Download PDF
Am J Perinatol 2010; 27(4): 293-298
DOI: 10.1055/s-0029-1241736
© Thieme Medical Publishers

The Association between Prepregnancy Maternal Body Mass Index and Preterm Delivery

Yan Zhong1 , 2 , Alison G. Cahill1 , George A. Macones1 , Fufan Zhu2 , Anthony O. Odibo1
  • 1Departments of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, Washington University in St. Louis, St. Louis, Missouri
  • 2Departments of Obstetrics and Gynecology, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
Further Information

Publication History

Publication Date:
12 October 2009 (online)

    Permissions and Reprints

ABSTRACT

We investigated the association between prepregnancy maternal body mass index (BMI) and preterm delivery (PTD). The study included 44,421 American women presenting for care in Saint Louis, Missouri between 1990 and 2006. Only singleton gestations were included. The authors examined the associations between categories of BMI with PTD <37 and <34 weeks, respectively. A stratified analysis by subtypes of PTD was also performed. The subtypes of PTD evaluated included spontaneous PTD without preterm premature rupture of membranes (PPROM), PPROM, and indicated PTD. Univariate and multivariable analyses were used to estimate the association between maternal BMI categories and PTD <37 weeks, PTD <34 weeks, and subtypes of PTD. Among women meeting the inclusion criteria, PTD <37 occurred in 4783 (10.8%) and PTD <34 weeks in 1132 (2.5%). Being underweight was associated with increased risks of PTD <37 weeks (adjusted odd ratio [OR] = 1.3, 95% confidence interval [CI]: 1.2, 1.5). Being obese was associated with decreased risks of spontaneous PTD without PPROM <37 weeks (adjusted OR = 0.8, 95% CI: 0.7, 0.9) and increased risk of PPROM <37 weeks (adjusted OR = 1.3, 95% CI: 1.1, 1.6) and PPROM <34 weeks (adjusted OR = 1.4, 95% CI: 1.0, 2.0). Prepregnancy obesity increases the risk of PPROM and decreases risk of spontaneous PTD without PPROM.

KEYWORDS

Body mass index - preterm birth - subtypes of preterm birth

REFERENCES

  • 1 Bhattacharya S, Campbell D M, Liston W A, Bhattacharya S. Effect of body mass index on pregnancy outcomes in nulliparous women delivering singleton babies.  BMC Public Health. 2007;  7 168
    CrossrefPubMedGoogle Scholar
  • 2 Smith G C, Shah I, Pell J P, Crossley J A, Dobbie R. Maternal obesity in early pregnancy and risk of spontaneous and elective preterm deliveries: a retrospective cohort study.  Am J Public Health. 2007;  97 157-162
    CrossrefPubMedGoogle Scholar
  • 3 Nohr E A, Bech B H, Vaeth M, Rasmussen K M, Henriksen T B, Olsen J. Obesity, gestational weight gain and preterm birth: a study within the Danish National Birth Cohort.  Paediatr Perinat Epidemiol. 2007;  21 5-14
    CrossrefPubMedGoogle Scholar
  • 4 Lynch C M, Sexton D J, Hession M, Morrison J J. Obesity and mode of delivery in primigravid and multigravid women.  Am J Perinatol. 2008;  25 163-167
    Article in Thieme ConnectPubMedGoogle Scholar
  • 5 Hendler I, Goldenberg R L, Mercer B M et al.. The Preterm Prediction Study: association between maternal body mass index and spontaneous and indicated preterm birth.  Am J Obstet Gynecol. 2005;  192 882-886
    CrossrefPubMedGoogle Scholar
  • 6 Gross T, Sokol R J, King K C. Obesity in pregnancy: risks and outcome.  Obstet Gynecol. 1980;  56 446-450
    PubMedGoogle Scholar
  • 7 Kumari A S. Pregnancy outcome in women with morbid obesity.  Int J Gynaecol Obstet. 2001;  73 101-107
    CrossrefPubMedGoogle Scholar
  • 8 Ehrenberg H M, Dierker L, Milluzzi C, Mercer B M. Low maternal weight, failure to thrive in pregnancy, and adverse pregnancy outcomes.  Am J Obstet Gynecol. 2003;  189 1726-1730
    CrossrefPubMedGoogle Scholar
  • 9 Neggers Y, Goldenberg R L. Some thoughts on body mass index, micronutrient intakes and pregnancy outcome.  J Nutr. 2003;  133(5 suppl 2) 1737S-1740S
    PubMedGoogle Scholar
  • 10 Hickey C A, Cliver S P, McNeal S F, Goldenberg R L. Low pregravid body mass index as a risk factor for preterm birth: variation by ethnic group.  Obstet Gynecol. 1997;  89 206-212
    CrossrefPubMedGoogle Scholar
  • 11 Hickey C A, Cliver S P, McNeal S F, Hoffman H J, Goldenberg R L. Prenatal weight gain patterns and spontaneous preterm birth among nonobese black and white women.  Obstet Gynecol. 1995;  85 909-914
    CrossrefPubMedGoogle Scholar
  • 12 Mercer B M, Goldenberg R L, Das A et al.. The preterm prediction study: a clinical risk assessment system.  Am J Obstet Gynecol. 1996;  174 1885-1893 discussion 1893-1895
    CrossrefPubMedGoogle Scholar
  • 13 Wen S W, Goldenberg R L, Cutter G R, Hoffman H J, Cliver S P. Intrauterine growth retardation and preterm delivery: prenatal risk factors in an indigent population.  Am J Obstet Gynecol. 1990;  162 213-218
    CrossrefPubMedGoogle Scholar
  • 14 Honest H, Bachmann L M, Ngai C, Gupta J K, Kleijnen J, Khan K S. The accuracy of maternal anthropometry measurements as predictor for spontaneous preterm birth—a systematic review.  Eur J Obstet Gynecol Reprod Biol. 2005;  119 11-20
    CrossrefPubMedGoogle Scholar
  • 15 Jensen D M, Damm P, Sørensen B et al.. Pregnancy outcome and prepregnancy body mass index in 2459 glucose-tolerant Danish women.  Am J Obstet Gynecol. 2003;  189 239-244
    CrossrefPubMedGoogle Scholar
  • 16 National Heart, Lung, and Blood Institute .Clinical guidelines on the identification, evaluation, and treatment of overweight and obesity in adults NIH Publication No. 98–4083. Bethesda, MD; Department of Health and Human Services, National Institutes of Health 1998
    PubMedGoogle Scholar
  • 17 International Classification of Diseases .9th revision. Geneva, Switzerland; World Health Organization 1980
    PubMedGoogle Scholar
  • 18 Goldenberg R L, Culhane J F. Infection as a cause of preterm birth.  Clin Perinatol. 2003;  30 677-700
    PubMedGoogle Scholar
  • 19 Lockwood C J, Kuczynski E. Markers of risk for preterm delivery.  J Perinat Med. 1999;  27 5-20
    CrossrefPubMedGoogle Scholar
  • 20 Sebire N J, Jolly M, Harris J P et al.. Maternal obesity and pregnancy outcome: a study of 287,213 pregnancies in London.  Int J Obes Relat Metab Disord. 2001;  25 1175-1182
    CrossrefPubMedGoogle Scholar
  • 21 Garbaciak Jr J AJ, Richter M, Miller S, Barton J J. Maternal weight and pregnancy complications.  Am J Obstet Gynecol. 1985;  152 238-245
    PubMedGoogle Scholar
  • 22 Kahn S E, Prigeon R L, Schwartz R S et al.. Obesity, body fat distribution, insulin sensitivity and Islet beta-cell function as explanations for metabolic diversity.  J Nutr. 2001;  131 354S-360S
    PubMedGoogle Scholar
  • 23 Ehrenberg H M, Iams J D, Goldenberg R L Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) Maternal-Fetal Medicine Units Network (MFMU) et al. Maternal obesity, uterine activity, and the risk of spontaneous preterm birth.  Obstet Gynecol. 2009;  113 48-52
    CrossrefPubMedGoogle Scholar
  • 24 Cnattingius S, Bergström R, Lipworth L, Kramer M S. Prepregnancy weight and the risk of adverse pregnancy outcomes.  N Engl J Med. 1998;  338 147-152
    CrossrefPubMedGoogle Scholar
  • 25 Castro L C, Avina R L. Maternal obesity and pregnancy outcomes.  Curr Opin Obstet Gynecol. 2002;  14 601-606
    CrossrefPubMedGoogle Scholar
  • 26 Liabsuetrakul T, Suntharasaj T, Suwanrath C, Leetanaporn R, Rattanaprueksachart R, Tuntiseranee P. Serial translabial sonographic measurement of cervical dimensions between 24 and 34 weeks' gestation in pregnant Thai women.  Ultrasound Obstet Gynecol. 2002;  20 168-173
    CrossrefPubMedGoogle Scholar

Anthony O OdiboM.D. M.S.C.E. 

Department of Obstetrics and Gynecology, Division of MFM and Ultrasound, Washington University Medical Center

4990 Children's Place, Suite 1130, St. Louis, MO 63110

Email: odiboa@wudosis.wustl.edu

      >