Maternal BMI and preterm birth: a systematic review of the literature with meta-analysis.
OBJECTIVE
To examine the association between high prepregnancy maternal body mass index (BMI) and the risk of preterm birth (PTB).


METHODS
A systematic review of the literature. We included cohorts and case-control studies published since 1968 that examined the association between BMI and PTB of all types, spontaneous (s), elective and with ruptured membranes (PPROM) in three gestational age categories: general (<37 weeks), moderate (32-36 weeks) and very (<32 weeks) PTB.


RESULTS
20,401 citations were screened and 39 studies (1,788,633 women) were included. Preobese (BMI, 25-29.9) and obese I (BMI, 30-34.9) women have a reduced risk for sPTB: AOR = 0.85 (95% CI: 0.80-0.92) and 0.83 (95% CI: 0.75-0.92), respectively. Their risk for moderate PTB was 1.20 (95% CI: 1.04-1.38) and 1.60 (95% CI: 1.32-1.94), respectively. Obese II women (BMI, 35-40) have an increased risk for PTB in general (AOR = 1.33, 95% CI: 1.12-1.57) moderate (AOR = 2.43, 95% CI: 1.46-4.05) and very PTB (AOR = 1.96, 95% CI: 1.66-2.31). Obese III women (BMI > 40) have an even higher risk for very PTB (AOR = 2.27, 95%CI: 1.76-2.94). High BMI does not modify the risk for PPROM and increases the risk for elective PTB.


CONCLUSIONS
High maternal BMI may have different effects on different types of PTB.
Torloni
Maria Regina
MR
Department of Obstetrics, São Paulo Federal University, São Paulo, Brazil. ginecologia@terra.com.br
Betrán
Ana Pilar
AP
Daher
Silvia
S
Widmer
Mariana
M
Dolan
Siobhan M
SM
Menon
Ramkumar
R
Bergel
Eduardo
E
Allen
Tomas
T
Merialdi
Mario
M
D015992:Body Mass Index; D005260:Female; D005322:Premature Rupture of Fetal Membranes / Q000453:epidemiology; D005865:Gestational Age; D006801:Humans; D009765:Obesity / Q000145:classification / Q000453:epidemiology*; D011247:Pregnancy; D047928:Premature Birth / Q000453:epidemiology*; D012306:Risk