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    Is pre-pregnancy BMI associated with maternal morbidity?

    Results of a large cohort study show that women whose body mass index (BMI) is below or above normal before pregnancy may be at increased risk of complications or death associated with birth.  The study, by investigators from Washington State, was published in JAMA.

    The findings reflect analysis of outcomes in 743,630 pregnant women who had singleton births in Washington State from 2004 to 2013. Linked birth certificates and hospitalization files were used to collect demographic data and morbidity diagnoses.

    The investigators looked at composite severe maternal morbidity or mortality including life-threatening conditions or conditions leading to serious sequelae, complications that required intensive care unit admission, and maternal death. With logistic regression, adjusted odds ratios (ORs) and adjusted rate differences were calculated with 95% confidence intervals (Cis) and adjustment for confounders such as maternal age and parity.

    Of the women, 3.2% were underweight before pregnancy, 47.5% were normal weight, 25.8% were overweight, 13.1% were obesity class 1, 6.2% were obesity class 2, and 4.2% were obesity class 3. The rates of severe maternal morbidity or mortality per 10,000 women in those BMI categories were 171.5, 143.2, 160.4, 167.9, 178.3, and 202.9, respectively. Adjusted ORs were 1.2 for underweight women, 1.1 for overweight women and those with class 1 obesity, 1.2 for women with class 2 obesity, and 1.4 for women with class 3 obesity compared with those with normal BMI. Absolute risk increases were 28.8 for underweight women, 17.6 for overweight women, 24.9 for those with class 1 obesity, 35.8 for those with class 2 obesity, and 61.1 for women with class 3 obesity.

    The authors concluded that in pregnant women in Washington State, low and high pre-pregnancy BMI were associated with a statistically significant but small absolute increase in severe maternal morbidity or mortality.  

    Judith M. Orvos, ELS
    Judith M. Orvos, ELS, is a a BELS-certified medical writer and editor and an editorial consultant for Contemporary OB/GYN.
    Ben Schwartz
    Ben Schwartz is Associate Editor, Contemporary OB/GYN.

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