title: High pre-pregnancy body mass index and the risk of poor obstetrics outcomes among Asian women using BMI criteria for Asians by World Health Organization Western Pacific Region (WPRO): a large cohort study.
abstract: OBJECTIVE
  To evaluate the effects of high pre-pregnancy body mass index (BMI) on the risk ofpoor obstetric outcomes among Asian women using BMI criteria by Regional Office for the Western Pacific Region of WHO (WPRO).
  
  
  METHODS
  The present study was a retrospective cohort. Subjects of live birth singletons who had full term delivered atfour tertiary care centers, teaching university hospitals between January and December 2012 were enrolled. All pregnant women with pre-pregnancy BMI 18.5 kg/m2 or over were recruited and categorized into two groups, normal BMI and high BMI Level of BMI at 18.5-22.9 kg/m2 was defined normal BMI, and level at or over than 23 kg/M2 was defined as high BMI, respectively. The association between high pre-pregnancy BMI and poor adverse pregnancy outcomes were evaluated.
  
  
  RESULTS
  Two thousands seven hundred and thirty-three pregnant women were recruited. Normal and high pre-pregnancy BMI women were 1,840 and 893, respectively. The average age was 2 7.81 +/- 5.67 and 29.48 +/- 13.03 years old respectively. Most ofsubject were primigravida. Mean BMI of normal group and high BMI group were 20.2 7 +/- 1.42 and 26.66 +/- 3.45 kg/ m2, respectively. In multivariate analysis, high pre-pregnancy BMI pregnant women have significantly higher adjusted risk ratio for gestational diabetes mellitus and preeclampsia, induction of labor prolong second stage of labor, including, caesarean delivery or obstetrics procedures (RR 1.54, 95% CI 1.30-1.84, RR 1.17, 95% CI 1. 12-1.23, RR 1.41, 95% CI 1. 04- 1.90, RR 1.28, 95% CI 1.11-1.48 and RR 1.17, 95% CI 1.05-1.27, respectively). In addition, the adjusted risk ratio of postpartum hemorrhage and neonatal macrosomia were significantly increased (RR 1.86, 95% CI 1.01-3.43 and RR 1.46, 95% CI 1.28-1.65, respectively).
  
  
  CONCLUSIONS
  This evidence strongly suggested that high pre-pregnancy BMI using WPRO criteria increased the risk of pregnancy complications and adverse pregnancy outcomes. This study was one of the largest studies among Asian populations.
authors.forename: Charintip
authors.initials: C
authors.lastname: Somprasit
authors.forename: Chamnan
authors.initials: C
authors.lastname: Tanprasertkul
authors.forename: Thawanwong
authors.initials: T
authors.lastname: Rattanasiri
authors.forename: Piyamas
authors.initials: P
authors.lastname: Saksiriwutth
authors.forename: Jamras
authors.initials: J
authors.lastname: Wongkum
authors.forename: Ekachai
authors.initials: E
authors.lastname: Kovavisarach
authors.forename: Khwanjira
authors.initials: K
authors.lastname: Jongfueangparinya
authors.forename: Pritsana
authors.initials: P
authors.lastname: Panichakul
authors.forename: Juthawadee
authors.initials: J
authors.lastname: Wuthiwong
mesh_terms: D000293:Adolescent; D044466:Asian People / Q000706:statistics & numerical data; D015992:Body Mass Index; D005260:Female; D006801:Humans; D009765:Obesity / Q000453:epidemiology; D011247:Pregnancy; D011248:Pregnancy Complications / Q000453:epidemiology*; D011256:Pregnancy Outcome / Q000453:epidemiology*; D012189:Retrospective Studies; D055815:Young Adult