title: The effect of prepregnancy body mass index on singleton cesarean delivery among term nulliparous women in Japanese population.
abstract: OBJECTIVE
  Overweight or obesity is a known risk factor for cesarean delivery although there is minimal data among Japanese women. The aim of the study was to examine the effect of prepregnancy body mass index (BMI) on singleton cesarean delivery among term nulliparous women using a national sample from the Human Milk Survey.
  
  
  METHODS
  Data from the Human Milk Survey between 1998 and 2008 were used for the secondary analysis. Women were categorized as underweight (BMI < 18.5 kg/m(2)), normal weight (18.5 ≤ BMI < 25.0), or overweight (BMI ≥ 25.0) based on their prepregnancy BMI. The association between maternal prepregnancy BMI and cesarean delivery was assessed using logistic regression models.
  
  
  RESULTS
  A total of 915 women were included in the analysis. The proportion of cesarean section was 10.1%. Overall, 17.1% of the women were underweight while 6.0% were overweight. After adjusting for maternal age, smoking status, pregnancy complications, and infant birthweight, overweight women were 2.7 times more likely to have a cesarean delivery compared to normal weight women (adjusted odds ratio [adjusted OR] = 2.7, 95% confidence interval [CI] = 1.4-5.4), and underweight women were half as likely to have a cesarean delivery compared to normal weight women (adjusted OR = 0.5, 95% CI = 0.2-1.1).
  
  
  CONCLUSIONS
  Being overweight before pregnancy more than doubled the risk of cesarean delivery independent of age, smoking, pregnancy complications, and infant birthweight among term nulliparous women. Overweight Japanese women should be advised to achieve normal prepregnancy BMI in their preconception period to prevent cesarean delivery.
authors.affiliation: Department of Public Health, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke City, Tochigi 329-0498, Japan. chihara@jichi.ac.jp
authors.forename: Izumi
authors.initials: I
authors.lastname: Chihara
authors.forename: Ritei
authors.initials: R
authors.lastname: Uehara
authors.forename: Kazuhiko
authors.initials: K
authors.lastname: Kotani
authors.forename: Atsuko
authors.initials: A
authors.lastname: Sadakane
authors.forename: Yasuko
authors.initials: Y
authors.lastname: Aoyama
authors.forename: Satoshi
authors.initials: S
authors.lastname: Tsuboi
authors.forename: Ryusuke
authors.initials: R
authors.lastname: Ae
authors.forename: Tsogzolbaatar
authors.initials: T
authors.lastname: Enkh-Oyun
authors.forename: Yosikazu
authors.initials: Y
authors.lastname: Nakamura
mesh_terms: D000328:Adult; D044466:Asian People / Q000706:statistics & numerical data; D001724:Birth Weight; D015992:Body Mass Index; D002585:Cesarean Section; D005260:Female; D006801:Humans; D008423:Maternal Age; D010298:Parity; D011247:Pregnancy; D011248:Pregnancy Complications / Q000453:epidemiology; D012306:Risk; D012907:Smoking / Q000453:epidemiology; D047929:Term Birth; D055815:Young Adult