title: Mortality in infants of obese mothers: is risk modified by mode of delivery?
abstract: OBJECTIVE
  To examine the association between maternal obesity and infant mortality, while including information about mode of delivery and interpregnancy weight change.
  
  
  METHODS
  Register-based cohort study.
  
  
  METHODS
  A total of 1 199 183 singletons, including 3481 infant deaths, from the Swedish Birth Register 1992-2006.
  
  
  METHODS
  Maternal body mass index (BMI) was obtained from self-reports in early pregnancy and categorized as underweight (<18.5 kg/m(2)), normal-weight (18.5-24.9 kg/m(2)), overweight (25-29.9 kg/m(2)), obese (30-34.9 kg/m(2)) and extremely obese (≥35 kg/m(2)). Cox regression was used to estimate hazard ratios (95% confidence intervals). Infants of normal-weight women were the referent.
  
  
  METHODS
  Neonatal and infant mortality.
  
  
  RESULTS
  Infant mortality increased with increasing maternal fatness [adjusted hazard ratios 1.2 (1.1-1.3), 1.4 (1.2-1.6) and 2.1 (1.8-2.5) for overweight, obesity and extreme obesity, respectively]. When accounting for mode of delivery, neonatal mortality was increased in infants of obese and extremely obese mothers after spontaneous births [adjusted hazard ratios 1.8 (1.4-2.4) and 2.6 (1.8-4.0), respectively, after term births, and 1.4 (1.1-1.9) and 2.2 (1.5-3.3), respectively, after preterm births]. No excess risk was present for infants of obese mothers after induced term and preterm births (p-values for interaction <0.05). For post-neonatal mortality, no interaction between mode of delivery and maternal obesity was observed. In women with two subsequent pregnancies, high interpregnancy weight change >1 BMI unit (1 kg/m(2)) seemed to involve a modest increase in neonatal mortality in the second infant, but only after spontaneous births [adjusted odds ratio 1.3 (0.9-1.7)].
  
  
  CONCLUSIONS
  Maternal obesity, especially at levels that may involve cardiometabolic morbidity, was associated with increased mortality in the offspring.
authors: Department of Epidemiology, Institute of Public Health, Aarhus University, Denmark. ean@soci.au.dk
authors: Ellen A
authors: EA
authors: Nohr
authors: Eduardo
authors: E
authors: Villamor
authors: Michael
authors: M
authors: Vaeth
authors: Jorn
authors: J
authors: Olsen
authors: Sven
authors: S
authors: Cnattingius
mesh_terms: D000328:Adult; D015992:Body Mass Index; D015331:Cohort Studies; D036861:Delivery, Obstetric / Q000379:methods*; D005260:Female; D006801:Humans; D007223:Infant; D007226:Infant Mortality; D007231:Infant, Newborn; D008297:Male; D009765:Obesity / Q000150:complications*; D050177:Overweight / Q000150:complications; D036801:Parturition; D011247:Pregnancy; D011248:Pregnancy Complications / Q000453:epidemiology; D047928:Premature Birth / Q000453:epidemiology / Q000209:etiology; D016016:Proportional Hazards Models; D012042:Registries; D012306:Risk; D057566:Self Report; D013548:Sweden / Q000453:epidemiology