This matched case-control study evaluated the independent effect of class III obesity (BMI ≥ 40) on mode of delivery and perinatal outcomes in 69 nulliparous patients, matched by gestational diabetes and maternal age to two control groups (BMI 30–39, n=70; BMI <30, n=70).
Class III obesity was independently linked to a significantly higher intrapartum cesarean delivery rate (53%) versus BMI 30–39 (39%) and BMI <30 (26%) (P=0.006); labor induction was also markedly higher (82% vs. 79% vs. 49%, P<0.001). Cesarean wound infection requiring re-hospitalization occurred in 20% of the class III group.
Small sample size (n=69 in the class III group) limits statistical power. Single-center or single-cohort design may limit generalizability. Retrospective matching cannot fully control for all confounders beyond GDM and maternal age.
Nearly 60% of nulliparous women with class III obesity will require cesarean delivery, most often intrapartum rather than planned — clinicians should counsel these patients accordingly. When clinically safe, allowing spontaneous labor onset may improve the chance of vaginal birth in this population.
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