Population attributable fractions of perinatal outcomes for nulliparous women associated with overweight and obesity, 1990-2014.

Publisher: Australasian Medical Publishing Co Country of Publication: Australia NLM ID: 0400714 Publication Model: Print Cited Medium: Internet ISSN: 1326-5377 (Electronic) Linking ISSN: 0025729X NLM ISO Abbreviation: Med J Aust Subsets: MEDLINE

Publication: : Pyrmont, NSW : Australasian Medical Publishing Co.
Original Publication: Sydney : Australasian Medical Pub. Co.

Obesity/*complications ; Overweight/*complications ; Parity/*physiology ; Perinatology/*statistics & numerical data ; Pregnancy Complications/*prevention & control; Australia/epidemiology ; Body Mass Index ; Cohort Studies ; Diabetes, Gestational/epidemiology ; Female ; Fetal Macrosomia/epidemiology ; Humans ; Obesity/epidemiology ; Outcome Assessment, Health Care ; Overweight/epidemiology ; Pre-Eclampsia/epidemiology ; Pregnancy ; Pregnancy Complications/epidemiology ; Prevalence ; Retrospective Studies ; Young Adult

Objective: To examine the prevalence across 25 years of overweight and obesity among nulliparous Australian women during early pregnancy; to estimate the proportions of adverse perinatal outcomes attributable to overweight and obesity in this population.
Design: Cohort study; retrospective analysis of electronic maternity data. Setting, participants: 42 582 nulliparous women with singleton pregnancies giving birth at the Royal Prince Alfred Hospital, an urban teaching hospital in Sydney, January 1990 - December 2014.
Main Outcome Measures: Maternal body mass index (BMI), socio-demographic characteristics, and selected maternal, birth and neonatal outcomes; the proportion of adverse perinatal outcomes that could be averted by reducing the prevalence of overweight and obesity in women prior to first pregnancies (population attributable fraction, PAF).
Results: The prevalence of overweight among nulliparous pregnant women increased from 12.7% (1990-1994) to 16.4% (2010-2014); the prevalence of obesity rose from 4.8% to 7.3% in the same period, while the proportion with normal range BMIs fell from 73.5% to 68.2%. The PAFs for key adverse maternal and neonatal outcomes increased across the study period; during 2010-2014, 23.8% of pre-eclampsia, 23.4% of fetal macrosomia, and 17.0% of gestational diabetes were attributable to overweight and obesity. Were overweight and obese women to have moved down one BMI category during 2010-2014, 19% of pre-eclampsia, 15.9% of macrosomia, 14.2% of gestational diabetes, 8.5% of caesarean deliveries, 7.1% of low for gestational age birthweight, 6.8% of post partum haemorrhage, 6.5% of admissions to special care nursery, 5.8% of prematurity, and 3.8% of fetal abnormality could have been averted.
Conclusions: Over the past 25 years, the proportions of adverse perinatal outcomes attributable to overweight and obesity have risen with the increasing prevalence of maternal overweight and obesity. A substantial proportion of these outcomes might be averted with obesity prevention strategies that reduce pre-pregnancy maternal weight.

Comment in: Med J Aust. 2018 Feb 19;208(3):112-113. (PMID: 29438645)
Comment in: Med J Aust. 2018 Jun 18;208(11):505-506. (PMID: 29902411)

Keywords: Epidemiology; Obesity; Perinatal; Pregnancy

Date Created: 20180214 Date Completed: 20190327 Latest Revision: 20191210

20221213

10.5694/mja17.00344

29438637