Date of Award
Doctor of Philosophy (PhD)
Brian W. Whitcomb
gestational weight gain, induction, intraventricular, physical activity, second stage labor
Prolonged second stage of labor, excessive gestational weight gain and cesarean delivery has been associated with adverse maternal and fetal outcomes. Physical activity during pregnancy is a modifiable risk factor which has never been studied among Hispanic women. Gestational weight gain, another modifiable risk factor has only been evaluated as a risk factor for cesarean delivery in two studies among women induced for labor. To date, no study has examined the effect of duration of second stage of labor on intra-ventricular hemorrhage in very preterm births. We examined these maternal risk factors for prolonged second stage of labor, rate of cesarean delivery and fetal outcomes. The first study evaluated the association between physical activity and duration of second stage of labor. Prior studies regarding physical activity and duration of second stage of labor have been conflicting and none have examined the Hispanic population. During pregnancy, activities such as household chores, childcare, sports and women's occupation constitute a significant proportion of physical activity but have not been considered in prior studies. We examined the association between total physical activity (occupational, sport/exercise, household/care giving, and active living) during pre, early and mid-pregnancy and duration of second stage of labor in a prospective cohort of 1,231 Hispanic participants. Physical activity was quantified using the Kaiser Physical Activity Survey administered during pregnancy. Using multivariate linear regression we did not find statistically significant association between pre, early and mid-pregnancy physical activity and duration of second stage of labor. The second study focused on the effect of gestational weight gain on the cesarean delivery rate after induction of labor. The rate of induction of labor (IOL) has more than doubled from 9.5% in 1990 to 22.5% in 2006. Cesarean delivery usually follows a failed IOL and is associated with maternal and fetal morbidity. One of the two studies evaluating the effect of gestational weight gain on the rate of cesarean section in patients undergoing IOL was restricted to women with normal Body Mass Index (BMI) and the other was subjected to bias because more than half of the patients were missing BMI data. Therefore, we evaluated the effect of gestational weight gain on the rate of cesarean delivery after labor induction. In a retrospective cohort study design, using data from May 2005 to June 2008 and a multivariate logistic regression we found a 13% increase in risk of cesarean delivery with 5 kg increase in gestational weight gain. Finally, we evaluated the effect of mode of delivery and duration of second stage of labor on intra-ventricular hemorrhage (IVH) among early preterm births. IVH is a serious complication associated with preterm birth and important predictors of cerebral palsy and neurodevelopmental delays. Prior studies on this relationship in early preterm births are sparse. In a retrospective cohort study of newborns born less than 30 weeks or less than 1500 g between May 2003 and August 2008, we found an increase in risk of IVH after vaginal delivery. However, duration of second stage of labor had no significant effect on risk of IVH.
Gawade, Prasad L., "Maternal and Fetal Factors Associated with Labor and Delivery Complications" (2012). Open Access Dissertations. Paper 503.