Risk of early birth by body mass index in a propensity score-matched sample: A retrospective cohort study.

Abstract

Evaluate the risk of preterm (<37weeks) or early term birth (37 or 38weeks) by body mass index (BMI) in a propensity score-matched sample. Retrospective cohort analysis. California, USA. Singleton live births from 2011-2017. Propensity scores were calculated for BMI groups using maternal factors. A referent sample of women with a BMI between 18.5 and <25.0kg/m2 was selected using exact propensity score matching. Risk ratios for preterm and early term birth were calculated. Early birth. Women with a BMI <18.5kg/m2 were at elevated risk of birth of 28-31weeks (relative risk [RR] 1.2, 95% CI 1.1-1.4), 32-36weeks (RR 1.3, 95% CI 1.2-1.3), and 37 or 38weeks (RR 1.1, 95% CI 1.1-1.1). Women with BMI ≥25.0kg/m2 were at 1.2-1.4-times higher risk of a birth <28weeks and were at reduced risk of a birth between 32 and 36weeks (RR 0.8-0.9) and birth during the 37th or 38th week (RR 0.9). Women with a BMI <18.5kg/m2 were at elevated risk of a preterm or early term birth. Women with BMI ≥25.0kg/m2 were at elevated risk of a birth <28weeks. Propensity score-matched women with BMI ≥30.0kg/m2 were at decreased risk of a spontaneous preterm birth with intact membranes between 32 and 36weeks, supporting the complexity of BMI as a risk factor for preterm birth. Propensity score-matched women with BMI ≥30kg/m2 were at decreased risk of a late spontaneous preterm birth.