# Introduction orldwide, obesity is the prevalent, chronic medical condition (1) . The rate of obesity in pregnant women is rising, increasing the significance of its impact on obesity-related pregnancy complications. (2) Maternal body mass index (BMI) is one of the predictors of the nutritional status of pregnant ladies. The problem of rising obesity is not unique to India. In earlier research, the relationship between maternal height and weight with pregnancy complications have been extensively explored, but in recent times, BMI is widely accepted as a better measure of over or underweight [3] . Most of the developing countries, including India, are now facing double burden because of extreme socioeconomic distribution. On one side, there is overweight and obesity which has reached epidemic proportions and on the other side, there is underweight and undernourishment. In India, 26% of pregnant women are overweight, and 8% are obese (4) . Obesity influences not only the chance of conception but also reduces the response to fertility treatment and increases the risk of miscarriage, congenital anomalies (5) as well as pregnancy complications like gestational diabetes, pregnancyinduced hypertension, cesarean delivery, macrosomia, and infections in addition to potential adverse effects on long term health of both mother and infant (6) The World Health Organization (7) and the National Institutes of Health (8) define normal weight as a BMI of 18.5-24.9, overweight as a BMI of 25-29.9 obesity as a BMI of 30 or greater. Obesity has further been characterized by BMI into Class I (30-34.9), Class II (35-39.9), and Class III (greater than 40). An increased association of morbidity and mortality with obesity is well established in both pregnant and nonpregnant women. [9] Pregnancy with obesity is considered as high risk, and it causes substantial feto-maternal morbidity and mortality. Hence the purpose of this study was to examine the association between high BMI and feto-maternal Author ? ?: e-mails: khushboodr81.kp@gmail.com, smitasomani123@gmail.com outcome in primigravida women delivering singleton babies. # II. # Aim & Objectives a) Aim To find out the effect of high body mass index on pregnancy outcomes and perinatal outcomes in nulliparous women delivering singleton babies. # b) Objective ? To determine the maternal risk in terms of antepartum, intrapartum, and postpartum complications about maternal BMI. ? To determine the perinatal outcome about high maternal BMI. III. # Material and Methods Following approval from Institutional Research Ethical Board and written informed patient consent, this study has been conducted at Geetanjali Medical College and Hospital (GMCH) Udaipur from January 2019 to January 2020. # Study area-department of obstetrics and gynecology of GMCH, Udaipur # Study design-A longitudinal observational study Source of data-All the antenatal patients attending OPD and admitted to GMCH from January 2019 to January 2020. # Inclusion criteria- ? Patients who give consent for the study ? Women with singleton pregnancies with high BMI (> 25) ? Booked cases with their first visit before 12 weeks of gestation. # Exclusion criteria- ? Women with multiple pregnancy ? Congenital malformation in the fetus ? Women with pre-existing medical disorders. # a) Methodology After obtaining approval from the Institutional research Ethical board and written informed patient consent, this study was conducted at Geetanjali Medical College and Hospital Udaipur from Jan 2019 to January 2020. Cases were taken from the obstetrics and gynecology department attending the OPD and admitted in maternity having high BMI. Detailed history and examination, height, weight and co morbidities were documented with the help of Performa. Women were followed up till deliveries, and their babies were followed up till discharge from the hospital. Various maternal, fetal, and perinatal outcomes were observed in this observational study. # b) Proposed Statistical Analysis Analysis of collected data was done on based of statistical tools and techniques. Data was presented in the form of tables, and charts and graphs such as bar diagrams and pie charts. Analysis of data will be done on based of inferential statistics and descriptive statistics, whatever is required to fulfill the objective. # c) Statistical Analysis The collected data was cross-checked and entered into Microsoft Excel Software and was exported to SPSS, IBM Inc version 21 for statistic analysis. IV. # Results Total of 150 primigravida patients of single tone pregnancy with BMI more than or equal to 25 Kg/metre2 were included in our study, and divided these patients into three groups having BMI 25-29.9 (group 1), 30-34.9(group 2), and more than and equal to 35(group 3). In our study we found maximum patients of BMI 25-29.9 among 21 to 30 years of age. Among 150 patients 93(62%) fall in 25-29.9 kg/metre 2 BMI group, 39(26%) in 30-34.9 BMI group and 18(12%) in more than and equal to 35 BMI group. For BMI 25-29.9 group, 67.7% of patients from the 21-30 years age group. For BMI 30-34.9 group maximum 58.9% patients were from 21-30 years age group. For BMI more than and equal to 35 groups again maximum of 61.1% patients from 21-30 years age group (table 1). Among 150 newborns of 150 mothers of BMI more than or equal to 25, we found 95 newborns, having APGAR at one minute of birth was less than 9. Among 39 obese mother' newborns 31(79.5%) had APGAR less than 9 Among 18 BMI more than or equal to 35mothers' newborns, we found 17(94.4%), newborns. With low APGAR which was highly significant with a pvalue of < 0.001(table 2). In our study, we found a high incidence of GDM in BMI more than or equal to 35patients with BMI more than or equals to 35 kg/metre 2 (38.9%), but it was not statistically significant. Incidence of preeclampsia was high among more than or equal to 35 BMI group (61.1%) with p Value of 0.006, which suggest it is highly significant. The present study showed the increasing incidence of preterm labor among BMI more than and equal to 35 patients 14 out of 18 patients (77.8%) with a p-value of 0.001 which suggested strong association between high maternal BMI and preterm labor. The present study showed a high incidence of macrosomia among BMI more than or equal to 35mothers (38.9%), which was not statistically found significant. Current study showed more cases of gestational hypertension among the BMI 25-29.9 group (552.7%) and less among BMI more than or equal to 35 patients of 16.7%, which was statistically significant. We found a 40.9% incidence of anemia in overweight patients compared to that 16% among BMI more than or equal to 35mothers (table 3). Table 4 shows the association between maternal high BMI and birth weight of the newborns. Among all mothers hiving high BMI, the incidence of low birth weight baby was 58.7%. Incidence of low birth weight is higher in BMI more than or equal to 35group (83.3%) whereas 76.9% among obese mothers and 46.2% in overweight mothers were found in our study. Which is having pvalue 0.003, and so it was statistically highly significant. The present study showed maximum NICU admission of newborns among BMI more than or equal to 35 patients (94.4%), which was statistically highly significant with p-value less than 0.001. In our study, we found four mortalities of baby among overweight mothers, o mortality among obese and one mortality among BMI more than or equal to 35mothers. It was found mortality occurs independently of maternal BMI and was statistically not significant (Table 5). V. # Discussion In our study, we found the maximum number of patients from 21 to 30 years of age group 64.7%, 30% from 31 to 40 years of age, and 8% from 41 to 50 years. We found the maximum number of patients in the overweight group. We didn't find a significant association between age and BMI. That may be because, as age advances the reproductivity decreases [10] . In our study, we found a low APGAR score in the newborns as maternal BMI advances. Kumar HSA et al, 2017 [11] have similar results. In our study, we found a strong association of maternal complications like preeclampsia with maternal BMI more than or equals to 35 kg/metre 2 .Which is like Doi L et al. [12] 2020 results. We found a high incidence of preterm labor among mothers hiving more than or equal to 35 BMI which is comparable with Vinturache A et al, 2017 study [13] . In our study, we didn't get a significant association between a high maternal BMI and caesarean rates but overall LSCS rate was high in our study. Pettersen-Dahletal [14] . The study showed a high incidence of caesarean section among overweight and obese compared to normal and underweight those were 23.2 and 29.1%, respectively. In our study, we found much more 62.4 and 61.5%, respectively. We found a significantly rising incidence of low birth weight babies among BMI more than or equal to 35mothers 83.3%. which is similar to Takai et al, 2017 [15] results which may be due to dysregulation of proinflammatory cytokines as well as increased risk of infection in obese and overweight individuals as they will lead to reduced placental surface area and also their vasculature with consequent uteroplacental insufficiency [16] In our study, we found more incidence of IUGR and NICU admissions in the BMI group more than or equal to 35, which is like Shah PM et al 2018 results [17] . VI. # Conclusion Through this study, it has been concluded that obese mothers have more risk of preterm LABOR and preeclampsia. Babies with high maternal BMI have high risk of Intra uterine growth retardation, preterm birth, low APGAR score at birth, low birth weight and high NICU admissions. Overall, patients have high risk of cesarean section. As obesity is modifiable and preventable, preconception counseling, weight loss before conception, diet and lifestyle modification before and during pregnancy, and creating awareness regarding associated health risks are highly required. 1Age group (years)BMI Group21-3031-4041-50Total632469325-29.9(67.7%)(25.8%)(6.45%)(62%)231603930-34.9(58.9%)(41.0%)(0%)(26%)115218>35(61.1%)(27.7%)(11.1%)(12%)97458Total(64.7%)(30%)(44.4%)150p=0.203 (NS) 2BMI Group25-29.930-34.9>35Total47311795APGAR <9(50.5%)(79.5%)(94.4%)(63.3%)468155APGAR =9(49.5%)(20.5%)(5.6%)(36.7%)Total933918150p<0.001 (HS) 3 3BMI Group25-29.930-34.9>35p valueComplications(n=93)(n=39)(n=18)Total82414960.429Mode of delivery (LSCS)(62.4%)(61.5%)(77.8%)1767300.095GDM(18.28%)(15.4%)(38.9%)342511700.006Pre-eclampsia(36.6%)(64.1%)(61.1%)362614750.001PRETERM LABOR(38.7%)(66.7%)(77.8%)1767300.095Macrosomia(18.3%)(15.4%)(38.9%)1850230.100Oligohydramnios(19.4%)(12.8%)(0%)49133650.006GHTN(52.7%)(33.3%)(16.7%)38233640.009Anemia(40.9%)(60%)(16.7%) 4BMI Group 5BMI Group © 2020 Global JournalsRelation of High Maternal Body Mass Index to Perinatal and Maternal Outcome * Gender-specific aspects of obesity MJLegato Int J Fertile Womens Med 42 1997 Google Scholar * The effect of the increasing prevalence of maternal obesity on perinatal morbidity GCLu DJRouse MDubard Am J ObstetGynecol 2001185 Google Scholar * Nutrition During Pregnancy and Lactation. Implementation Guide. 1992 2011 Apr 25 125 * SDMcdonald ZHan SMulla JBeyene * Overweight and obesity in mothers and risk of preterm birth and low birth weight infants: Systematic review and metaanalyses BMJ 341 3428 2010 Knowledge Synthesis Group * Impact of obesity on infertility in women ZÖDa? BDilbaz 10.5152/jtgga.2015.15232 J Turk Ger Gynecol Assoc 16 2 2015. 2015 Jun 1 * Impact of obesity on fetomaternal outcome in pregnant saudi females Meher-Un-Nisa Int J Health Sci (Qassim) 5 2 2011 Suppl 1 * World Health Organization Obesity; preventing and managing the global epidemic Report of the WHO consultation on obesity Geneva: World Health Organization. 3±5 June1997 [Google Scholar * National Institutes of Health Clinical guidelines on the identification, evaluation, and treatment of overweight and obesity in adults: the evidence report Bethesda, MD: National Institutes of Health, US Department of Health and Human Services 1998 Google Scholar * Obesity in pregnancy: risks and management KJFitzsimons JModder IAGreer 10.1258/om.2009.090009 Obstet Med 2 2 2009 * Female age-related fertility decline. Committee Opinion No. 589 AmericanCollege Of O GynecologistsCommittee On Gynecologic PPractice C Fertility and sterility 101 3 2014 * Effect of Maternal Body Mass Index on Pregnancy Outcome HsaKumar VKChellamma Int J Sci Stud 4 10 2017 * Cohort study of high maternal body mass index and the risk of adverse pregnancy and delivery outcomes in Scotland LDoi AJWilliams LMarryat doi:10. 1136/bmjopen-2018-026168 BMJ Open 10 e026168 2020 * Maternal body mass index and the prevalence of spontaneous and elective preterm deliveries in an Irish obstetric population: a retrospective cohort study AVinturache AMckeating NDaly doi:10.1136/ bmjopen-2016-015258 BMJ Open 7 e015258 2017 * Maternal body mass index as a predictor for delivery method APettersen-Dahl GMurzakanova LSandvik KLaine Acta ObstetGynecolScand 97 2018 * First trimester body mass index and pregnancy outcomes: A 3-year retrospective study from a low-resource setting IUTakai IJOmeje ASKwayabura Arch Int Surg 7 2017 * The Impact of Infection in Pregnancy on Placental Vascular Development and Adverse Birth Outcomes AMWeckman MNgai JWright CRMcdonald KCKain 10.3389/fmicb.2019.01924 Front Microbiol 10 2019. 1924. 2019 Aug 22 * Retrospective study on the effect of Body Mass Index (BMI) on maternal and neonatal outcome PMShah AKChatrapati PKBandekar Int J Reprod Contracept 7 ObstetGynecol2018