Association of BMI and interpregnancy BMI change with birth outcomes in an Australian obstetric population: A retrospective cohort study

Cathy KNIGHT-AGARWAL, Lauren Williams, Deborah DAVIS, Rachel DAVEY, Tom COCHRANE, Peter Rickwood

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Abstract

Objective: To assess maternal and neonatal outcomes associated with increasing body mass index (BMI) and interpregnancy BMI changes in an Australian obstetric population. Methods: A retrospective cohort study from 2008 to 2013 was undertaken. BMI for 14 875 women was categorised as follows: underweight (=18 kg/m2); normal weight (19-24 kg/m2); overweight (25-29 kg/m2); obese class I (30-34 kg/m2); obese class II (35-39 kg/m2) and obese class III (40+ kg/m2). BMI categories and maternal, neonatal and birthing outcomes were examined using logistic regression. Interpregnancy change in BMI and the risk of adverse outcomes in the subsequent pregnancy were also examined. Results: Within this cohort, 751 (5.1%) women were underweight, 7431 (50.0%) had normal BMI, 3748 (25.1%) were overweight, 1598 (10.8%) were obese class I, 737 (5.0%) were obese class II and 592 (4.0%) were obese class III. In bivariate adjusted models, obese women were at an increased risk of caesarean section, gestational diabetes, hypertensive disorders of pregnancy and neonatal morbidities including macrosomia, large for gestational age (LGA), hypoglycaemia, low 5 min Apgar score and respiratory distress. Multiparous women who experienced an interpregnancy increase of =3 BMI units had a higher adjusted OR (AOR) (CI) of the following adverse outcomes in their subsequent pregnancy: low 5-min Apgar score 3.242 (1.557 to 7.118); gestational diabetes mellitus (GDM) 3.258 (1.129 to 10.665) and hypertensive disorders of pregnancy 3.922 (1.243 to 14.760). These women were more likely to give birth vaginally 2.030 (1.417 to 2.913). Conversely, women whose parity changed from 0 to 1 and who experienced an interpregnancy increase of =3 BMI units had a higher AOR (CI) of caesarean section in their second pregnancy 1.806 (1.139 to 2.862). Conclusions: Women who are overweight or obese have a significantly increased risk of various adverse outcomes. Interpregnancy weight gain, regardless of parity and baseline BMI, also increases various adverse outcomes. Effective weight management strategies are needed.
Original languageEnglish
Pages (from-to)1-10
Number of pages10
JournalBMJ Open
Volume6
Issue number5
DOIs
Publication statusPublished - 2016

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Obstetrics
Body Mass Index
Cohort Studies
Retrospective Studies
Parturition
Population
Pregnancy
Gestational Diabetes
Apgar Score
Thinness
Parity
Cesarean Section
Mothers
Weights and Measures
Hypoglycemia
Gestational Age
Weight Gain
Logistic Models
Morbidity

Cite this

@article{22589949958f4dd3a3ee3956791508bb,
title = "Association of BMI and interpregnancy BMI change with birth outcomes in an Australian obstetric population: A retrospective cohort study",
abstract = "Objective: To assess maternal and neonatal outcomes associated with increasing body mass index (BMI) and interpregnancy BMI changes in an Australian obstetric population. Methods: A retrospective cohort study from 2008 to 2013 was undertaken. BMI for 14 875 women was categorised as follows: underweight (=18 kg/m2); normal weight (19-24 kg/m2); overweight (25-29 kg/m2); obese class I (30-34 kg/m2); obese class II (35-39 kg/m2) and obese class III (40+ kg/m2). BMI categories and maternal, neonatal and birthing outcomes were examined using logistic regression. Interpregnancy change in BMI and the risk of adverse outcomes in the subsequent pregnancy were also examined. Results: Within this cohort, 751 (5.1{\%}) women were underweight, 7431 (50.0{\%}) had normal BMI, 3748 (25.1{\%}) were overweight, 1598 (10.8{\%}) were obese class I, 737 (5.0{\%}) were obese class II and 592 (4.0{\%}) were obese class III. In bivariate adjusted models, obese women were at an increased risk of caesarean section, gestational diabetes, hypertensive disorders of pregnancy and neonatal morbidities including macrosomia, large for gestational age (LGA), hypoglycaemia, low 5 min Apgar score and respiratory distress. Multiparous women who experienced an interpregnancy increase of =3 BMI units had a higher adjusted OR (AOR) (CI) of the following adverse outcomes in their subsequent pregnancy: low 5-min Apgar score 3.242 (1.557 to 7.118); gestational diabetes mellitus (GDM) 3.258 (1.129 to 10.665) and hypertensive disorders of pregnancy 3.922 (1.243 to 14.760). These women were more likely to give birth vaginally 2.030 (1.417 to 2.913). Conversely, women whose parity changed from 0 to 1 and who experienced an interpregnancy increase of =3 BMI units had a higher AOR (CI) of caesarean section in their second pregnancy 1.806 (1.139 to 2.862). Conclusions: Women who are overweight or obese have a significantly increased risk of various adverse outcomes. Interpregnancy weight gain, regardless of parity and baseline BMI, also increases various adverse outcomes. Effective weight management strategies are needed.",
author = "Cathy KNIGHT-AGARWAL and Lauren Williams and Deborah DAVIS and Rachel DAVEY and Tom COCHRANE and Peter Rickwood",
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Association of BMI and interpregnancy BMI change with birth outcomes in an Australian obstetric population: A retrospective cohort study. / KNIGHT-AGARWAL, Cathy; Williams, Lauren; DAVIS, Deborah; DAVEY, Rachel; COCHRANE, Tom; Rickwood, Peter.

In: BMJ Open, Vol. 6, No. 5, 2016, p. 1-10.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Association of BMI and interpregnancy BMI change with birth outcomes in an Australian obstetric population: A retrospective cohort study

AU - KNIGHT-AGARWAL, Cathy

AU - Williams, Lauren

AU - DAVIS, Deborah

AU - DAVEY, Rachel

AU - COCHRANE, Tom

AU - Rickwood, Peter

PY - 2016

Y1 - 2016

N2 - Objective: To assess maternal and neonatal outcomes associated with increasing body mass index (BMI) and interpregnancy BMI changes in an Australian obstetric population. Methods: A retrospective cohort study from 2008 to 2013 was undertaken. BMI for 14 875 women was categorised as follows: underweight (=18 kg/m2); normal weight (19-24 kg/m2); overweight (25-29 kg/m2); obese class I (30-34 kg/m2); obese class II (35-39 kg/m2) and obese class III (40+ kg/m2). BMI categories and maternal, neonatal and birthing outcomes were examined using logistic regression. Interpregnancy change in BMI and the risk of adverse outcomes in the subsequent pregnancy were also examined. Results: Within this cohort, 751 (5.1%) women were underweight, 7431 (50.0%) had normal BMI, 3748 (25.1%) were overweight, 1598 (10.8%) were obese class I, 737 (5.0%) were obese class II and 592 (4.0%) were obese class III. In bivariate adjusted models, obese women were at an increased risk of caesarean section, gestational diabetes, hypertensive disorders of pregnancy and neonatal morbidities including macrosomia, large for gestational age (LGA), hypoglycaemia, low 5 min Apgar score and respiratory distress. Multiparous women who experienced an interpregnancy increase of =3 BMI units had a higher adjusted OR (AOR) (CI) of the following adverse outcomes in their subsequent pregnancy: low 5-min Apgar score 3.242 (1.557 to 7.118); gestational diabetes mellitus (GDM) 3.258 (1.129 to 10.665) and hypertensive disorders of pregnancy 3.922 (1.243 to 14.760). These women were more likely to give birth vaginally 2.030 (1.417 to 2.913). Conversely, women whose parity changed from 0 to 1 and who experienced an interpregnancy increase of =3 BMI units had a higher AOR (CI) of caesarean section in their second pregnancy 1.806 (1.139 to 2.862). Conclusions: Women who are overweight or obese have a significantly increased risk of various adverse outcomes. Interpregnancy weight gain, regardless of parity and baseline BMI, also increases various adverse outcomes. Effective weight management strategies are needed.

AB - Objective: To assess maternal and neonatal outcomes associated with increasing body mass index (BMI) and interpregnancy BMI changes in an Australian obstetric population. Methods: A retrospective cohort study from 2008 to 2013 was undertaken. BMI for 14 875 women was categorised as follows: underweight (=18 kg/m2); normal weight (19-24 kg/m2); overweight (25-29 kg/m2); obese class I (30-34 kg/m2); obese class II (35-39 kg/m2) and obese class III (40+ kg/m2). BMI categories and maternal, neonatal and birthing outcomes were examined using logistic regression. Interpregnancy change in BMI and the risk of adverse outcomes in the subsequent pregnancy were also examined. Results: Within this cohort, 751 (5.1%) women were underweight, 7431 (50.0%) had normal BMI, 3748 (25.1%) were overweight, 1598 (10.8%) were obese class I, 737 (5.0%) were obese class II and 592 (4.0%) were obese class III. In bivariate adjusted models, obese women were at an increased risk of caesarean section, gestational diabetes, hypertensive disorders of pregnancy and neonatal morbidities including macrosomia, large for gestational age (LGA), hypoglycaemia, low 5 min Apgar score and respiratory distress. Multiparous women who experienced an interpregnancy increase of =3 BMI units had a higher adjusted OR (AOR) (CI) of the following adverse outcomes in their subsequent pregnancy: low 5-min Apgar score 3.242 (1.557 to 7.118); gestational diabetes mellitus (GDM) 3.258 (1.129 to 10.665) and hypertensive disorders of pregnancy 3.922 (1.243 to 14.760). These women were more likely to give birth vaginally 2.030 (1.417 to 2.913). Conversely, women whose parity changed from 0 to 1 and who experienced an interpregnancy increase of =3 BMI units had a higher AOR (CI) of caesarean section in their second pregnancy 1.806 (1.139 to 2.862). Conclusions: Women who are overweight or obese have a significantly increased risk of various adverse outcomes. Interpregnancy weight gain, regardless of parity and baseline BMI, also increases various adverse outcomes. Effective weight management strategies are needed.

U2 - 10.1136/bmjopen-2015-010667

DO - 10.1136/bmjopen-2015-010667

M3 - Article

VL - 6

SP - 1

EP - 10

JO - BMJ Open

JF - BMJ Open

SN - 2044-6055

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