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Maternal body mass index and the risk of fetal and infant death; a cohort study from the North of England

Lookup NU author(s): Peter Tennant, Professor Judith Rankin, Dr Ruth Bell


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BACKGROUND: Early-pregnancy obesity (body mass index, BMI, ≥ 30kg/m2) carries significant health implications. This cohort study from the North of England investigated the association between early pregnancy BMI and the risk of fetal and infant death in pregnancies not affected by congenital anomalies or pre-gestational diabetes. METHODS: Data on singleton pregnancies delivered during 2003-2005 at five hospitals in the North of England were linked with data from three regional registers: the Northern Perinatal Mortality Survey, the Northern Diabetes in Pregnancy Survey, and the Northern Congenital Abnormality Survey. Cases associated with pre-gestational diabetes or congenital anomalies were excluded. Logistic regression models were used to determine the crude and adjusted odds ratios (aOR) of a spontaneous fetal death (≥20 weeks gestation) and infant death (aged up to 1 year), among underweight (BMI <18.5kg/m2), overweight (BMI 25-29.9kg/m2), and obese women compared to women of recommended BMI (BMI 18.5–24.9Kg/m2). Locally weighted scatter plot smoothing and spline regression were used to examine the relationship between continuous BMI and the risks of fetal and infant death. RESULTS: Compared to women of recommended BMI, obese women were at significantly increased risks of both fetal death [adjusted odds ratio, aOR=2.32 (95% confidence interval: 1.64 to 3.28), p<0.001] and infant death [aOR=1.97 (1.13 to 3.45), p=0.02]. Continuous analyses revealed a V-shaped relationship between BMI and the risk of fetal and infant death, with a minimum risk at 23kg/m2, and significantly increased risk thereafter for both fetal death [aOR, per unit=1.07 (1.05 to 1.10), p<0.001] and infant death [aOR, per unit=1.06 (1.02 to 1.10), p=0.007]. No significant excess risks, however, were identified for either maternal underweight [fetal death: aOR=0.98 (0.42 to 2.25), p=0.96; infant death: aOR=1.89 (0.73 to 4.88), p=0.19] or maternal overweight [fetal death: aOR=1.34 (0.94 to 1.89), p=0.10; infant death: aOR=1.35 (0.79 to 2.32), p=0.27] as categories. Except for higher rates of pre-eclampsia among stillbirths, no specific cause of death could explain the increased odds of fetal and infant death among the obese. CONCLUSIONS: Early pregnancy obesity is significantly associated with fetal and infant death, independent of the known relationships with congenital anomalies and maternal pre-gestational diabetes.

Publication metadata

Author(s): Tennant PWG, Rankin J, Bell R

Publication type: Article

Publication status: Published

Journal: Human Reproduction

Year: 2011

Volume: 26

Issue: 6

Pages: 1501-1511

Print publication date: 05/04/2011

ISSN (print): 0268-1161

ISSN (electronic): 1460-2350

Publisher: Oxford University Press


DOI: 10.1093/humrep/der052


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