title: Maternal obesity and gestational weight gain are risk factors for infant death.
abstract: OBJECTIVE
  Assessment of the joint and independent relationships of gestational weight gain and prepregnancy body mass index (BMI) on risk of infant mortality was performed.
  
  
  METHODS
  This study used Pennsylvania linked birth-infant death records (2003-2011) from infants without anomalies born to mothers with prepregnancy BMI categorized as underweight (n = 58,973), normal weight (n = 610,118), overweight (n = 296,630), grade 1 obesity (n = 147,608), grade 2 obesity (n = 71,740), and grade 3 obesity (n = 47,277). Multivariable logistic regression models stratified by BMI category were used to estimate dose-response associations between z scores of gestational weight gain and infant death after confounder adjustment.
  
  
  RESULTS
  Infant mortality risk was lowest among normal-weight women and increased with rising BMI category. For all BMI groups except for grade 3 obesity, there were U-shaped associations between gestational weight gain and risk of infant death. Weight loss and very low weight gain among women with grades 1 and 2 obesity were associated with high risks of infant mortality. However, even when gestational weight gain in women with obesity was optimized, the predicted risk of infant death remained higher than that of normal-weight women.
  
  
  CONCLUSIONS
  Interventions aimed at substantially reducing preconception weight among women with obesity and avoiding very low or very high gestational weight gain may reduce risk of infant death.
authors.affiliation: Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.|Department of Obstetrics, Gynecology, and Reproductive Sciences, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.|Magee-Womens Research Institute, Pittsburgh, Pennsylvania, USA.
authors.forename: Lisa M
authors.initials: LM
authors.lastname: Bodnar
authors.affiliation: Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.
authors.forename: Lara L
authors.initials: LL
authors.lastname: Siminerio
authors.affiliation: Department of Obstetrics, Gynecology, and Reproductive Sciences, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.|Magee-Womens Research Institute, Pittsburgh, Pennsylvania, USA.
authors.forename: Katherine P
authors.initials: KP
authors.lastname: Himes
authors.affiliation: Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, British Columbia, Canada.
authors.forename: Jennifer A
authors.initials: JA
authors.lastname: Hutcheon
authors.affiliation: Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA.
authors.forename: Timothy L
authors.initials: TL
authors.lastname: Lash
authors.affiliation: Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.
authors.forename: Sara M
authors.initials: SM
authors.lastname: Parisi
authors.affiliation: Division of Epidemiology, University of California at Berkeley School of Public Health, Berkeley, California, USA.
authors.forename: Barbara
authors.initials: B
authors.lastname: Abrams
mesh_terms: D000293:Adolescent; D000328:Adult; D015992:Body Mass Index; D001835:Body Weight; D005260:Female; D006801:Humans; D007223:Infant; D066088:Infant Death / Q000209:etiology*; D016015:Logistic Models; D009035:Mothers / Q000706:statistics & numerical data*; D009765:Obesity / Q000150:complications*; D050177:Overweight / Q000150:complications; D010414:Pennsylvania; D011247:Pregnancy; D012307:Risk Factors; D013851:Thinness / Q000150:complications; D015430:Weight Gain