Overweight and pregnancy complications.
The association between increased prepregnancy weight for height and seven pregnancy complications was studied in a multi-racial sample of more than 4100 recent deliveries. Body mass indices were calculated and used to classify women as average weight (90-119 percent of ideal or BMI 19.21-25.60), moderately overweight (120-135 percent ideal or BMI 25.61-28.90), and very overweight (greater than 135 percent ideal or BMI greater than 28.91) prior to pregnancy. Compared to women of average weight for height, very overweight women had a higher risk of diabetes, hypertension, pregnancy-induced hypertension and primary cesarean section delivery. Moderately overweight women were also at higher risk than average for diabetes, pregnancy-induced hypertension and primary cesarean deliveries but the relative risks were of a smaller magnitude than for very overweight women. With women of average prepregnancy body mass as reference, moderately elevated, but not significant relative risks were found for perinatal mortality in the very overweight group, for urinary tract infections in both overweight groups, and a decreased risk for anemia was found in the very overweight group. However, post-hoc power analyses indicated that the number of overweight women in the sample did not allow adequate statistical power to detect these small differences in risk. To overcome limitations associated with low statistical power, the results of three recent studies of these outcomes in very overweight pregnant women were combined and summarized using Mantel-Haenzel techniques. This second, larger analysis suggested that very overweight women are at significantly higher risk for all seven outcomes studied. Summary results for moderately overweight women could not be calculated, since only two of the studies had evaluated moderately overweight women separately. These latter results support other findings that both moderate overweight and very overweight are risk factors during pregnancy, with the highest risk occurring in the heaviest group. Although these results indicate that moderate overweight is a risk factor during pregnancy, additional studies are needed to confirm the impact of being 20-35 percent above ideal weight prior to pregnancy. The results of this analysis also imply that since the baseline incidence of many perinatal complications is low, studies relating overweight and pregnancy complications should include large enough samples of overweight women so that there is adequate statistical power to reliably detect differences in complication rates.
Abrams
B
B
Department of Social and Administrative Health Sciences, School of Public Health, University of California, Berkeley 94720.
Parker
J
J
D000293:Adolescent; D000328:Adult; D002140:California; D005260:Female; D006801:Humans; D008875:Middle Aged; D009765:Obesity / Q000150:complications*; D011247:Pregnancy; D011248:Pregnancy Complications / Q000453:epidemiology*; D012307:Risk Factors