Applying the Edmonton Obesity Staging System to Holistic Assessment of Obesity in Pregnancy: a Retrospective Review of Births in British Columbia (2008-2018)

Introduction The concept of metabolically healthy (preclinical) obesity has not been widely applied to perinatal care. The Edmonton Obesity Staging System (EOSS could identify preclinical obesity, enabling clinicians to provide more personalized, cost-effective care. Methods A perinatal EOSS was applied to 317,957 British Columbian birth records from 2008 to 2018. Objectives were to investigate 1) How many individuals were in EOSS stages 0, 1, 2, 3, and 4, and 2) What was the occurrence of metabolically health (preclinical obesity) in individuals with and without obesity at the end of pregnancy? Results Most individuals were in EOSS stage 0 (no metabolic disease 81.6%), or EOSS 1 (subclinical disease 0.5 %). Births to people with obesity in EOSS stage 0 (metabolic health) is notable; 70.7 % with class I obesity, 63.6% in class II, and 56.6% in class III and IV. Those in EOSS Stage 2 with obesity had twice the odds of pregnancy induced hypertension and 1.5 times the odds of preeclampsia, compared to those with normal weights. Rates of non-insulin dependent diabetes (EOSS stage 2 metabolic disease) were similar across BMI groups. Insulin dependent diabetes (EOSS stages 3 or 4) occurred in 72.0 % of individuals with obesity compared to 64.6 % in those with normal weights. Although metabolic health decreased as obesity class increased, 56.6% of those in obesity classes III and IV had no obesity-related disease. Conclusion The Perinatal EOSS gives a more holistic picture of health than BMI alone. Even at high BMIs, more than half of pregnant people are metabolically healthy (preclinical obesity) and could be supported to have uncomplicated births.