Abstract
Maternal overweight and obesity increase risks of pregnancy and delivery complications and neonatal mortality, but the mechanisms are unclear. The objective of the study was to investigate associations between maternal body mass index (BMI) in early pregnancy and severe asphyxia-related outcomes in infants delivered at term (≥37 weeks). A nation-wide Swedish cohort study based on data from the Medical Birth Register included all live singleton term births in Sweden between 1992 and 2010. Logistic regression analyses were used to obtain odds ratios (ORs) with 95% CIs for Apgar scores between 0 and 3 at 5 and 10 minutes, meconium aspiration syndrome, and neonatal seizures, adjusted for maternal height, maternal age, parity, mother's smoking habits, education, country of birth, and year of infant birth. Among 1,764,403 term births, 86% had data on early pregnancy BMI and Apgar scores. There were 1,380 infants who had Apgar score 0-3 at 5 minutes (absolute risk = 0.8 per 1,000) and 894 had Apgar score 0-3 at 10 minutes (absolute risk = 0.5 per 1,000). Compared with infants of mothers with normal BMI (18.5-24.9), the adjusted ORs (95% CI) for Apgar scores 0-3 at 10 minutes were as follows: BMI 25-29.9: 1.32 (1.10-1.58); BMI 30-34.9: 1.57 (1.20-2.07); BMI 35-39.9: 1.80 (1.15-2.82); and BMI ≥40: 3.41 (1.91-6.09). The ORs for Apgar scores 0-3 at 5 minutes, meconium aspiration, and neonatal seizures increased similarly with maternal BMI. A study limitation was lack of data on effects of obstetric interventions and neonatal resuscitation efforts. Risks of severe asphyxia-related outcomes in term infants increase with maternal overweight and obesity. Given the high prevalence of the exposure and the severity of the outcomes studied, the results are of potential public health relevance and should be confirmed in other populations. Prevention of overweight and obesity in women of reproductive age is important to improve perinatal health.
Highlights
The obesity epidemic continues to expand globally and WHO projects that 2.3 billion adults will be overweight and 700 million will be obese by 2015 [1]
Risks of severe asphyxia-related outcomes in term infants increase with maternal overweight and obesity
There are a number of possible causes of low Apgar scores [13,14], among term infants without malformations the vast majority of cases with Apgar scores between 0 and 3 at 5 minutes are due to perinatal asphyxia [15]
Summary
The obesity epidemic continues to expand globally and WHO projects that 2.3 billion adults will be overweight and 700 million will be obese by 2015 [1]. An Apgar score 0–3 at 5 minutes is one of the essential criteria for the presence of perinatal asphyxia as stated by the American Academy of Obstetrics and Gynecology and the American Academy of Pediatrics [20].We have only identified two studies investigating risks of Apgar scores 0–3 at 5 minutes in women with overweight or obesity [21,22]. In these studies, which included preterm infants and infants with congenital anomalies, maternal obesity was related to low Apgar scores at 5 minutes.
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