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Extreme obesity and risk of stillbirth among black and white gravidas.
Obstet Gynecol. 2007 Sep; 110(3):552-7.OG

Abstract

OBJECTIVE

To estimate the risk for stillbirth among three generally accepted obesity subtypes based on severity.

METHODS

We used the Missouri maternally linked cohort data containing births from 1978 to 1997. Using prepregnancy weight and height, mothers were classified on the basis of calculated body mass index (BMI) above 30 into three subsets: class I (30-34.9), class II (35-39.9), and extreme obesity (greater than or equal to 40). Using normal-weight, white women (18.5-24.9) as a reference, we applied Cox proportional hazard regression models to estimate risks for stillbirth.

RESULTS

The prevalence of obesity in pregnant women was 9.5% (12.8% among blacks and 8.9% among whites). Overall, obese mothers were about 40% more likely to experience stillbirth compared with nonobese gravidas (adjusted hazard ratio 1.4; 95% confidence interval [CI] 1.3-1.5). The risk for stillbirth increased in a dose-dependent fashion with increase in BMI: class I (adjusted hazard ratio 1.3; 95% CI 1.2-1.4); class II (adjusted hazard ratio 1.4; 95% CI 1.3-1.6) and extreme obesity (adjusted hazard ratio 1.9; 95% CI 1.6-2.1; P for trend <.01). Obese black mothers experienced more stillbirths than their white counterparts (adjusted hazard ratio 1.9; 95% CI 1.7-2.1 compared with adjusted hazard ratio 1.4; 95% CI 1.3-1.5). The black disadvantage in stillbirth widened with increase in BMI, with the greatest difference observed among extremely obese black mothers (adjusted hazard ratio 2.3; 95% CI 1.8-2.9).

CONCLUSION

Obesity is a risk factor for stillbirth, particularly among extremely obese, black mothers. Strategies to reduce black-white disparities in birth outcomes should consider targeting obese, black women.

LEVEL OF EVIDENCE

II.

Authors+Show Affiliations

Department of Epidemiology, University of South Florida, Tampa, Florida, USA. hamisu.salihu@gmail.comNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

17766599

Citation

Salihu, Hamisu M., et al. "Extreme Obesity and Risk of Stillbirth Among Black and White Gravidas." Obstetrics and Gynecology, vol. 110, no. 3, 2007, pp. 552-7.
Salihu HM, Dunlop AL, Hedayatzadeh M, et al. Extreme obesity and risk of stillbirth among black and white gravidas. Obstet Gynecol. 2007;110(3):552-7.
Salihu, H. M., Dunlop, A. L., Hedayatzadeh, M., Alio, A. P., Kirby, R. S., & Alexander, G. R. (2007). Extreme obesity and risk of stillbirth among black and white gravidas. Obstetrics and Gynecology, 110(3), 552-7.
Salihu HM, et al. Extreme Obesity and Risk of Stillbirth Among Black and White Gravidas. Obstet Gynecol. 2007;110(3):552-7. PubMed PMID: 17766599.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Extreme obesity and risk of stillbirth among black and white gravidas. AU - Salihu,Hamisu M, AU - Dunlop,Anne-Lang, AU - Hedayatzadeh,Maryam, AU - Alio,Amina P, AU - Kirby,Russell S, AU - Alexander,Greg R, PY - 2007/9/4/pubmed PY - 2007/10/3/medline PY - 2007/9/4/entrez SP - 552 EP - 7 JF - Obstetrics and gynecology JO - Obstet Gynecol VL - 110 IS - 3 N2 - OBJECTIVE: To estimate the risk for stillbirth among three generally accepted obesity subtypes based on severity. METHODS: We used the Missouri maternally linked cohort data containing births from 1978 to 1997. Using prepregnancy weight and height, mothers were classified on the basis of calculated body mass index (BMI) above 30 into three subsets: class I (30-34.9), class II (35-39.9), and extreme obesity (greater than or equal to 40). Using normal-weight, white women (18.5-24.9) as a reference, we applied Cox proportional hazard regression models to estimate risks for stillbirth. RESULTS: The prevalence of obesity in pregnant women was 9.5% (12.8% among blacks and 8.9% among whites). Overall, obese mothers were about 40% more likely to experience stillbirth compared with nonobese gravidas (adjusted hazard ratio 1.4; 95% confidence interval [CI] 1.3-1.5). The risk for stillbirth increased in a dose-dependent fashion with increase in BMI: class I (adjusted hazard ratio 1.3; 95% CI 1.2-1.4); class II (adjusted hazard ratio 1.4; 95% CI 1.3-1.6) and extreme obesity (adjusted hazard ratio 1.9; 95% CI 1.6-2.1; P for trend <.01). Obese black mothers experienced more stillbirths than their white counterparts (adjusted hazard ratio 1.9; 95% CI 1.7-2.1 compared with adjusted hazard ratio 1.4; 95% CI 1.3-1.5). The black disadvantage in stillbirth widened with increase in BMI, with the greatest difference observed among extremely obese black mothers (adjusted hazard ratio 2.3; 95% CI 1.8-2.9). CONCLUSION: Obesity is a risk factor for stillbirth, particularly among extremely obese, black mothers. Strategies to reduce black-white disparities in birth outcomes should consider targeting obese, black women. LEVEL OF EVIDENCE: II. SN - 0029-7844 UR - https://www.unboundmedicine.com/medline/citation/17766599/Extreme_obesity_and_risk_of_stillbirth_among_black_and_white_gravidas_ DB - PRIME DP - Unbound Medicine ER -