title: Modeling the potential public health impact of prepregnancy obesity on adverse fetal and infant outcomes.
abstract: OBJECTIVE
  Approximately one-third of US reproductive-aged women are obese, and prepregnancy obesity is a strong risk factor for adverse fetal and infant outcomes. The annual number of preventable adverse fetal and infant outcomes associated with prepregnancy obesity in the U.S. was estimated.
  
  
  METHODS
  Adverse fetal and infant outcomes for which statistically significant associations with prepregnancy obesity had been reported by peer-reviewed meta-analyses, which included fetal deaths and nine different major birth defects, were assessed. The true prevalence of prepregnancy obesity was estimated by multiplying self-reported prepregnancy obesity by a bias factor based on the difference between measured and self-reported obesity in U.S. adult women. A Monte Carlo simulation approach was used to model the attributable fraction and preventable number, accounting for uncertainty in the estimates for: strength of the association with obesity, obesity prevalence, and outcome prevalence.
  
  
  RESULTS
  Eliminating the impact of prepregnancy obesity would potentially prevent the highest numbers of four outcomes: fetal deaths (6,990; uncertainty interval [UI] 4,110-10,080), congenital heart defects (2,850; UI 1,035-5,065), hydrocephalus (490; UI 150-850), and spina bifida (405; UI 305-505). If 10% of women with prepregnancy obesity achieved a healthy weight before pregnancy or otherwise mitigated the impact of obesity, nearly 300 congenital heart defects and 700 fetal deaths per year could potentially be prevented.
  
  
  CONCLUSIONS
  This simulation suggests that effective prevention strategies to reduce prepregnancy obesity or the risk associated with obesity could have a measurable impact on infant health in the US.
authors.affiliation: National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA, USA. MHonein@cdc.gov
authors.forename: Margaret A
authors.initials: MA
authors.lastname: Honein
authors.forename: Owen
authors.initials: O
authors.lastname: Devine
authors.forename: Andrea J
authors.initials: AJ
authors.lastname: Sharma
authors.forename: Sonja A
authors.initials: SA
authors.lastname: Rasmussen
authors.forename: Sohyun
authors.initials: S
authors.lastname: Park
authors.forename: James E
authors.initials: JE
authors.lastname: Kucik
authors.forename: Coleen
authors.initials: C
authors.lastname: Boyle
mesh_terms: D015992:Body Mass Index; D001835:Body Weight; D005260:Female; D005313:Fetal Death / Q000209:etiology / Q000473:pathology*; D005333:Fetus / Q000473:pathology; D006330:Heart Defects, Congenital / Q000209:etiology / Q000473:pathology*; D006801:Humans; D006849:Hydrocephalus / Q000209:etiology / Q000473:pathology*; D007223:Infant; D015201:Meta-Analysis as Topic; D009765:Obesity / Q000150:complications / Q000453:epidemiology*; D010380:Peer Review; D011247:Pregnancy; D015995:Prevalence; D011634:Public Health; D012307:Risk Factors; D057566:Self Report; D016135:Spinal Dysraphism / Q000209:etiology / Q000473:pathology*