title: Maternal super-obesity (body mass index > or = 50) and adverse pregnancy outcomes.
abstract: OBJECTIVE
  To determine if pregnancy complications are increased in super-obese (a body mass index (BMI) of 50 or more) compared to other, less obese parturients.
  
  
  METHODS
  Cross-sectional study.
  
  
  METHODS
  All 19,700 eligible women, including 425 (2.2%) super-obese women with singleton births between 1996 and 2007 delivering at a tertiary referral center, identified using a perinatal research database.
  
  
  METHODS
  Bivariate and trend analyses were used to assess the relation between super-obesity and various pregnancy complications compared to other well-established BMI categories. Adjusted odds ratios (ORs) were calculated using multivariable logistic regression techniques.
  
  
  METHODS
  Outcomes for adjusted and unadjusted analyses were small-for-gestational age (SGA) birth, large-for-gestational age (LGA) birth, preeclampsia, gestational diabetes mellitus (GDM), fetal death, preterm birth, placental abruption, cesarean delivery, and Apgar scores < 7.
  
  
  RESULTS
  Compared to all other obese and non-obese women, super-obese women had the highest rates of preeclampsia, GDM, LGA, and cesarean delivery (all p < 0.05 for trend test). Super-obesity was also associated with a 44% reduction in SGA compared to all other women (OR 0.55, 95% confidence interval (CI) 0.40-0.76) and a 25% reduction compared to other, less obese women (OR 0.75, 95% CI 0.54-1.03). Super-obesity was positively associated with LGA, GDM, preeclampsia, cesarean delivery, and a 5-minute Apgar score < 7 compared to all other women after controlling for important confounders.
  
  
  CONCLUSIONS
  Super-obesity is associated with higher rates of pregnancy complications compared to women of all other BMI classes, including other obese women.
authors.affiliation: Department of Obstetrics and Gynecology, Medical University of South Carolina, Charleston, South Carolina 29425, USA. alanis@musc.edu
authors.forename: Mark Christopher
authors.initials: MC
authors.lastname: Alanis
authors.forename: William H
authors.initials: WH
authors.lastname: Goodnight
authors.forename: Elizabeth G
authors.initials: EG
authors.lastname: Hill
authors.forename: Christopher J
authors.initials: CJ
authors.lastname: Robinson
authors.forename: Margaret S
authors.initials: MS
authors.lastname: Villers
authors.forename: Donna D
authors.initials: DD
authors.lastname: Johnson
mesh_terms: D000328:Adult; D001034:Apgar Score; D001724:Birth Weight; D015992:Body Mass Index; D015984:Causality; D002585:Cesarean Section / Q000706:statistics & numerical data; D016001:Confidence Intervals; D003430:Cross-Sectional Studies; D005260:Female; D005320:Fetal Macrosomia / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D007231:Infant, Newborn; D007232:Infant, Newborn, Diseases / Q000453:epidemiology; D007236:Infant, Small for Gestational Age; D016015:Logistic Models; D015999:Multivariate Analysis; D009767:Obesity, Morbid / Q000175:diagnosis / Q000453:epidemiology*; D011225:Pre-Eclampsia / Q000453:epidemiology; D011247:Pregnancy; D011248:Pregnancy Complications / Q000175:diagnosis / Q000453:epidemiology*; D011256:Pregnancy Outcome; D012307:Risk Factors; D014481:United States / Q000453:epidemiology