Maternal excessive weight gain as a potential risk factor for prolonged labor in Japanese pregnant women: The Japan Environment and Children’s Study

by Satoshi Shinohara, Sayaka Horiuchi, Reiji Kojima, Ryoji Shinohara, Sanae Otawa, Megumi Kushima, Kunio Miyake, Hideki Yui, Tadao Ooka, Yuka Akiyama, Hiroshi Yokomichi, Zentaro Yamagata, the Japan Environment and Children’s Study Group

Aim

This study aimed to determine whether excessive maternal weight gain during pregnancy was associated with a higher risk of prolonged labor.

Methods

We analyzed the data regarding maternal weight gain during pregnancy for the participants of Japan Environment and Children’s Study (JECS), which is an ongoing nationwide prospective birth cohort study in Japan. After excluding participants with multiple pregnancies, with deliveries before 37 or beyond 42 weeks of gestation, or who had undergone cesarean section, 71,154 (nulliparous, n = 28,442) Japanese women were included. Prolonged labor was defined by a cutoff ranking at the 95^th percentile and consequently defined as labor duration exceeding 12.7 h in multiparous women and exceeding 23.2 h in nulliparous women. These classifications were made according to labor curves established by the Japanese Society of Obstetrics and Gynecology Perinatal Committee developed in June 2021. Considering that no studies have conducted an investigation based on this new guideline, we analyzed the association between excessive maternal weight gain during pregnancy and prolonged labor by parity.

Results

The overall incidence of prolonged labor was 10.2% (2,907/28,442) in nulliparous women and 6.1% (2,597/42,712) in multiparous women. Multivariable analysis indicated that excessive maternal weight gain was significantly associated with prolonged labor in nulliparous (adjusted odds ratio, 1.21; 95% confidence interval, 1.10–1.32) and multiparous women (adjusted odds ratio, 1.15; 95% confidence interval, 1.05–1.27). Kaplan–Meier survival analysis showed that as labor progressed, the percentage of women who had not yet delivered was higher among those with excessive maternal weight gain than among those with normal maternal weight gain in both the nulliparous (median labor duration 12.9 h vs 12.2 h, p<0.001) and multiparous (median labor duration 6.2 h vs 5.8 h, p<0.001) groups.

Conclusion

Excessive maternal weight gain was significantly associated with prolonged labor in Japanese women.