Abstract
ObjectivesTo quantify the proportion of adverse pregnancy outcome attributable to maternal obesity.DesignCross sectional analysis of routine obstetric dataset.SettingGuy’s and St Thomas’s NHS Foundation Trust (GSTFT).Population23,668 women who had singleton deliveries at GSTFT between 2004 and 2008.MethodsLogistic regression was used to estimate the association between BMI and outcome in different ethnic groups. Adjusted odds ratios, and the proportions of obese women, were used to calculate population attributable risk fractions (PAFs).Main Outcome Measures(i) Maternal outcomes: diabetes, type of delivery, post-partum haemorrhage, and preterm delivery. (ii) Perinatal outcomes: macrosomia, low birth weight, admission to neonatal intensive care/special care baby unit, and perinatal death.ResultsThe prevalence of maternal obesity was 14%. Increasing BMI was independently associated with increasing risk of adverse obstetric and neonatal outcome. At the individual level, the effect of obesity on diabetes was highest in Asian women compared to white women (p for interaction = 0.03). Calculation of population attributable risk fractions demonstrated that one third of diabetes cases and one in six Caesarean sections could be avoided in this population if all obese women were of normal BMI. At the population level, the contribution of obesity to diabetes was highest for Black women (42%), and lowest for oriental women (8%). Seven percent of neonatal macrosomia in all the population, and 13% in Black mothers, were attributable to obesity.ConclusionsPreventing obesity prior to pregnancy will substantially reduce the burden of obstetric and neonatal morbidity in this population. This reduction will be higher in Black women.
Highlights
Over half of the women of childbearing age in most developed countries are either overweight (BMI 25–29.9 kg/m2) or obese ($30 kg/m2) [1]
Increasing BMI was independently associated with increasing risk of adverse obstetric and neonatal outcome
Calculation of population attributable risk fractions demonstrated that one third of diabetes cases and one in six Caesarean sections could be avoided in this population if all obese women were of normal BMI
Summary
Over half of the women of childbearing age in most developed countries are either overweight (BMI 25–29.9 kg/m2) or obese ($30 kg/m2) [1]. It has been estimated that at the start of pregnancy around one in six women in England are obese [2]. Women who are obese pre-pregnancy face an increased risk of adverse obstetric outcomes [3,4]. These risks include gestational diabetes [5], pre-eclampsia [6], thromboembolism [7], increasing caesarean section [8] and perinatal morbidity and mortality [9,10]. An understanding of the independent impact of obesity in pregnant women in general, and blacks or ethnic minorities in particular, is important in identifying relevant interventions [12]. Some recent evidence suggested that there might be a substantial difference between ethnic groups in the association of obesity with adverse outcomes [13]
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