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. 2015 Jan;125(1):133-143.
doi: 10.1097/AOG.0000000000000591.

Risk of adverse pregnancy outcomes by prepregnancy body mass index: a population-based study to inform prepregnancy weight loss counseling

Laura Schummers  1 , Jennifer A Hutcheon, Lisa M Bodnar, Ellice Lieberman, Katherine P Himes
Affiliations

Risk of adverse pregnancy outcomes by prepregnancy body mass index: a population-based study to inform prepregnancy weight loss counseling

Laura Schummers et al. Obstet Gynecol. 2015 Jan.

Abstract

Objective: To estimate the absolute risks of adverse maternal and perinatal outcomes based on small differences in prepregnancy body mass (eg, 10% of body mass or 10-20 pounds).

Methods: This population-based cohort study (N=226,958) was drawn from all singleton pregnancies in British Columbia (Canada) from 2004 to 2012. The relationships between prepregnancy body mass index (BMI) (as a continuous, nonlinear variable) and adverse pregnancy outcomes were examined using logistic regression models. Analyses were adjusted for maternal age, height, parity, and smoking in pregnancy. Adjusted absolute risks of each outcome are reported according to incremental differences in prepregnancy BMI and weight in pounds.

Results: A 10% difference in prepregnancy BMI was associated with at least a 10% lower risk of preeclampsia, gestational diabetes, indicated preterm delivery, macrosomia, and stillbirth. In contrast, larger differences in prepregnancy BMI (20-30% differences in BMI) were necessary to meaningfully reduce risks of cesarean delivery, shoulder dystocia, neonatal intensive care unit stay 48 hours or longer, and in-hospital newborn mortality. Prepregnancy BMI was not associated with risk of postpartum hemorrhage requiring intervention, severe maternal morbidity or maternal mortality, or spontaneous preterm delivery before 32 weeks of gestation.

Conclusion: These results can inform prepregnancy weight loss counseling by defining achievable weight loss goals for patients that may reduce their risk of poor perinatal outcomes.

Level of evidence: II.

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Figures

Figure 1
Figure 1
Crude and adjusted predicted risk per 1,000 of preeclampsia among nulliparas (A), gestational diabetes mellitus (B), spontaneous preterm delivery at less than 32 weeks of gestation (C), indicated preterm delivery at less than 37 weeks of gestation (D), macrosomia, birth weight greater than 4,500 grams (E), shoulder dystocia (F), cesarean delivery among nulliparas (G), postpartum hemorrhage requiring intervention to control bleeding (H), maternal mortality or severe morbidity (I), stillbirth (J), neonatal intensive care unit (NICU) stay of 48 hours or longer (K), in-hospital newborn mortality according to prepregnancy body mass index (L), with 95% confidence intervals (CI).
Figure 1
Figure 1
Crude and adjusted predicted risk per 1,000 of preeclampsia among nulliparas (A), gestational diabetes mellitus (B), spontaneous preterm delivery at less than 32 weeks of gestation (C), indicated preterm delivery at less than 37 weeks of gestation (D), macrosomia, birth weight greater than 4,500 grams (E), shoulder dystocia (F), cesarean delivery among nulliparas (G), postpartum hemorrhage requiring intervention to control bleeding (H), maternal mortality or severe morbidity (I), stillbirth (J), neonatal intensive care unit (NICU) stay of 48 hours or longer (K), in-hospital newborn mortality according to prepregnancy body mass index (L), with 95% confidence intervals (CI).
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References

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