To Örebro University

BACKGROUND: Over the past 30 years, the global use of cesarean section (CS) has increased significantly, surpassing the recommended population-based rate of 10-15%. Increased maternal weight is a major factor for cesarean section (CS) delivery.

OBJECTIVE: This systematic review and meta-analysis assessed the association between maternal overweight/obesity and CS delivery, estimating the proportion of CS deliveries attributable to excess maternal weight in Middle East and North Africa (MENA) countries.

METHODS: Electronic databases (PubMed, Scopus, Embase, CINAHL, Web of Science, and Cochrane) were searched for studies published between Jan 2000 and Nov 2024 in MENA countries. Two authors reviewed studies and extracted data. Subgroup analyses examined obesity class (I-III) and CS type. Attributable risk fractions (ARFs) and population-attributable risk fractions (PARFs) were calculated. Random-effects models were used.

RESULTS: Forty-five studies from 12 MENA countries, including 97,518 women, were analyzed. Compared to women with a normal body mass index (BMI), overweight and obese women had a 35.0% (aOR 1.35; 95% CI, 1.24-1.49) and a 77.0% (aOR 1.77; 95% CI, 1.49-2.11) elevated likelihood of CS, respectively. The likelihood of CS significantly increased with increasing obesity class by 78% for class I, 121% for class II, and 161% for class III. Overweight women were also at higher risk of emergency CS (aOR 1.34; 95% CI, 1.02-1.76). An estimated 25.9% and 43.5% of CS deliveries were attributable to maternal overweight and obesity. The highest estimated PARF for maternal overweight was in Syria (15.9%) and for obesity in Saudi Arabia (35.4%).

LIMITATIONS: Few included studies lacked standardized definitions or classifications of BMI and maternal weight, which may have affected comparability. Substantial heterogeneity was observed in subgroup analyses, requiring cautious interpretation of the pooled estimates.

CONCLUSIONS: Promoting healthy weight before and during pregnancy could reduce unnecessary and emergency CS deliveries, offering a critical intervention for improving maternal health. SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD42024551878.