title: Maternal obesity and fetal deaths: results from the Brazilian cross-sectional Demographic Health Survey, 2006.
abstract: BACKGROUND
  Obesity is highly related to negative reproductive health outcomes, but its relationship with spontaneous abortion and stillbirth remains to be understood, especially in transitioning economies. This study aimed to examine the relationship between obesity and spontaneous abortions and stillbirths in a representative sample of the Brazilian population.
  
  
  METHODS
  Cross-sectional study using secondary data of Brazilian women of reproductive age (15-45 years old) from the National Demographic and Health Survey in 2006. Obesity was measured by body mass index (BMI), waist circumference (WC) and waist-to-height ratio (WHR). Logistic regression modeling of the survey data was used to evaluate the relationship between obesity and the study outcomes.
  
  
  RESULTS
  The three obesity markers used were found to be strongly and positively associated with spontaneous abortion and stillbirth occurrence. In the adjusted models, there was strong evidence that for each unit increase in BMI (OR = 1.05; 95%CI: 1.02-1.08) and WHR (OR = 1.32; 95%CI: 1.03-1.69), the odds of having a spontaneous abortion was higher. In addition, compared to those of optimal weight, obese women were more likely to have negative outcomes. Maternal age, parity, skin color, educational level and household income were important covariates for adjustment. A sensitivity analysis among women who had only one pregnancy was also performed and showed similar results.
  
  
  CONCLUSIONS
  Obesity is potentially associated with an increased risk of spontaneous abortion and stillbirth in a representative sample of the Brazilian population. These findings are in accordance with previous studies and thus reinforce the need for obstetric care providers to counsel obese reproductive-age women regarding the risks, complications and importance of weight loss and weight control prior to pregnancy.
authors.forename: Mariana Santos
authors.initials: MS
authors.lastname: Felisbino-Mendes
authors.forename: Fernanda Penido
authors.initials: FP
authors.lastname: Matozinhos
authors.forename: J Jaime
authors.initials: JJ
authors.lastname: Miranda
authors.forename: Eduardo
authors.initials: E
authors.lastname: Villamor
authors.affiliation: Department of Maternal and Child Nursing and Public Health, Escola de Enfermagem, Universidade Federal de Minas Gerais (UFMG), Av, Alfredo Balena, 190 - Bairro Santa Efigênia, 30130-100, Belo Horizonte, MG, Brasil. guveme@ufmg.br.
authors.forename: Gustavo
authors.initials: G
authors.lastname: Velasquez-Melendez
mesh_terms: D000022:Abortion, Spontaneous / Q000453:epidemiology*; D000293:Adolescent; D000328:Adult; D001827:Body Height; D015992:Body Mass Index; D001938:Brazil / Q000453:epidemiology; D003430:Cross-Sectional Studies; D005260:Female; D006306:Health Surveys; D006801:Humans; D009765:Obesity / Q000453:epidemiology*; D011247:Pregnancy; D015995:Prevalence; D050497:Stillbirth / Q000453:epidemiology*; D055105:Waist Circumference; D055815:Young Adult