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The New “Obstetrical Dilemma”: Stunting, Obesity and the Risk of Obstructed Labour

Wells, JCK; (2017) The New “Obstetrical Dilemma”: Stunting, Obesity and the Risk of Obstructed Labour. Anatomical Record , 300 (4) pp. 716-731. 10.1002/ar.23540. Green open access

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Abstract

The “obstetrical dilemma” refers to the tight fit between maternal pelvic dimensions and neonatal size at delivery. Most interest traditionally focused on its generic significance for humans, for example our neonatal altriciality and our complex and lengthy birth process. Across contemporary populations, however, the obstetrical dilemma manifests substantial variability, illustrated by differences in the incidence of cephalo-pelvic disproportion, obstructed labour and cesarean section. Beyond accounting for 12% of maternal mortality worldwide, obstructed labour also imposes a huge burden of maternal morbidity, in particular through debilitating birth injuries. This article explores how the double burden of malnutrition and the global obesity epidemic may be reshaping the obstetrical dilemma. First, short maternal stature increases the risk of obstructed labour, while early age at marriage also risks pregnancy before pelvic growth is completed. Second, maternal obesity increases the risk of macrosomic offspring. In some populations, short maternal stature may also promote the risk of gestational diabetes, another risk factor for macrosomic offspring. These nutritional influences are furthermore sensitive to social values relating to issues such as maternal and child nutrition, gender inequality and age at marriage. Secular trends in maternal obesity are substantially greater than those in adult stature, especially in low- and middle-income countries. The association between the dual burden of malnutrition and the obstetrical dilemma is therefore expected to increase, because the obesity epidemic is emerging faster than stunting is being resolved. However, we currently lack objective population-specific data on the association between maternal obesity and birth injuries.

Type: Article
Title: The New “Obstetrical Dilemma”: Stunting, Obesity and the Risk of Obstructed Labour
Open access status: An open access version is available from UCL Discovery
DOI: 10.1002/ar.23540
Publisher version: http://doi.org/10.1002/ar.23540
Language: English
Additional information: Copyright © 2017 Wiley Periodicals, Inc. All rights reserved. This is the peer reviewed version of the following article: Wells, JCK; (2017) The New “Obstetrical Dilemma”: Stunting, Obesity and the Risk of Obstructed Labour. Anatomical Record , 300 (4) pp. 716-731, which has been published in final form at http://doi.org/10.1002/ar.23540. This article may be used for non-commercial purposes in accordance with Wiley Terms and Conditions for Self-Archiving.
Keywords: Pelvis; birth weight; maternal obesity; cesarean; obstructed labour; vesicovaginal fistula
UCL classification: UCL
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > UCL GOS Institute of Child Health
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > UCL GOS Institute of Child Health > Population, Policy and Practice Dept
URI: https://discovery.ucl.ac.uk/id/eprint/1545175
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