{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,7]],"date-time":"2026-07-07T06:35:21Z","timestamp":1783406121155,"version":"3.54.6"},"reference-count":19,"publisher":"Public Library of Science (PLoS)","issue":"2","license":[{"start":{"date-parts":[[2022,2,25]],"date-time":"2022-02-25T00:00:00Z","timestamp":1645747200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:sec id=\"sec001\">\n<jats:title>Background<\/jats:title>\n<jats:p>Obesity is increasing in Sweden and is also of huge global concern. Obesity increases the risk of complications during pregnancy and the need for the induction of labor. Induction of labor increases the number of complications during delivery, leading to women with more negative birth experience. This study investigated how maternal body mass index (BMI) during antenatal care enrollment affects labor outcomes (proportion of cesarean section at induction of labor).<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec002\">\n<jats:title>Method<\/jats:title>\n<jats:p>This was a retrospective cohort study of 3772 women with mixed parity and induction of labor at Soderhospital, Stockholm, in 2009\u20132010 and 2012\u20132013. The inclusion criteria were simplex, \u226534 gestational weeks, cephalic presentation and no previous cesarean section. The women were grouped according to BMI, and statistical analyzes were performed to compare the proportion of cesarean sections after induction of labor. The primary outcome was the proportion of cesarean section after induction of labor divided by group of maternal BMI. The secondary outcomes were postpartum hemorrhage &gt;1000 ml, time of labor, fetal outcome data, and indication for emergency cesarean section.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec003\">\n<jats:title>Result<\/jats:title>\n<jats:p>The induction of labor in women with a high BMI resulted in a significantly increased risk of cesarean section, with 18.4\u201324.1% of deliveries, depending on the BMI group. This outcome persisted after adjustment in women with BMI 25\u201329.9 (aOR 1.4; 95% CI; 1.1\u20131.7) and BMI 30\u201334.9 (aOR 1.5; 95% CI; 1.1\u20132.1). There was also a significantly higher risk for CS among primiparous women (aOR 3.6; 95% CI; 2.9\u201345) and if the newborn weighted \u2265 four kilos (aOR 1.6; 95% CI; 1.3\u20132.0).<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec004\">\n<jats:title>Conclusion<\/jats:title>\n<jats:p>Our findings show that a higher BMI increased the risk of cesarean section after induction of labor in the groups with BMI 25\u201334.9. Parity seems to be the strongest risk factor for CS regardless other variables.<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pone.0263685","type":"journal-article","created":{"date-parts":[[2022,2,25]],"date-time":"2022-02-25T18:50:52Z","timestamp":1645815052000},"page":"e0263685","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":44,"title":["Is there an increased risk of cesarean section in obese women after induction of labor? A retrospective cohort study"],"prefix":"10.1371","volume":"17","author":[{"given":"Jenny","family":"Bjorklund","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eva","family":"Wiberg-Itzel","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2502-4116","authenticated-orcid":true,"given":"Tove","family":"Wallstrom","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2022,2,25]]},"reference":[{"key":"pone.0263685.ref001","unstructured":"F\u00f6rekomst av \u00f6vervikt och fetma Folk\u00e4lsomyndigheten.se: Folkh\u00e4lsomyndigheten; 2020 [updated 2020-10-27]. Available from: https:\/\/www.folkhalsomyndigheten.se\/livsvillkor-levnadsvanor\/fysisk-aktivitet-och-matvanor\/overvikt-och-fetma\/forekomst-av-overvikt-och-fetma\/."},{"key":"pone.0263685.ref002","doi-asserted-by":"crossref","first-page":"315","DOI":"10.1186\/s12889-015-1624-6","article-title":"The educational gradient of obesity increases among Swedish pregnant women: a register-based study.","volume":"15","author":"H Bjermo","year":"2015","journal-title":"BMC Public Health"},{"key":"pone.0263685.ref003","unstructured":"Statistik om graviditeter, f\u00f6rlossningar och nyf\u00f6dda barn 2017 Socialstyrelsen.se [updated 2019-05-02]. Available from: https:\/\/www.socialstyrelsen.se\/globalassets\/sharepoint-dokument\/artikelkatalog\/statistik\/2019-5-2.pdf."},{"key":"pone.0263685.ref004","volume-title":"Pregnancies Complicated by Obesity- Focus on Stillbirth and Infants Born Large for Gestational Age [doctoral degree]","author":"H. \u00c5mark","year":"2020"},{"issue":"1","key":"pone.0263685.ref005","doi-asserted-by":"crossref","first-page":"104","DOI":"10.1097\/AOG.0000000000001465","article-title":"Obstetric and Neonatal Risks Among Obese Women Without Chronic Disease","volume":"128","author":"SS Kim","year":"2016","journal-title":"Obstetrics and gynecology"},{"issue":"2","key":"pone.0263685.ref006","doi-asserted-by":"crossref","first-page":"128.e1","DOI":"10.1016\/j.ajog.2011.03.051","article-title":"The effect of maternal obesity on the rate of failed induction of labor","volume":"205","author":"KB Wolfe","year":"2011","journal-title":"American journal of obstetrics and gynecology"},{"issue":"18","key":"pone.0263685.ref007","doi-asserted-by":"crossref","first-page":"3000","DOI":"10.3109\/14767058.2015.1112371","article-title":"Induction of labor with an unfavorable cervix: how does BMI affect success? (\u2021).","volume":"29","author":"JR Lassiter","year":"2016","journal-title":"The journal of maternal-fetal & neonatal medicine: the official journal of the European Association of Perinatal Medicine, the Federation of Asia and Oceania Perinatal Societies, the International Society of Perinatal Obstet"},{"issue":"4","key":"pone.0263685.ref008","doi-asserted-by":"crossref","first-page":"697","DOI":"10.1111\/jog.13561","article-title":"Influence of body mass index on induction of labor: A historical cohort study","volume":"44","author":"U Dammer","year":"2018","journal-title":"J Obstet Gynaecol Res"},{"issue":"4","key":"pone.0263685.ref009","doi-asserted-by":"crossref","first-page":"356","DOI":"10.1016\/j.ajog.2018.06.006","article-title":"A conceptual framework for the impact of obesity on risk of cesarean delivery","volume":"219","author":"AJG Rogers","year":"2018","journal-title":"American journal of obstetrics and gynecology"},{"issue":"1","key":"pone.0263685.ref010","doi-asserted-by":"crossref","first-page":"55","DOI":"10.1111\/jmwh.12935","article-title":"Influence of Maternal Obesity on Labor Induction: A Systematic Review and Meta-Analysis","volume":"64","author":"JA Ellis","year":"2019","journal-title":"Journal of midwifery & women\u2019s health"},{"issue":"5","key":"pone.0263685.ref011","doi-asserted-by":"crossref","first-page":"578","DOI":"10.1111\/j.1471-0528.2010.02889.x","article-title":"Maternal obesity and labour complications following induction of labour in prolonged pregnancy","volume":"118","author":"S Arrowsmith","year":"2011","journal-title":"BJOG: an international journal of obstetrics and gynaecology"},{"key":"pone.0263685.ref012","article-title":"The Swedish Pregnancy Register\u2013for quality of care improvement and research","author":"PK Stephansson O","year":"2017","journal-title":"Acta Obstet Gynecol"},{"issue":"1","key":"pone.0263685.ref013","doi-asserted-by":"crossref","first-page":"172","DOI":"10.1097\/GRF.0000000000000174","article-title":"Intrapartum Management of the Obese Gravida","volume":"59","author":"JR Carpenter","year":"2016","journal-title":"Clin Obstet Gynecol"},{"key":"pone.0263685.ref014","doi-asserted-by":"crossref","first-page":"422","DOI":"10.1186\/s12884-014-0422-y","article-title":"Pre-pregnancy Body Mass Index (BMI) and delivery outcomes in a Canadian population","volume":"14","author":"A Vinturache","year":"2014","journal-title":"BMC Pregnancy Childbirth"},{"issue":"3","key":"pone.0263685.ref015","doi-asserted-by":"crossref","first-page":"394","DOI":"10.1016\/j.bpobgyn.2014.07.024","article-title":"Induction of labour and intrapartum care in obese women","volume":"29","author":"N Kobayashi","year":"2015","journal-title":"Best practice & research Clinical obstetrics & gynaecology"},{"issue":"5","key":"pone.0263685.ref016","doi-asserted-by":"crossref","first-page":"1059","DOI":"10.1097\/AOG.0000000000001083","article-title":"Predicting Cesarean Delivery After Induction of Labor Among Nulliparous Women at Term.","volume":"126","author":"MC Tolcher","year":"2015","journal-title":"Obstetrics and gynecology"},{"issue":"6","key":"pone.0263685.ref017","doi-asserted-by":"crossref","first-page":"1113","DOI":"10.1097\/AOG.0b013e318253d7aa","article-title":"Normal progress of induced labor","volume":"119","author":"LM Harper","year":"2012","journal-title":"Obstetrics and gynecology"},{"key":"pone.0263685.ref018","volume-title":"WHO recommendations: Intrapartum care for a positive childbirth experience","author":"WHO Guidelines Approved by the Guidelines Review Committee","year":"2018"},{"key":"pone.0263685.ref019","doi-asserted-by":"crossref","first-page":"56","DOI":"10.1186\/1471-2393-10-56","article-title":"The risk of adverse pregnancy outcomes in women who are overweight or obese","volume":"10","author":"C Athukorala","year":"2010","journal-title":"BMC Pregnancy Childbirth"}],"container-title":["PLOS ONE"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0263685","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,2,25]],"date-time":"2022-02-25T18:51:09Z","timestamp":1645815069000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0263685"}},"subtitle":[],"editor":[{"given":"David","family":"Desseauve","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2022,2,25]]},"references-count":19,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2022,2,25]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0263685","relation":{},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,2,25]]}}}