title: The educational gradient of obesity increases among Swedish pregnant women: a register-based study.
abstract: BACKGROUND
  Overweight or obesity is detrimental during pregnancy. We studied time trends in the educational gradient of overweight and obesity among pregnant women. Differences in overweight and obesity by area of residence and country of birth were also examined.
  
  
  METHODS
  The study was based on the Swedish Medical Birth Register between 1992 and 2010 and included 1,569,173 singleton pregnancies. Weight and height were registered during the first visit at the antenatal-care clinic. Data on education, country of birth, and area of residence were derived from registers with national coverage.
  
  
  RESULTS
  In 2008-2010, 32% of Swedish nulliparous pregnant women were overweight or obese. The relative risk of obesity among lower educated women compared to women with higher education increased from 1.91 (95% confidence interval: 1.85-1.97) in 1992-1995 to 2.09 (95% confidence interval: 2.05-2.14) in 2008-2010. There was an inverse linear relationship between risks of overweight or obesity, and population density and type of residence municipality. An excessive gestational weight gain according to the American Institute of Medicine was observed among 57-63% of the overweight or obese women, but there were small differences by education. Pregnant women born in Africa, Middle East or Latin America had higher risks of being overweight or obese compared to women born in Sweden.
  
  
  CONCLUSIONS
  The prevalence of obesity as well as the social inequalities in obesity during pregnancy increased in Sweden between 1992 and 2010. Further understanding of social inequalities and geographical differentials in health behaviours of pregnant women is needed when planning public health interventions.
authors.affiliation: Unit of Child and Adolescent Health, Centre for Epidemiology and Community Medicine, Stockholm County Council, Box 1497, SE-171 29, Solna, Sweden. helena.bjermo@sll.se.|Child and Adolescent Public Health Epidemiology, Department of Public Health Sciences, Karolinska Institutet, SE-171 77, Stockholm, Sweden. helena.bjermo@sll.se.
authors.forename: Helena
authors.initials: H
authors.lastname: Bjermo
authors.affiliation: Unit of Child and Adolescent Health, Centre for Epidemiology and Community Medicine, Stockholm County Council, Box 1497, SE-171 29, Solna, Sweden. simon.lind@sll.se.
authors.forename: Simon
authors.initials: S
authors.lastname: Lind
authors.affiliation: Unit of Child and Adolescent Health, Centre for Epidemiology and Community Medicine, Stockholm County Council, Box 1497, SE-171 29, Solna, Sweden. finn.rasmussen@ki.se.|Child and Adolescent Public Health Epidemiology, Department of Public Health Sciences, Karolinska Institutet, SE-171 77, Stockholm, Sweden. finn.rasmussen@ki.se.
authors.forename: Finn
authors.initials: F
authors.lastname: Rasmussen
mesh_terms: D000328:Adult; D000349:Africa / Q000208:ethnology; D015992:Body Mass Index; D004522:Educational Status; D005260:Female; D006801:Humans; D016014:Linear Models; D008877:Middle East / Q000208:ethnology; D009765:Obesity / Q000453:epidemiology* / Q000208:ethnology; D011247:Pregnancy; D011248:Pregnancy Complications / Q000453:epidemiology; D011295:Prenatal Care; D015995:Prevalence; D012042:Registries; D012923:Social Class; D013548:Sweden / Q000453:epidemiology; D014481:United States; D055815:Young Adult