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Association Between Prepregnancy Body Mass Index and Severe Maternal Morbidity.
JAMA 2017; 318(18):1777-1786JAMA

Abstract

Importance

Although high body mass index (BMI) is associated with adverse birth outcomes, the association with severe maternal morbidity is unclear.

Objective

To examine the association between prepregnancy BMI and severe maternal morbidity.

Design, Setting, and Participants

Retrospective population-based cohort study including all singleton hospital births in Washington State, 2004-2013. Demographic data and morbidity diagnoses were obtained from linked birth certificates and hospitalization files.

Exposures

Prepregnancy BMI (weight in kilograms divided by height in meters squared) categories included underweight (<18.5), normal BMI (18.5-24.9), overweight (25.0-29.9), obesity class 1 (30.0-34.9), obesity class 2 (35.0-39.9), and obesity class 3 (≥40).

Main Outcomes and Measures

Composite severe maternal morbidity or mortality included life-threatening conditions and conditions leading to serious sequelae (eg, amniotic fluid embolism, hysterectomy), complications requiring intensive care unit admission, and maternal death. Logistic regression was used to obtain adjusted odds ratios (ORs) and adjusted rate differences with 95% confidence intervals, adjusted for confounders (eg, maternal age and parity).

Results

Overall, 743 630 women were included in the study (mean age, 28.1 [SD, 6.0] years; 41.4% nulliparous). Prepregnancy BMI was distributed as follows: underweight, 3.2%; normal weight, 47.5%; overweight, 25.8%; obesity class 1, 13.1%; obesity class 2, 6.2%; and obesity class 3, 4.2%. Rates of severe maternal morbidity or mortality were 171.5, 143.2, 160.4, 167.9, 178.3 and 202.9 per 10 000 women, respectively. Adjusted ORs were 1.2 (95% CI, 1.0-1.3) for underweight women; 1.1 (95% CI, 1.1-1.2) for overweight women; 1.1 (95% CI, 1.1-1.2) for women with class 1 obesity; 1.2 (95% CI, 1.1-1.3) for women with class 2 obesity; and 1.4 (95% CI, 1.3-1.5) for women with class 3 obesity compared with women with normal BMI. Absolute risk increases (adjusted rate differences per 10 000 women, compared with women with normal BMI) were 28.8 (95% CI, 12.2-47.2) for underweight women, 17.6 (95% CI, 10.5-25.1) for overweight women, 24.9 (95% CI, 15.7-34.6) for women with class 1 obesity, 35.8 (95% CI, 23.1-49.5) for women with class 2 obesity, and 61.1 (95% CI, 44.8-78.9) for women with class 3 obesity.

Conclusions and Relevance

Among pregnant women in Washington State, low and high prepregnancy BMI, compared with normal BMI, were associated with a statistically significant but small absolute increase in severe maternal morbidity or mortality.

Authors+Show Affiliations

Department of Obstetrics and Gynaecology, University of British Columbia and the Children's and Women's Hospital and Health Centre of British Columbia, Vancouver, Canada. School of Population and Public Health, University of British Columbia, Vancouver, Canada.Department of Obstetrics and Gynaecology, University of British Columbia and the Children's and Women's Hospital and Health Centre of British Columbia, Vancouver, Canada. School of Population and Public Health, University of British Columbia, Vancouver, Canada.Department of Medicine, University of British Columbia and Women's Hospital and Health Centre of British Columbia, Vancouver, Canada.Department of Obstetrics and Gynaecology, University of British Columbia and the Children's and Women's Hospital and Health Centre of British Columbia, Vancouver, Canada.Department of Medicine, University of British Columbia and Women's Hospital and Health Centre of British Columbia, Vancouver, Canada.Department of Obstetrics and Gynaecology, University of British Columbia and the Children's and Women's Hospital and Health Centre of British Columbia, Vancouver, Canada.Department of Obstetrics and Gynaecology, University of British Columbia and the Children's and Women's Hospital and Health Centre of British Columbia, Vancouver, Canada.

Pub Type(s)

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

Language

eng

PubMed ID

29136442

Citation

Lisonkova, Sarka, et al. "Association Between Prepregnancy Body Mass Index and Severe Maternal Morbidity." JAMA, vol. 318, no. 18, 2017, pp. 1777-1786.
Lisonkova S, Muraca GM, Potts J, et al. Association Between Prepregnancy Body Mass Index and Severe Maternal Morbidity. JAMA. 2017;318(18):1777-1786.
Lisonkova, S., Muraca, G. M., Potts, J., Liauw, J., Chan, W. S., Skoll, A., & Lim, K. I. (2017). Association Between Prepregnancy Body Mass Index and Severe Maternal Morbidity. JAMA, 318(18), pp. 1777-1786. doi:10.1001/jama.2017.16191.
Lisonkova S, et al. Association Between Prepregnancy Body Mass Index and Severe Maternal Morbidity. JAMA. 2017 11 14;318(18):1777-1786. PubMed PMID: 29136442.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Association Between Prepregnancy Body Mass Index and Severe Maternal Morbidity. AU - Lisonkova,Sarka, AU - Muraca,Giulia M, AU - Potts,Jayson, AU - Liauw,Jessica, AU - Chan,Wee-Shian, AU - Skoll,Amanda, AU - Lim,Kenneth I, PY - 2017/11/15/entrez PY - 2017/11/15/pubmed PY - 2017/11/29/medline SP - 1777 EP - 1786 JF - JAMA JO - JAMA VL - 318 IS - 18 N2 - Importance: Although high body mass index (BMI) is associated with adverse birth outcomes, the association with severe maternal morbidity is unclear. Objective: To examine the association between prepregnancy BMI and severe maternal morbidity. Design, Setting, and Participants: Retrospective population-based cohort study including all singleton hospital births in Washington State, 2004-2013. Demographic data and morbidity diagnoses were obtained from linked birth certificates and hospitalization files. Exposures: Prepregnancy BMI (weight in kilograms divided by height in meters squared) categories included underweight (<18.5), normal BMI (18.5-24.9), overweight (25.0-29.9), obesity class 1 (30.0-34.9), obesity class 2 (35.0-39.9), and obesity class 3 (≥40). Main Outcomes and Measures: Composite severe maternal morbidity or mortality included life-threatening conditions and conditions leading to serious sequelae (eg, amniotic fluid embolism, hysterectomy), complications requiring intensive care unit admission, and maternal death. Logistic regression was used to obtain adjusted odds ratios (ORs) and adjusted rate differences with 95% confidence intervals, adjusted for confounders (eg, maternal age and parity). Results: Overall, 743 630 women were included in the study (mean age, 28.1 [SD, 6.0] years; 41.4% nulliparous). Prepregnancy BMI was distributed as follows: underweight, 3.2%; normal weight, 47.5%; overweight, 25.8%; obesity class 1, 13.1%; obesity class 2, 6.2%; and obesity class 3, 4.2%. Rates of severe maternal morbidity or mortality were 171.5, 143.2, 160.4, 167.9, 178.3 and 202.9 per 10 000 women, respectively. Adjusted ORs were 1.2 (95% CI, 1.0-1.3) for underweight women; 1.1 (95% CI, 1.1-1.2) for overweight women; 1.1 (95% CI, 1.1-1.2) for women with class 1 obesity; 1.2 (95% CI, 1.1-1.3) for women with class 2 obesity; and 1.4 (95% CI, 1.3-1.5) for women with class 3 obesity compared with women with normal BMI. Absolute risk increases (adjusted rate differences per 10 000 women, compared with women with normal BMI) were 28.8 (95% CI, 12.2-47.2) for underweight women, 17.6 (95% CI, 10.5-25.1) for overweight women, 24.9 (95% CI, 15.7-34.6) for women with class 1 obesity, 35.8 (95% CI, 23.1-49.5) for women with class 2 obesity, and 61.1 (95% CI, 44.8-78.9) for women with class 3 obesity. Conclusions and Relevance: Among pregnant women in Washington State, low and high prepregnancy BMI, compared with normal BMI, were associated with a statistically significant but small absolute increase in severe maternal morbidity or mortality. SN - 1538-3598 UR - https://www.unboundmedicine.com/medline/citation/29136442/Association_Between_Prepregnancy_Body_Mass_Index_and_Severe_Maternal_Morbidity_ L2 - https://jamanetwork.com/journals/jama/fullarticle/10.1001/jama.2017.16191 DB - PRIME DP - Unbound Medicine ER -