Prediction of Vaginal Delivery in Pregnant Individuals with Class III Obesity Undergoing Induction of Labor: Development and Internal Validation of a Prediction Model
7 affiliations
- 1Department of Obstetrics, McMaster University, Hamilton, ON L8S 4K1, Canada
- 2Women’s College Research Institute, Women’s College Hospital, Toronto, ON M5S 1B2, Canada
- 3Department of Nursing, Toronto Metropolitan University, Toronto, ON M5B 2K3, Canada
- 4Ruth and Bruce Rappaport Faculty of Medicine, Technion, Israel Institute of Technology, 31096 Haifa, Israel
- 5Department of Obstetrics and Gynecology, Temerty Faculty of Medicine, University of Toronto, Toronto, ON M5G 1E2, Canada
- 6Department of Obstetrics and Gynecology, Schulich School of Medicine and Dentistry, University of Western Ontario, London, ON N6A 5C1, Canada
- 7Department of Obstetrics and Gynecology, Sinai Health, Mount Sinai Hospital, Toronto, ON M5G 1Z5, Canada
Abstract
Objective: The objective of this study was to develop and internally validate a model predicting vaginal delivery after labor induction in individuals with class III obesity, and to describe maternal and neonatal outcomes by delivery mode. Methods: This was a retrospective cohort study of singleton term inductions in individuals with class III obesity (BMI ≥ 40 kg/m2) and no prior cesarean delivery at a tertiary care center (2010–2020). Eight predictors available at admission for induction were prespecified: maternal age, parity, pre-pregnancy BMI, gestational weight gain, prior bariatric surgery, hypertensive disorders, diabetes mellitus, and cervical dilation. Missing data were addressed using multiple imputation. Internal validation was carried out using bootstrap resampling, and coefficients were shrunken using the optimism-corrected calibration slope. Results: Of 183 individuals, 92 (50.3%) achieved vaginal delivery. The mean BMI was 50.5 ± 5.2 kg/m2; 68.9% were nulliparous. Multiparity (adjusted odds ratio [aOR] 7.38, 95% CI 3.26–16.70) and younger maternal age (aOR 0.91 per year, 95% CI 0.85–0.98) were associated with vaginal delivery; BMI was not (aOR 0.99 per kg/m2, 95% CI 0.93–1.06). Labor dystocia accounted for 69 of 91 cesarean deliveries (75.8%). Composite maternal morbidity occurred in 9.8% of patients after vaginal delivery and in 14.3% after cesarean delivery. The optimism-corrected AUC was 0.746 (95% CI 0.675–0.806) and the optimism-corrected calibration slope was 0.74. Conclusion: Half of the individuals with class III obesity achieved vaginal delivery after labor induction. Parity, not BMI, was the main determinant. This internally validated model requires external validation before it is used for counseling.
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BibTeX
@article{ashwal2026prediction,
title = {{Prediction of Vaginal Delivery in Pregnant Individuals with Class III Obesity Undergoing Induction of Labor: Development and Internal Validation of a Prediction Model}},
author = {Eran Ashwal and Wan Yao Chen and Manal Massalha and Zainab Doleeb and Noora Alshamsi and Chloe Lau and Maclite Tesfaye and Cynthia Maxwell},
journal = {Journal of Clinical Medicine},
year = {2026},
month = oct,
doi = {10.3390/jcm15218371},
url = {https://www.mdpi.com/2077-0383/15/21/8371},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Prediction of Vaginal Delivery in Pregnant Individuals with Class III Obesity Undergoing Induction of Labor: Development and Internal Validation of a Prediction Model
AU - Eran Ashwal
AU - Wan Yao Chen
AU - Manal Massalha
AU - Zainab Doleeb
AU - Noora Alshamsi
AU - Chloe Lau
AU - Maclite Tesfaye
AU - Cynthia Maxwell
PY - 2026
DA - 2026/10/27
JO - Journal of Clinical Medicine
DO - 10.3390/jcm15218371
UR - https://www.mdpi.com/2077-0383/15/21/8371
AB - Objective: The objective of this study was to develop and internally validate a model predicting vaginal delivery after labor induction in individuals with class III obesity, and to describe maternal and neonatal outcomes by delivery mode. Methods: This was a retrospective cohort study of singleton term inductions in individuals with class III obesity (BMI ≥ 40 kg/m2) and no prior cesarean delivery at a tertiary care center (2010–2020). Eight predictors available at admission for induction were prespecified: maternal age, parity, pre-pregnancy BMI, gestational weight gain, prior bariatric surgery, hypertensive disorders, diabetes mellitus, and cervical dilation. Missing data were addressed using multiple imputation. Internal validation was carried out using bootstrap resampling, and coefficients were shrunken using the optimism-corrected calibration slope. Results: Of 183 individuals, 92 (50.3%) achieved vaginal delivery. The mean BMI was 50.5 ± 5.2 kg/m2; 68.9% were nulliparous. Multiparity (adjusted odds ratio [aOR] 7.38, 95% CI 3.26–16.70) and younger maternal age (aOR 0.91 per year, 95% CI 0.85–0.98) were associated with vaginal delivery; BMI was not (aOR 0.99 per kg/m2, 95% CI 0.93–1.06). Labor dystocia accounted for 69 of 91 cesarean deliveries (75.8%). Composite maternal morbidity occurred in 9.8% of patients after vaginal delivery and in 14.3% after cesarean delivery. The optimism-corrected AUC was 0.746 (95% CI 0.675–0.806) and the optimism-corrected calibration slope was 0.74. Conclusion: Half of the individuals with class III obesity achieved vaginal delivery after labor induction. Parity, not BMI, was the main determinant. This internally validated model requires external validation before it is used for counseling.
SN - 2077-0383
ER -