Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2020 Jun:46:49-56.e5.
doi: 10.1016/j.annepidem.2020.04.009. Epub 2020 May 7.

Maternal prepregnancy BMI and size at birth: race/ethnicity-stratified, within-family associations in over 500,000 siblings

Janne Boone-Heinonen  1 , Frances M Biel  2 , Nicole E Marshall  3 , Jonathan M Snowden  4
Affiliations

Maternal prepregnancy BMI and size at birth: race/ethnicity-stratified, within-family associations in over 500,000 siblings

Janne Boone-Heinonen et al. Ann Epidemiol. 2020 Jun.

Abstract

Purpose: To estimate racial/ethnic-stratified effects of maternal prepregnancy BMI on size for gestational age at birth, by comparing siblings within families.

Methods: This study examined linked vital statistics and patient discharge data from 580,960 infants born to 278,770 women in the State of California (2007-2012). To control for family-level confounding, we used fixed effects multinomial regression, modeling size for gestational age (small [SGA], appropriate, large [LGA]) as a function of maternal BMI (underweight, normal weight, overweight, obesity class I, II, III) and time-varying covariates. We conducted overall and race/ethnicity-stratified (non-Hispanic white, black, Asian; Hispanic) analyses. For comparison, we fit analogous random effects models, which do not control for family-level confounding.

Results: In fixed effects models, maternal BMI was most strongly associated with LGA in non-Hispanic white women, reaching 6.7 times greater for class III obesity (OR [95% CI]: 6.7 [5.1, 8.7]); and weakest in black women (OR [95% CI]: 3.0 [1.5, 5.7]). Associations with SGA were similar across race/ethnicity. Compared with random effects estimates, fixed effects were most attenuated for LGA associations among racial/ethnic minority women.

Conclusions: Maternal prepregnancy BMI was differentially associated with size for gestational age across racial/ethnic groups, with the strongest family-level confounding in racial/ethnic minority women.

Keywords: Birth weight; Obesity; Pregnancy; Race/ethnicity.

PubMed Disclaimer

Figures

FIGURE 1.
FIGURE 1.. Construction of analytic sample
California Office of Statewide Health Planning & Development Linked Vital Statistics/Patient Discharge Database (2007-2012)
FIGURE 2.
FIGURE 2.. Adjusted Associations Between Maternal Pre-pregnancy BMI Category and Size for Gestational Age
California Office of Statewide Health Planning & Development linked vital statistics/patient discharge database (2007-2012). Estimates derived from multinomial fixed or random effects models in the total sample (580,960 infants, 269,871 mothers), for Small for Gestational Age (SGA; Panel A) and Large for Gestational Age (LGA; Panel B) outcomes. Fixed effects model adjusted for maternal age at delivery, parity. Random effects model adjusted for maternal age at delivery, parity, child sex, maternal education, and maternal receipt of public insurance. Error bars indicate 95% Confidence Interval. aOR, adjusted odds ratio; BMI, Body Mass Index
See this image and copyright information in PMC

References

    1. Liu P, Xu L, Wang Y, et al. Association between perinatal outcomes and maternal pre-pregnancy body mass index. Obes Rev. 2016;17(11):1091–1102. - PubMed
    1. Yu Z, Han S, Zhu J, Sun X, Ji C, Guo X. Pre-pregnancy body mass index in relation to infant birth weight and offspring overweight/obesity: a systematic review and meta-analysis. PLoS One. 2013;8(4):e61627. - PMC - PubMed
    1. Woo Baidal JA, Locks LM, Cheng ER, Blake-Lamb TL, Perkins ME, Taveras EM. Risk Factors for Childhood Obesity in the First 1,000 Days: A Systematic Review. Am J Prev Med. 2016;50(6):761–779. - PubMed
    1. Beta J, Khan N, Khalil A, Fiolna M, Ramadan G, Akolekar R. Maternal and neonatal complications of fetal macrosomia: systematic review and meta-analysis. Ultrasound Obstet Gynecol. 2019;54(3):308–318. - PubMed
    1. Snowden JM, Mission JF, Marshall NE, et al. The Impact of maternal obesity and race/ethnicity on perinatal outcomes: Independent and joint effects. Obesity (Silver Spring). 2016;24(7):1590–1598. - PMC - PubMed

Publication types