title: Increasing pre-pregnancy body mass index is predictive of a progressive escalation in adverse pregnancy outcomes.
abstract: OBJECTIVE
  To evaluate the association between pre-pregnancy body mass index (BMI) and adverse pregnancy outcomes using a large administrative database.
  
  
  METHODS
  Retrospective cohort study of California women delivering singletons in 2007. The association between pre-pregnancy BMI category and adverse outcomes were evaluated using multivariate logistic regression.
  
  
  RESULTS
  Among 436,414 women, increasing BMI was associated with increasing odds of adverse outcomes. Obese women (BMI=30-39.9) were nearly 3 x more likely to have gestational diabetes (OR=2.83, 95% CI=2.74-2.92) and gestational hypertension/preeclampsia (2.68, 2.59-2.77) and nearly twice as likely to undergo cesarean (1.82, 1.78-1.87), when compared to normal BMI women (BMI=18.5-24.9). Morbidly obese women (BMI ≥ 40) were 4x more likely to have gestational diabetes (4.72, 4.46-4.99) and gestational hypertension/preeclampsia (4.22, 3.97-4.49) and nearly 3 x as likely to undergo cesarean (2.60, 2.46-2.74).
  
  
  CONCLUSIONS
  There is a strong association between increasing maternal BMI and adverse pregnancy outcomes. This information is important for counseling women regarding the risks of obesity in pregnancy.
authors.affiliation: California Maternal Quality Care Collaborative Data Committee, Stanford University, Stanford, CA, USA. judithc@uci.edu
authors.forename: Judith H
authors.initials: JH
authors.lastname: Chung
authors.forename: Kathryn A
authors.initials: KA
authors.lastname: Melsop
authors.forename: William M
authors.initials: WM
authors.lastname: Gilbert
authors.forename: Aaron B
authors.initials: AB
authors.lastname: Caughey
authors.forename: Cheryl K
authors.initials: CK
authors.lastname: Walker
authors.forename: Elliot K
authors.initials: EK
authors.lastname: Main
mesh_terms: D000328:Adult; D015992:Body Mass Index; D002140:California / Q000453:epidemiology; D015331:Cohort Studies; D018450:Disease Progression; D005260:Female; D006801:Humans; D009765:Obesity / Q000150:complications / Q000175:diagnosis / Q000453:epidemiology; D011247:Pregnancy; D011248:Pregnancy Complications / Q000175:diagnosis* / Q000453:epidemiology / Q000209:etiology*; D011256:Pregnancy Outcome / Q000453:epidemiology; D011379:Prognosis; D012189:Retrospective Studies; D015430:Weight Gain / Q000502:physiology*; D055815:Young Adult