Estimating bias in derived body mass index in the Maternity Experiences Survey.
BACKGROUND
The objective of this study was to assess bias in the body mass index (BMI) measure in the Canadian Maternity Experiences Survey (MES) and possible implications of bias on the relationship between BMI and selected pregnancy outcomes.


METHODS
We assessed BMI classification based on self-reported versus measured values. We used a random sample of 6175 women from the MES, which derived BMI from self-reported height and weight, and a random sample of 259 women who had previously given birth from the Canadian Health Measures Survey (CHMS), which derived BMI from self-reported and measured height and weight. Two correction equations were applied to self-reported based BMI, and the impact of these corrections on associations between BMI and caesarean section, small-for-gestational age (SGA) and large-for-gestational age (LGA) births was studied.


RESULTS
Overall, 86.9% of the CHMS subsample was classified into the same BMI category based on self-reported versus measured data. However, misclassification had a substantial effect on the proportion of women in underweight and obese BMI categories. For example, 14.5% versus 20.8% of women were classified as obese based on self-reported data versus measured data. Corrections improved estimates of obesity prevalence, but over- and underestimated other BMI categories. Corrections had nonsignificant effects on the associations between BMI and SGA, LGA, and caesarean section.


CONCLUSIONS
While there was high concordance in BMI classification based on selfreported versus measured height and weight, bias in self-reported based measures may slightly over- or underestimate the risks associated with a particular BMI class. However, the general trend in associations is unaffected.
Maternal and Infant Health Section, Surveillance and Epidemiology Division, Public Health Agency of Canada, Ottawa, Ontario, Canada.
S
S
Dzakpasu
Household Survey Methods Division, Statistics Canada, Ottawa, Ontario, Canada.
J
J
Duggan
Reproductive Care Program of Nova Scotia, Halifax, Nova Scotia, Canada.
J
J
Fahey
Department of Community and Family Health, College of Public Health, University of South Florida, Tampa, Florida, United States of America.
R S
RS
Kirby
D000328:Adult; D015982:Bias; D001724:Birth Weight; D015992:Body Mass Index; D002170:Canada / Q000453:epidemiology; D002585:Cesarean Section / Q000706:statistics & numerical data*; D059026:Diagnostic Self Evaluation; D005260:Female; D006801:Humans; D009765:Obesity / Q000175:diagnosis / Q000453:epidemiology / Q000517:prevention & control; D011247:Pregnancy; D011256:Pregnancy Outcome / Q000453:epidemiology*; D015995:Prevalence; D011897:Random Allocation; D057566:Self Report; D013223:Statistics as Topic; D011795:Surveys and Questionnaires
body mass index; reproductive outcomes; self-reported height; self-reported prepregnancy weight; validity
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