title: Existing maternal obesity guidelines may increase inequalities between ethnic groups: a national epidemiological study of 502,474 births in England.
abstract: BACKGROUND
  Asians are at increased risk of morbidity at a lower body mass index (BMI) than European Whites, particularly relating to metabolic risk. UK maternal obesity guidelines use general population BMI criteria to define obesity, which do not represent the risk of morbidity among Asian populations. This study compares incidence of first trimester obesity using Asian-specific and general population BMI criteria.
  
  
  METHODS
  A retrospective epidemiological study of 502,474 births between 1995 and 2007, from 34 maternity units across England. Data analyses included a comparison of trends over time between ethnic groups using Asian-specific and general population BMI criteria. Logistic regression estimated odds ratios for first trimester obesity among ethnic groups following adjustment for population demographics.
  
  
  RESULTS
  Black and South Asian women have a higher incidence of first trimester obesity compared with White women. This is most pronounced for Pakistani women following adjustment for population structure (OR 2.19, 95% C.I. 2.08, 2.31). There is a twofold increase in the proportion of South Asian women classified as obese when using the Asian-specific BMI criteria rather than general population BMI criteria. The incidence of obesity among Black women is increasing at the most rapid rate over time (p=0.01).
  
  
  CONCLUSIONS
  The twofold increase in maternal obesity among South Asians when using Asian-specific BMI criteria highlights inequalities among pregnant women. A large proportion of South Asian women are potentially being wrongly assigned to low risk care using current UK guidelines to classify obesity and determine care requirements. Further research is required to identify if there is any improvement in pregnancy outcomes if Asian-specific BMI criteria are utilised in the clinical management of maternal obesity to ensure the best quality of care is provided for women irrespective of ethnicity.
authors.affiliation: Institute of Health & Society, Newcastle University, Newcastle upon Tyne, UK. nicola.heslehurst@ncl.ac.uk
authors.forename: Nicola
authors.initials: N
authors.lastname: Heslehurst
authors.forename: Naveed
authors.initials: N
authors.lastname: Sattar
authors.forename: Daghni
authors.initials: D
authors.lastname: Rajasingam
authors.forename: John
authors.initials: J
authors.lastname: Wilkinson
authors.forename: Carolyn D
authors.initials: CD
authors.lastname: Summerbell
authors.forename: Judith
authors.initials: J
authors.lastname: Rankin
mesh_terms: D000293:Adolescent; D000328:Adult; D044466:Asian People / Q000706:statistics & numerical data; D044383:Black People / Q000706:statistics & numerical data; D015992:Body Mass Index; D004739:England / Q000453:epidemiology; D005260:Female; D006801:Humans; D016015:Logistic Models; D009765:Obesity / Q000175:diagnosis* / Q000208:ethnology; D017410:Practice Guidelines as Topic; D011247:Pregnancy; D011248:Pregnancy Complications / Q000175:diagnosis* / Q000208:ethnology; D011261:Pregnancy Trimester, First; D044469:Racial Groups / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D044465:White People / Q000706:statistics & numerical data; D055815:Young Adult