title: The Impact of maternal obesity and race/ethnicity on perinatal outcomes: Independent and joint effects.
abstract: Independent and joint impacts of maternal race/ethnicity and obesity on adverse birth outcomes, including pre-eclampsia, low birth weight, and macrosomia, were characterized.
  
  
  
  Retrospective cohort study of all 2007 California births was conducted using vital records and claims data. Maternal race/ethnicity and maternal body mass index (BMI) were the key exposures; their independent and joint impact on outcomes using regression models was analyzed.
  
  
  
  Racial/ethnic minority women of normal weight generally had higher risk as compared with white women of normal weight (e.g., African-American women, pre-eclampsia adjusted odds ratio [aOR] 1.60, 95% confidence interval [CI]: 1.48-1.74 vs. white women). However, elevated BMI did not usually confer additional risk (e.g., pre-eclampsia aOR comparing African-American women with excess weight with white women with excess weight, 1.17, 95% CI: 0.89-1.54). Obesity was a risk factor for low birth weight only among white women (excess weight aOR, 1.24, 95% CI: 1.04-1.49 vs. white women of normal weight) and not among racial/ethnic minority women (e.g., African-American women, 0.95, 95% CI: 0.83-1.08).
  
  
  
  These findings add nuance to our understanding of the interplay between maternal race/ethnicity, BMI, and perinatal outcomes. While the BMI/adverse outcome gradient appears weaker in racial/ethnic minority women, this reflects the overall risk increase in racial/ethnic minority women of all body sizes.
authors.affiliation: Department of Obstetrics & Gynecology, Oregon Health & Science University, Portland, Oregon, USA.|School of Public Health, Oregon Health & Science University/Portland State University, Portland, Oregon, USA.
authors.forename: Jonathan M
authors.initials: JM
authors.lastname: Snowden
authors.affiliation: Department of Obstetrics, Gynecology, and Reproductive Sciences, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.
authors.forename: John F
authors.initials: JF
authors.lastname: Mission
authors.affiliation: Department of Obstetrics & Gynecology, Oregon Health & Science University, Portland, Oregon, USA.
authors.forename: Nicole E
authors.initials: NE
authors.lastname: Marshall
authors.affiliation: Department of Obstetrics & Gynecology, Oregon Health & Science University, Portland, Oregon, USA.
authors.forename: Brian
authors.initials: B
authors.lastname: Quigley
authors.affiliation: California Maternal Quality Care Collaborative (CMQCC), Stanford, California, USA.
authors.forename: Elliott
authors.initials: E
authors.lastname: Main
authors.affiliation: Sutter Medical Center, Sacramento, Sacramento, California, USA.
authors.forename: William M
authors.initials: WM
authors.lastname: Gilbert
authors.affiliation: University of California, Irvine Medical Center, Orange, California, USA.
authors.forename: Judith H
authors.initials: JH
authors.lastname: Chung
authors.affiliation: Department of Obstetrics & Gynecology, Oregon Health & Science University, Portland, Oregon, USA.
authors.forename: Aaron B
authors.initials: AB
authors.lastname: Caughey
mesh_terms: D000328:Adult; D001741:Black or African American / Q000706:statistics & numerical data; D001724:Birth Weight; D015992:Body Mass Index; D002140:California / Q000453:epidemiology; D005006:Ethnicity / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D007230:Infant, Low Birth Weight; D007231:Infant, Newborn; D039382:Maternal Nutritional Physiological Phenomena / Q000208:ethnology*; D009765:Obesity / Q000150:complications / Q000208:ethnology*; D016017:Odds Ratio; D011225:Pre-Eclampsia / Q000208:ethnology; D011247:Pregnancy; D011248:Pregnancy Complications / Q000208:ethnology* / Q000209:etiology; D011256:Pregnancy Outcome; D044469:Racial Groups / Q000706:statistics & numerical data*; D012044:Regression Analysis; D012189:Retrospective Studies; D012307:Risk Factors; D015430:Weight Gain / Q000208:ethnology; D044465:White People / Q000706:statistics & numerical data