Abstract
Objective Maternal prepregnancy obesity is related to increased maternal morbidity and mortality and poor birth outcomes. However, prevalence and risk factors for prepregnancy obesity in US cities are not known. This study examines the prevalence and social and environmental determinants of maternal prepregnancy obesity (BMI ≥30), overweight/obesity (BMI ≥25), and severe obesity (BMI ≥40) in the 68 largest metropolitan cities of the United States. Methods We fitted logistic and Poisson regression models to the 2013–2016 national vital statistics birth cohort data (N = 3,083,600) to derive unadjusted and adjusted city differentials in maternal obesity and to determine social and environmental determinants. Results Considerable disparities existed across cities, with the prevalence of prepregnancy obesity ranging from 10.4% in San Francisco to 36.6% in Detroit. Approximately 63.0% of mothers in Detroit were overweight or obese before pregnancy, compared with 29.2% of mothers in San Francisco. Severe obesity ranged from 1.4% in San Francisco to 8.5% in Cleveland. Women in Anchorage, Buffalo, Cleveland, Fresno, Indianapolis, Louisville, Milwaukee, Oklahoma City, Sacramento, St Paul, Toledo, Tulsa, and Wichita had >2 times higher adjusted odds of prepregnancy obesity compared to those in San Francisco. Race/ethnicity, maternal age, parity, marital status, nativity/immigrant status, and maternal education were important individual-level risk factors and accounted for 63%, 39%, and 72% of the city disparities in prepregnancy obesity, overweight/obesity, and severe obesity, respectively. Area deprivation, violent crime rates, physical inactivity rates, public transport use, and access to parkland and green spaces remained significant predictors of prepregnancy obesity even after controlling for individual-level covariates. Conclusions Substantial disparities in maternal prepregnancy obesity among the major US cities remain despite risk-factor adjustment, with women in several Southern and Midwestern cities experiencing high risks of obesity. Sound urban policies are needed to promote healthier lifestyles and favorable social and built environments for obesity reduction and improved maternal health.
Highlights
Obesity rates in the United States continue to rise unabated despite concerted efforts to reverse this trend [1,2,3,4]
Information on prepregnancy height and weight has been collected on the birth certificate for selected states by the National Center for Health Statistics since 2003 [5, 35, 36]. e birth certificate data include the place of residence, such as state, county, and city of residence, a wide range of maternal and infant characteristics, medical risk factors and complications, and birth outcomes [35, 36]
Substantial disparities existed across cities, with the prevalence of prepregnancy obesity ranging from 10.4% in San Francisco and 13.4% in Seattle to 33.8% in Cleveland and 36.6% in Detroit (Table 1)
Summary
Obesity rates in the United States continue to rise unabated despite concerted efforts to reverse this trend [1,2,3,4]. Maternal prepregnancy obesity is considered an underlying cause of maternal mortality as it increases the risk of both direct and indirect obstetric causes of maternal death, including spontaneous abortion, hemorrhage, and uterine rupture [14,15,16]. Maternal prepregnancy obesity can increase the risk of stillbirth, fetal macrosomia, preterm birth, selected birth defects, and infant mortality [5,6,7,8,9,10,11,12, 17]. Children of mothers who are overweight/obese are at increased risk of obesity across the life course [8, 10, 12]
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