Bias in Self-reported Prepregnancy Weight Across Maternal and Clinical Characteristics

Abstract

Objectives: Prepregnancy body mass index (BMI) and gestational weight gain (GWG) are known determinants of maternal and child health; calculating both requires an accurate measure of prepregnancy weight. We compared self-reported prepregnancy weight to measured weights to assess reporting bias by maternal and clinical characteristics.

Methods: We conducted a retrospective cohort study among pregnant women using electronic health records (EHR) data from Kaiser Permanente Northwest, a non-profit integrated health care system in Oregon and southwest Washington State. We identified women age ≥ 18 years who were pregnant between 2000 and 2010 with self-reported prepregnancy weight, ≥ 2 measured weights between ≤ 365-days-prior-to and ≤ 42-days-after conception, and measured height in their EHR. We compared absolute and relative difference between self-reported weight and two "gold-standards": (1) weight measured closest to conception, and (2) usual weight (mean of weights measured 6-months-prior-to and ≤ 42-days-after conception). Generalized-estimating equations were used to assess predictors of misreport controlling for covariates, which were obtained from the EHR or linkage to birth certificate.

Results: Among the 16,227 included pregnancies, close agreement (± 1 kg or ≤ 2%) between self-reported and closest-measured weight was 44% and 59%, respectively. Overall, self-reported weight averaged 1.3 kg (SD 3.8) less than measured weight. Underreporting was higher among women with elevated BMI category, late prenatal care entry, and pregnancy outcome other than live/stillbirth (p < .05). Using self-reported weight, BMI was correctly classified for 91% of pregnancies, but ranged from 70 to 98% among those with underweight or obesity, respectively. Results were similar using usual weight as gold standard. CONCLUSIONS FOR PRACTICE: Accurate measure of prepregnancy weight is essential for clinical guidance and surveillance efforts that monitor maternal health and evaluate public-health programs. Identification of characteristics associated with misreport of self-reported weight can inform understanding of bias when assessing the influence of prepregnancy BMI or GWG on health outcomes.

Keywords: Body mass index; Body weights and measures; Gestational weight gain; Pregnancy; Validation studies.

Fig. 1

Consort diagrams for primary analysis (2000–2010) and secondary analysis (2015–2016) a Comparison of pregnancies included in primary analysis to pregnancies excluded can be found in eTable 1. b Comparison of pregnancies included in primary sub-analysis to pregnancies excluded can be found in eTable 2. c Comparison of pregnancies included in secondary analysis to pregnancies excluded can be found in eTable 3.

Fig. 2

By body mass index category, distribution of reporting error in self-reported prepregnancy weight compared to weight measured CLOSEST^a to conception in terms of absolute difference (Panels A and B) and as a proportion of measured weight (Panels C and D) ^a Measured weight closest to date of conception between 6-months-prior-to (≤182 days) and ≤42-days-after conception.