Association Between Pre-pregnancy Obesity and Adverse Obstetric Outcomes: A Retrospective Cohort Study at a Secondary Care Center in Tbilisi, Georgia.

Background Maternal obesity is an increasingly important public health concern and has been consistently associated with adverse pregnancy outcomes, including hypertensive disorders of pregnancy, cesarean delivery, fetal overgrowth, and preterm birth (PTB). Local institutional data remain valuable because patient characteristics and obstetric practice patterns may vary across healthcare settings. This study aimed to evaluate the unadjusted and adjusted associations between pre-pregnancy obesity and selected adverse obstetric outcomes - hypertensive disorders of pregnancy, postpartum hemorrhage (PPH), cesarean delivery, macrosomia, and PTB - among women delivering at Zhordania Medical Center, a secondary care center in Tbilisi, Georgia. Methods This retrospective cohort study included 428 pregnant women with documented pre-pregnancy body mass index (BMI) who delivered at Zhordania Medical Center during the study period. Participants were divided into two groups according to pre-pregnancy BMI: BMI ≥ 30 kg/m² (obese group, n = 145) and BMI < 30 kg/m² (non-obese group, n = 283). The outcomes of interest were hypertensive disorders of pregnancy, PPH, cesarean delivery, macrosomia, and PTB. Categorical variables were summarized as frequencies and percentages, and group comparisons were performed using the chi-squared test or Fisher's exact test, as appropriate. Odds ratios (ORs) with 95% confidence intervals (CIs) were calculated using univariable logistic regression; multivariable logistic regression, adjusting for maternal age, parity, and (where estimable) prior cesarean delivery, was subsequently performed using patient-level data. A two-sided p-value < 0.05 was considered statistically significant. Results Women with pre-pregnancy BMI ≥ 30 kg/m² had significantly higher odds of hypertensive disorders of pregnancy than women with BMI < 30 kg/m² (26/145 vs. 14/283; OR 4.20, 95% CI 2.12-8.32; p < 0.001; adjusted OR 3.80, 95% CI 1.88-7.69). Cesarean delivery was also more common in the obese group (85/145 vs. 126/283; OR 1.77, 95% CI 1.18-2.65; p = 0.006; adjusted OR 1.83, 95% CI 1.19-2.81). Macrosomia, defined as birth weight > 4,000 g, occurred more frequently among women with obesity (23/145 vs. 23/283; OR 2.13, 95% CI 1.15-3.95; p = 0.014; adjusted OR 2.02, 95% CI 1.07-3.82). No statistically significant associations were observed for PPH (9/145 vs. 11/283; OR 1.64, 95% CI 0.66-4.04; p = 0.28) or PTB (15/145 vs. 19/283; OR 1.60, 95% CI 0.79-3.26; p = 0.19), though the achieved sample provided limited power (approximately 21% and 27%, respectively) to detect effects of this magnitude. Conclusions Pre-pregnancy obesity was associated with increased odds of hypertensive disorders of pregnancy, cesarean delivery, and macrosomia in this retrospective cohort from a secondary care center in Georgia, independent of maternal age, parity, and prior cesarean delivery where adjustment was feasible. These associative findings highlight the importance of preconception counseling and enhanced antenatal surveillance for women with obesity, although causal inference requires confirmation in larger, prospective studies.