Trends in maternal prepregnancy body mass index (BMI) and its association with birth and maternal outcomes in California, 2007–2016: A retrospective cohort study

Autoři: Anura W. G. Ratnasiri aff001;  Henry C. Lee aff003;  Satyan Lakshminrusimha aff004;  Steven S. Parry aff001;  Vivi N. Arief aff002;  Ian H. DeLacy aff002;  Jo-Shing Yang aff005;  Ralph J. DiLibero aff001;  Julia Logan aff006;  Kaye E. Basford aff002
Působiště autorů: Benefits Division, California Department of Health Care Services, Sacramento, California, United States of America aff001;  School of Agriculture and Food Sciences, Faculty of Science, The University of Queensland, Brisbane, Queensland, Australia aff002;  Division of Neonatology, School of Medicine, Stanford University, Stanford, California, United States of America aff003;  Department of Pediatrics, School of Medicine, University of California Davis, Sacramento, California, United States of America aff004;  Anesthesia Room ML, University of California San Francisco, San Francisco, California, United States of America aff005;  Health Plan Administration Division, California Public Employees' Retirement System, Sacramento, California, United States of America aff006;  School of Biomedical Sciences, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia aff007
Vyšlo v časopise: PLoS ONE 14(9)
Kategorie: Research Article
doi: 10.1371/journal.pone.0222458



To determine recent trends in maternal prepregnancy body mass index (BMI) and to quantify its association with birth and maternal outcomes.


A population-based retrospective cohort study included resident women with singleton births in the California Birth Statistical Master Files (BSMF) database from 2007 to 2016. There were 4,621,082 women included out of 5,054,968 women registered in the database. 433,886 (8.6%) women were excluded due to invalid or missing information for BMI. Exposures were underweight (BMI < 18.5 kg/m2), normal weight (18.5–24.9 kg/m2), overweight (25.0–29.9 kg/m2), and obese (≥ 30 kg/m2) at the onset of pregnancy. Obesity was subcategorized into class I (30.0–34.9 kg/m2), class II (35.0–39.9 kg/m2), and class III (≥ 40 kg/m2), while adverse outcomes examined were low birth weight (LBW), very low birth weight (VLBW), macrosomic births, preterm birth (PTB), very preterm birth (VPTB), small-for-gestational-age birth (SGA), large-for-gestational-age birth (LGA), and cesarean delivery (CD). Descriptive analysis, simple linear regression, and multivariate logistic regression were performed, and adjusted odds ratios (AORs) with 95% confidence intervals (CIs) for associations were estimated.


Over the ten-year study period, the prevalence of underweight and normal weight women at time of birth declined by 10.6% and 9.7%, respectively, while the prevalence of overweight and obese increased by 4.3% and 22.9%, respectively. VLBW increased significantly with increasing BMI, by 24% in overweight women and by 76% in women with class III obesity from 2007 to 2016. Women with class III obesity also had a significant increase in macrosomic birth (170%) and were more likely to deliver PTB (33%), VPTB (66%), LGA (231%), and CD (208%) than women with a normal BMI. However, obese women were less likely to have SGA infants; underweight women were 51% more likely to have SGA infants than women with a normal BMI.


In California from 2007 to 2016, there was a declining trend in women with prepregnancy normal weight, and a rising trend in overweight and obese women, particularly obesity class III. Both extremes of prepregnancy BMI were associated with an increased incidence of adverse neonatal outcomes; however, the worse outcomes were prominent in those women classified as obese.

Klíčová slova:

Biology and life sciences – Physiology – Physiological parameters – Obesity – Birth weight – Medicine and health sciences – Body weight – Body Mass Index – Women's health – Maternal health – Birth – Preterm birth – Labor and delivery – Pregnancy – Pregnancy complications – Obstetrics and gynecology – Surgical and invasive medical procedures – Obstetric procedures – Cesarean section – People and places – Population groupings – Age groups – Children – Infants – Families


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