UAMS Study Finds Excessive Weight Gain In Pregnancy Linked to Increase in C-sections

LITTLE ROCK — Researchers at the University of Arkansas for Medical Sciences (UAMS) Institute for Community Health Innovation found that excessive gestational weight gain is linked to an increase in cesarean sections, according to a study published recently in the American Journal of Obstetrics and Gynecology.

The percentage of women in the United States who have a C-section increased from 7% in 1990 to 32% in 2023 — far above the acceptable percentage of 10-15%. In Arkansas, approximately 34% of all births in 2023 were cesarean deliveries. While sometimes medically necessary, cesarean births carry increased chances of maternal and infant health complications.

Researchers analyzed data from more than 82,000 live births in Arkansas between 2014 and 2022. Not only did researchers find women with an excessive rate of gestational weight gain had a significantly higher risk of cesarean delivery than those with a healthy gestational weight gain rate, but a woman’s pre-pregnancy BMI category was also indicative of cesarean delivery risk if she was overweight or obese.

“This research is unique because it demonstrated that excess gestational weight gain was correlated with increased cesarean delivery regardless of a woman’s starting BMI,” said Pearl McElfish, Ph.D., director of the institute. “That is, even among women who were normal weight when beginning pregnancy, excess gestational weight gain increased cesarean delivery. These findings suggest that weight gain before or during pregnancy can be a key modifiable risk factor for cesarean deliveries and can inform interventions to help women better manage weight gain during pregnancy.

“Not all C-sections are preventable, but by identifying and addressing some of the factors that lead to increased chances of cesarean deliveries, we can provide women and infants improved health outcomes and reduce maternal and infant morbidity and mortality,” she added.

The study suggests the need for interventions focused on increased counseling about gestational weight gain and access to healthy foods for pregnancy women. The institute, partnering with Community Health Centers of Arkansas (CHCA), will launch an intervention called Delivering HOPE in March. This intervention includes gestational weight gain counseling, help applying for WIC and SNAP and the provision of healthy food.

“Food insecurity and limited access to maternal health resources remain critical barriers in our state, disproportionately impacting low-income and rural communities,” said Lanita White, Pharm.D., chief executive officer at CHCA. “Through the Delivering HOPE initiative, CHCA is proud to partner with UAMS to address these challenges by providing enhanced nutrition support and targeted counseling in addition to the essential maternal health services that community health centers provide. We remain committed to reducing maternal health disparities and improving outcomes for Arkansas families to ensure we have healthy moms and healthy babies.”

Arkansas is ranked as one of the worst for both maternal health outcomes and food insecurity among U.S. states and has the third highest infant mortality rate. Arkansas also has the second highest prevalence of overweight or obese women in the U.S., with about 65% of women in Arkansas being overweight or obese when they become pregnant. These women are at greater risk of excessive gestational weight gain and its associated complications.

A healthy diet during pregnancy promotes healthy weight gain; however, many pregnant women do not have access to such healthy foods as fruits and vegetables, lean proteins and whole grains. This is especially true for low-income, rural and food-insecure women who face financial and transportation barriers.

“In order to address the disparities in maternal morbidity and mortality, we must address social determinants of health such as food insecurity,” McElfish said. “Results from this study have great potential to improve maternal health outcomes in Arkansas and throughout the U.S.”