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. 2011 Aug;15(6):772-81.
doi: 10.1007/s10995-010-0633-4.

The association between pre-pregnancy BMI and preterm delivery in a diverse southern California population of working women

Jessica Lang Kosa  1 , Sylvia Guendelman, Michelle Pearl, Steve Graham, Barbara Abrams, Martin Kharrazi
Affiliations

The association between pre-pregnancy BMI and preterm delivery in a diverse southern California population of working women

Jessica Lang Kosa et al. Matern Child Health J. 2011 Aug.

Abstract

Whereas preterm birth has consistently been associated with low maternal pre-pregnancy weight, the relationship with high pre-pregnancy weight has been inconsistent. We quantified the pre-pregnancy BMI-preterm delivery (PTD) relationship using traditional BMI categories (underweight, normal weight, overweight and obese) as well as continuous BMI. Eligible women participated in California's statewide prenatal screening program, worked during pregnancy, and delivered a live singleton birth in Southern California in 2002-2003. The final analytic sample included 354 cases delivering at <37 weeks, as identified by clinical estimate of gestational age from screening records, and 710 term normal-birthweight controls. Multivariable logistic regression models using categorical BMI levels and continuous BMI were compared. In categorical analyses, PTD was significantly associated with pre-pregnancy underweight only. Nonparametric local regression revealed a V-shaped relationship between continuous BMI and PTD, with minimum risk at the high end of normal, around 24 kg/m2. The odds ratio (OR) for PTD associated with low BMI within the normal range (19 kg/m2) was 2.84 (95% CI = 1.61-5.01); ORs for higher BMI in the overweight (29 kg/m2) and obese (34 kg/m2) ranges were 1.42 (95% CI = 1.10-1.84) and 2.01 (95% CI = 1.20-3.39) respectively, relative to 24 kg/m2). BMI categories obscured the preterm delivery risk associated with low-normal, overweight, and obese BMI. We found that higher BMI up to around 24 kg/m2 is increasingly protective of preterm delivery, beyond which a higher body mass index becomes detrimental. Current NHLBI/WHO BMI categories may be inadequate for identifying women at higher risk for PTD.

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Figures

Fig. 1
Fig. 1
Flow chart of exclusion criteria
Fig. 2
Fig. 2
Loess plot of log odds of PTD as a function of prepregnancy BMI. Equivalent odds ratios are indicated on vertical axis. Vertical lines indicate borders of IOM BMI categories as labeled
Fig. 3
Fig. 3
Log odds of PTD predicted by categorical (dark line) and continuous (gray line) models of BMI
See this image and copyright information in PMC

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