Maternal Weight and Cesarean Section in MENA Region: A Meta-Analysis and Attributable Risk Fraction

Abstract Background Increased maternal weight significantly contributes to the rising rates of cesarean section (CS) deliveries. This systematic review assesses the association between maternal body mass index (BMI) categories and CS delivery among pregnant women in the Middle East and North Africa (MENA) region. Additionally, it estimates the proportion of CS deliveries attributable to BMI categories, providing insights for public health interventions. Methods A systematic search (2000-January 2023) included studies from MENA countries on maternal weight and CS delivery. For studies with crude odds ratios (cOR), crude relative risk (cRR) was calculated. Random-effects meta-analysis generated pooled crude and adjusted estimates by BMI category and CS type. Attributable risk fraction (ARF) and population attributable risk fraction (PARF) quantified CS deliveries linked to BMI. Results 39 studies included 40,374 pregnant women, from 11 MENA countries, were reviewed. Maternal overweight and obesity increased the likelihood and probability of CS by 40% (adjusted OR [aOR]: 1.40, 95%: 1.23-1.59, I2: 45.6%) and 94% (aOR: 1.94, 95% CI: 1.58-2.39, I2: 79.6%), and by 27% (cRR: 1.27, 95% CI: 1.17-1.37, I2: 84.2%) and 76% (cRR: 1.76, 95% CI: 1.54-2.02, I2: 93.7%), respectively. Overall, relative to normal maternal weight, overweight and obesity were associated with an increased likelihood and probability of CS by 66% (aOR: 1.66, 95% CI: 1.36-2.01, I2: 94.4%) and 60% (Adjusted relative risk [aRR]: 1.60, 95% CI: 1.43-1.78, I2: 0.0%), respectively. On average, 39.8% of CS deliveries are attributed to a maternal BMI exceeding 24.9 km/m2. Conclusions Maternal overweight and obesity are strongly associated with a substantial proportion of CS deliveries in the MENA region. To reduce health and economic burden of CS deliveries, findings highlight the urgent need for targeted public health interventions to manage maternal weight effectively. Key messages • Maternal overweight and obesity significantly increase the likelihood of C-section (CS) deliveries. Nearly 40% of CS deliveries in the MENA region attributed to maternal BMI exceeding 24.9 kg/m². • Effective maternal weight management strategies are urgently needed to reduce the health and economic burden of CS deliveries, emphasizing the importance of targeted public health interventions.