Delivery Dilemmas: Study evaluating Obesity's Influence on Cesarean Section Trends

Recent study investigated the relationship between second-trimester anthropometric obesity indicators and cesarean section (CS) in Chinese pregnant women, aiming to identify effective predictors to reduce unnecessary CS rates. The research highlighted the increasing global CS rates and the associated short- and long-term risks for both mothers and infants. Maternal obesity during the second trimester has been linked to an elevated CS risk, emphasizing the need for reliable obesity indicators for prenatal risk assessment. Different indicators like Body Mass Index (BMI), Subcutaneous Fat Thickness (SCFT), Waist Circumference (WC), Body Fat Percentage (BFP), and Body Roundness Index (BRI) were evaluated for their associations with CS risk.

Key Findings and Associations

The findings showed that BMI, BFP, WC, and BRI were significant predictors of CS risk, with BRI demonstrating the strongest association. Maternal age and fetal sex were identified as modifiers influencing these associations, with advanced maternal age and male infants showing heightened CS risks. The study included a large sample of Chinese pregnant women, and statistical analyses revealed significant correlations between anthropometric indicators and CS risk after adjusting for covariates.

Recommendations for CS Risk Assessment

Integrated approaches combining BMI and WC were recommended for effective CS risk assessment, with BRI being a superior indicator despite its complexity. The study emphasized the importance of early identification of high-risk subgroups and integrating obesity-related indicators into routine prenatal care to optimize delivery planning and develop targeted interventions. The research findings suggested that an individualized perinatal care approach using multiple anthropometric indicators could enhance risk stratification and improve maternal and neonatal outcomes.

Limitations and Future Research Directions

While the study provided valuable insights into the associations between anthropometric obesity indicators and CS risk, certain limitations such as the observational design, single-center setting, limited participant characteristics, and the need for further longitudinal studies to confirm the findings were acknowledged. Future research directions were proposed to explore the longitudinal impact of maternal adiposity changes on delivery outcomes and develop accessible tools for integrating anthropometric indicators into routine obstetric care for enhanced risk assessment and improved maternal health outcomes.

Key Points

- Investigated the relationship between second-trimester anthropometric obesity indicators and cesarean section (CS) in Chinese pregnant women to identify predictors for reducing unnecessary CS rates in response to the increasing global CS rates and associated risks for mothers and infants.

- Found that Body Mass Index (BMI), Body Fat Percentage (BFP), Waist Circumference (WC), and Body Roundness Index (BRI) were significant predictors of CS risk, with BRI showing the strongest association, while maternal age and fetal sex modulated these associations.

- Recommended integrated BMI and WC approaches for effective CS risk assessment, suggesting the superiority of BRI as an indicator and highlighting the importance of early identification of high-risk subgroups and integrating obesity-related indicators into routine prenatal care.

- Acknowledged study limitations such as observational design, single-center setting, and the need for further longitudinal research to confirm findings, proposing future directions to explore the impact of maternal adiposity changes on delivery outcomes and develop accessible tools for enhanced risk assessment in obstetric care.

- Emphasized the need for reliable obesity indicators for prenatal risk assessment due to the linkage between maternal obesity during the second trimester and elevated CS risk, aiming to optimize delivery planning, develop targeted interventions, and improve maternal and neonatal outcomes through individualized perinatal care approaches using multiple anthropometric indicators.

Reference –

Anqi Xiong et al. (2025). Second-Trimester Anthropometric Estimators Of Cesarean Section: The Agreement Between Body Roundness Index, Body Mass Index, Body Fat Percentage, And Waist Circumference. *BMC Pregnancy And Childbirth*, 25. https://doi.org/10.1186/s12884-025-07643-8.