidity through chronic pain, anal incontinence, and impaired quality of life.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To quantify the association of pre\u2010pregnancy BMI on the risk of OASI.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Search Strategy<\/jats:title>\n                    <jats:p>We searched seven databases (MEDLINE, OVID, Embase, Emcare, Cochrane Library, Wiley, and Web of Science) from inception to September 1, 2024, with an initial search performed on February 2, 2023 and an updated search conducted on September 1, 2024.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Selection Criteria<\/jats:title>\n                    <jats:p>Observational studies comparing the risk of OASI by pre\u2010pregnancy BMI categories as specified by the World Health Organization (underweight, standard weight, overweight, obesity class I, obesity class II, and obesity class III) were included.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Data Collection and Analysis<\/jats:title>\n                    <jats:p>Two reviewers independently completed screening, data extraction, and quality assessment of all included studies. Odds ratios (ORs) of included studies were pooled using random effects models. The quality of studies was assessed using Cochrane's ROBINS\u2010E tool.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Main Results<\/jats:title>\n                    <jats:p>Seven cohort studies fulfilled eligibility criteria for inclusion in the meta\u2010analysis. Meta\u2010analyses of adjusted estimates showed increased odds of OASI among individuals with underweight versus standard pre\u2010pregnancy BMI (OR 1.29, 95% confidence interval [CI] 1.23\u20131.36), and lower odds of OASI were found in both the overweight (OR 0.94, 95% CI 0.89\u20130.99) and obese versus standard BMI (OR 0.80, 95% CI 0.73\u20130.88) groups. Heterogeneity among studies was moderate to high. Most studies were found to be at high risk of residual confounding.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Maternal pre\u2010pregnancy BMI is inversely associated with OASI in a dose\u2010responsive manner, such that OASI risk decreases as BMI increases. These findings highlight the need to consider maternal BMI in risk stratification and preventative strategies during childbirth.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/ijgo.71311","type":"journal-article","created":{"date-parts":[[2026,8,20]],"date-time":"2026-08-20T07:00:48Z","timestamp":1787209248000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Maternal pre\u2010pregnancy body mass index and obstetric anal sphincter injury: A systematic review and meta\u2010analysis"],"prefix":"10.1002","author":[{"ORCID":"https:\/\/orcid.org\/0009-0004-4692-8258","authenticated-orcid":false,"given":"Thilini","family":"Wijesekera","sequence":"first","affiliation":[{"name":"Department of Obstetrics and Gynecology McMaster University  Hamilton Ontario Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-3712-5490","authenticated-orcid":false,"given":"Parnian","family":"Hossein\u2010Pour","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology McMaster University  Hamilton Ontario Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0007-8255-4152","authenticated-orcid":false,"given":"Pruedence","family":"Hughes","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology McMaster University  Hamilton Ontario Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4618-0839","authenticated-orcid":false,"given":"Giulia M.","family":"Muraca","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology McMaster University  Hamilton Ontario Canada"},{"name":"Department of Health Research Methods, Evidence and Impact McMaster University  Hamilton Ontario Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,8,20]]},"reference":[{"key":"e_1_2_9_2_1","unstructured":"FernandoR SultanA FreemanR WilliamsA Bolton AdamsE.The Management of Third\u2010 and Fourth\u2010Degree Perineal Tears. 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