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Table of Contents
Vol. 30, No. 4, 2011
Issue release date: December 2011
Section title: Original Paper
Editor's Choice -- Free Access
Fetal Diagn Ther 2011;30:250–265
(DOI:10.1159/000328083)

Body Mass Index at 11–13 Weeks’ Gestation and Pregnancy Complications

Syngelaki A.a–c · Bredaki F.E.a, c · Vaikousi E.a, c · Maiz N.a · Nicolaides K.H.a–c
aHarris Birthright Research Centre of Fetal Medicine, King’s College Hospital, London, bDepartment of Fetal Medicine, Medway Maritime Hospital, Gillingham, and cDepartment of Fetal Medicine, University College Hospital, London, UK
email Corresponding Author

Abstract

Objective: To examine the association between body mass index (BMI) at 11–13 weeks’ gestation and a wide range of adverse pregnancy outcomes after adjustment for confounding factors in obstetric history and maternal characteristics. Methods: This was a prospective screening study for adverse obstetric outcomes in women with singleton pregnancies attending for their first routine hospital visit at 11+0–13+6 weeks of gestation. The maternal weight and height were measured and the BMI was calculated. Regression analysis was performed to examine the association between BMI and each of the adverse pregnancy outcomes. Results: We examined 41,577 pregnancies with a live fetus at 11–13 weeks. There was a significant contribution from maternal BMI, in addition to maternal characteristics and obstetric history, in the prediction of subsequent miscarriage, stillbirth, preeclampsia, gestational hypertension, gestational diabetes mellitus, delivery of small and large for gestational age neonates, and both elective and emergency cesarean section, but not spontaneous preterm delivery. The risk for each pregnancy complication increased exponentially with BMI, except for delivery of small for gestational age neonates which decreased with BMI. Conclusions: Maternal BMI at 11–13 weeks can be combined with other maternal characteristics and obstetric history to estimate patient-specific risks for many pregnancy complications.

© 2011 S. Karger AG, Basel


  

Key Words

  • Body mass index
  • First-trimester screening
  • Miscarriage
  • Stillbirth
  • Preeclampsia
  • Diabetes mellitus, gestational
  • Preterm delivery
  • Birth weight
  • Cesarean section

References

  1. Sebire NJ, Jolly M, Harris JP, Wadsworth J, Joffe M, Beard RW, Regan L, Robinson S: Maternal obesity and pregnancy outcome: a study of 287,213 pregnancies in London. Int J Obesity 2001;25:1175–1182.
  2. O’Brien TE, Ray JG, Chan WS: Maternal body mass index and the risk of preeclampsia: a systematic overview. Epidemiology 2003;14:368–374.
  3. Cedergren MI: Maternal morbid obesity and the risk of adverse pregnancy outcome. Obstet Gynecol 2004;103:219–224.
  4. Chu SY, Kim SY, Schmid CH, Dietz PM, Callaghan WM, Lau J, Curtis KM: Maternal obesity and risk of cesarean delivery: a meta-analysis. Obes Rev 2007;8:385–394.
  5. Chu SY, Callaghan WM, Kim SY, Schmid CH, Lau J, England LJ, Dietz PM: Maternal obesity and risk of gestational diabetes mellitus. Diabetes Care 2007;30:2070–2076.
  6. Chu SY, Kim SY, Lau J, Schmid CH, Dietz PM, Callaghan WM, Curtis KM: Maternal obesity and risk of stillbirth: a metaanalysis. Am J Obstet Gynecol 2007;197:223–228.
  7. Mc Donald SD, Han Z, Mulla S, Beyene J; Knowledge Synthesis Group: Overweight and obesity in mothers and risk of preterm birth and low birth weight infants: systematic review and meta-analyses. BMJ 2010;341:c3428.

    External Resources

  8. Robinson HP, Fleming JE: A critical evaluation of sonar crown rump length measurements. Br J Obstet Gynaecol 1975;182:702–710.
  9. Snijders RJ, Noble P, Sebire NJ, Souka AP, Nicolaides KH: UK multicentre project on assessment of risk of trisomy 21 by maternal age and fetal nuchal-translucency thickness at 10–14 weeks of gestation. Fetal Medicine Foundation First Trimester Screening Group. Lancet 1998;352:343–346.
  10. Syngelaki A, Chelemen T, Dagklis T, Allan L, Nicolaides KH: Challenges in the diagnosis of fetal non-chromosomal abnormalities at 11–13 weeks. Prenat Diagn 2011;31:90–102.
  11. Brown MA, Lindheimer MD, de Swiet M, Van Assche A, Moutquin JM: The classification and diagnosis of the hypertensive disorders of pregnancy: statement from the international society for the study of hypertension in pregnancy (ISSHP). Hypertens Pregnancy 2001;20:IX–XIV.
  12. World Health Organization: Definition and Diagnosis of Diabetes Mellitus and Intermediate Hyperglycaemia. Report of a WHO/IDF consultation. Geneva, WHO, 2006, pp 1–46 (www.who.int).
  13. Poon LC, Karagiannis G, Staboulidou I, Shafiei A, Nicolaides KH: Reference range of birth weight with gestation and first-trimester prediction of small-for-gestation neonates. Prenat Diagn 2011;31:58–65.
  14. Cnattingius S, Bergstrom R, Lipworth L, Kramer MS: Prepregnancy weight and the risk of adverse pregnancy outcomes. N Engl J Med 1998;338:147–152.
  15. Kristensen J, Vestergaard M, Wisborg K, Kesmodel U, Secher NJ: Pre-pregnancy weight and the risk of stillbirth and neonatal death. BJOG 2005;112:403–408.
  16. Callaway LK, Prins JB, Chang AM, McIntyre HD: The prevalence and impact of overweight and obesity in an Australian obstetric population. Med J Aust 2006;184:56–59.
  17. Raatikainen K, Heiskanen N, Heinonen S: Transition from overweight to obesity worsens pregnancy outcome in a BMI-dependent manner. Obesity (Silver Spring) 2006;14:165–171.
  18. Bhattacharya S, Campbell DM, Liston WA, Bhattacharya S: Effect of body mass index on pregnancy outcomes in nulliparous women delivering singleton babies. BMC Public Health 2007;7:168.
  19. Sahu MT, Agarwal A, Das V, Pandey A: Impact of maternal body mass index on obstetric outcome. J Obstet Gynaecol Res 2007;33:655–659.
  20. Salihu HM, Dunlop AL, Hedayatzadeh M, Alio AP, Kirby RS, Alexander GR: Extreme obesity and risk of stillbirth among black and white gravidas. Obstet Gynecol 2007;110:552–557.
  21. Hauger MS, Gibbons L, Vik T, Belizán JM: Prepregnancy weight status and the risk of adverse pregnancy outcome. Acta Obstet Gynecol Scand 2008;87:953–959.
  22. Aydin C, Baloglu A, Yavuzcan A, Inci A: The effect of body mass index value during labor on pregnancy outcomes in Turkish population (obesity and pregnancy outcomes). Arch Gynecol Obstet 2010;281:49–54.
  23. Crane JMG, White J, Murphy P, Burrage L, Hutchens D: The effect of gestational weight gain by body mass index on maternal and neonatal outcomes. J Obstet Gynaecol Can 2009;31:28–35.

    External Resources

  24. Khashan AS, Kenny LC: The effects of maternal body mass index on pregnancy outcome. Eur J Epidemiol 2009;24:697–705.
  25. Beyer DA, Amari F, Lüdders DW, Diedrich K, Weichert J: Obesity decreases the chance to deliver spontaneously. Arch Gynecol Obstet 2011;283:981–988.
  26. Sibai BM, Ewell M, Levine RJ, Klebanoff MA, Esterlitz J, Catalano PM, Goldenberg RL, Joffe G: Risk factors associated with preeclampsia in healthy nulliparous women. The Calcium for Preeclampsia Prevention (CPEP) Study Group. Am J Obstet Gynecol 1997;177:1003–1010.
  27. Thadhani R, Stampfer MJ, Hunter DJ, Manson JE, Solomon CG, Curhan GC: High body mass index and hypercholesterolemia: risk of hypertensive disorders of pregnancy. Obstet Gynecol 1999;94:543–550.
  28. Conde-Agudelo A, Belizán JM: Risk factors for pre-eclampsia in a large cohort of Latin American and Caribbean women. BJOG 2000;107:75–83.
  29. Baeten JM, Bukusi EA, Lambe M: Pregnancy complications and outcomes among overweight and obese nulliparous women. Am J Public Health 2001;91:436–440.
  30. Ramos GA, Caughey AB: The interrelationship between ethnicity and obesity on obstetric outcomes. Am J Obstet Gynecol 2005;193:1089–1093.
  31. Rode L, Nilas L, Wojdemann K, Tabor A: Obesity-related complications in Danish single cephalic term pregnancies. Obstet Gynecol 2005;105:537–542.
  32. Vahratian A, Zhang J, Troendle JF, Savitz DA, Siega-Riz AM: Maternal pre-pregnancy overweight and obesity and the pattern of labor progression in term nulliparous women. Obstet Gynecol 2004;104:943–951.
  33. Sukalich S, MingioneMJ, Glantz JC: Obstetric outcomes in overweight and obese adolescents. Am J Obstet Gynecol 2006;195:851–855.
  34. Driul L, Cacciaguerra G, Citossi A, Martina MD, Peressini L, Marchesoni D: Prepregnancy body mass index and adverse pregnancy outcomes. Arch Gynecol Obstet 2008;278:23–26.
  35. Smith GC, Shah I, Pell JP, Crossley JA, 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.
  36. Athukorala C, Rumbold AR, Willson KJ, Crowther CA: The risk of adverse pregnancy outcomes in women who are overweight or obese. BMC Pregnancy Childbirth 2010;10:56.
  37. Dye TD, Knox KL, Artal R, Aubry RH, Wojtowycz MA: Physical activity, obesity, and diabetes in pregnancy. Am J Epidemiol 1997;146:961–965.
  38. Solomon CG, Willett WC, Carey VJ, Rich-Edwards J, Hunter DJ, Colditz GA, Stampfer MJ, Speizer FE, Spiegelman D, Manson JE: A prospective study of pregravid determinants of gestational diabetes mellitus. JAMA 1997;278:1078–1083.
  39. Di Cianni G, Volpe L, Lencioni C, Miccoli R, Cuccuru I, Ghio A, Chatzianagnostou K, Bottone P, Teti G, Del Prato S, Benzi L: Prevalence and risk factors for gestational diabetes assessed by universal screening. Diabetes Res Clin Pract 2003;62:131–137.
  40. Jensen DM, Damm P, Sorensen B, Molsted-Pedersen L, Westergaard JG, Ovesen P, Beck-Nielsen H: Pregnancy outcome and prepregnancy body mass index in 2459 glucose-tolerant Danish women. Am J Obstet Gynecol 2003;189:239–244.
  41. Gilboa SM, Correa A, Alverson CJ: Use of spline regression in an analysis of maternal prepregnancy body mass index and adverse birth outcomes: does it tell us more than we already know? Ann Epidemiol 2008;18:196–205.
  42. Young TK, Woodmansee B: Factors that are associated with cesarean delivery in a large private practice: the importance of prepregnancy body mass index and weight gain. Am J Obstet Gynecol 2002;187:312–318.
  43. Ehrenberg HM, Durnwald CP, Catalano P, Mercer BM: The influence of obesity and diabetes on the risk of cesarean delivery. Am J Obstet Gynecol 2004;191:969–974.
  44. Barau G, Robillard PY, Hulsey TC, Dedecker F, Laffite A, Gérardin P, Kauffmann E: Linear association between maternal pre-pregnancy body mass index and risk of caesarean section in term deliveries. BJOG 2006;113:1173–1177.
  45. Siega-Riz AM, Adair LS, Hobel CJ: Maternal underweight status and inadequate rate of weight gain during the third trimester of pregnancy increases the risk of preterm delivery. J Nutr 1996;126:146–153.
  46. Savitz DA, Dole N, Herring AH, Kaczor D, Murphy J, Siega-Riz AM, Thorp JM Jr, MacDonald TL: Should spontaneous and medically indicated preterm births be separated for studying aetiology? Paediatr Perinat Epidemiol 2005;19:97–105.
  47. Nicolaides KH: The 11–13 weeks assessment as the base of a new pyramid of pregnancy care. Fetal Diagn Ther 2011;29:183–196.
  48. Akolekar R, Syngelaki A, Sarquis A, Zvanca M, Nicolaides KH: Prediction of early, intermediate and late preeclampsia from maternal factors, biophysical and biochemical markers at 11–13 weeks. Prenat Diagn 2011;31:66–74.
  49. Bujold E, Roberge S, Lacasse Y, Bureau M, Audibert F, Marcoux S, Forest JC, Giguère Y: Prevention of preeclampsia and intrauterine growth restriction with aspirin started in early pregnancy: a meta-analysis. Obstet Gynecol 2010;116:402–414.
  50. Akolekar R, Bower S, Flack N, Bilardo CM, Nicolaides KH: Prediction of miscarriage and stillbirth at 11–13 weeks and the contribution of chorionic villus sampling. Prenat Diagn 2011;31:38–45.
  51. Maasilta P, Bachour A, Teramo K, Polo O, Laitinen LA: Sleep-related disordered breathing during pregnancy in obese women. Chest 2001;120:1448–1454.
  52. Goldenberg RL, Kirby R, Culhane JF: Stillbirth: a review. J Matern Fetal Neonatal Med 2004;16:79–94.
  53. Fretts RC: Etiology and prevention of stillbirth. Am J Obstet Gynecol 2005;193:1923–1935.
  54. Nanda S, Savvidou M, Syngelaki A, Akolekar R, Nicolaides KH: Prediction of gestational diabetes mellitus by maternal factors and biomarkers at 11–13 weeks. Prenat Diagn 2011;31:135–141.
  55. Nanda S, Akolekar R, Sarquis R, Mosconi AP, Nicolaides KH: Maternal serum adiponectin at 11–13 weeks’ of gestation in the prediction of macrosomia. Prenat Diagn 2010;in press.
  56. Arita Y, Kihara S, Ouchi N, Takahashi M, Maeda K, Miyagawa J, Hotta K, Shimomura I, Nakamura T, Miyaoka K, Kuriyama H, Nishida M, Yamashita S, Okubo K, Matsubara K, Muraguchi M, Ohmoto Y, Funahashi T, Matsuzawa Y: Paradoxical decrease of an adipose-specific protein, adiponectin in obesity. Biochem Biophys Res Commun 1999;257:79–83.
  57. Hotta K, Funahashi T, Arita Y, Takahashi M, Matsuda M, Okamoto Y, Iwahashi H, Kuriyama H, Ouchi N, Maeda K, Nishida M, Kihara S, Sakai N, Nakajima T, Hasegawa K, Muraguchi M, Ohmoto Y, Nakamura T, Yamashita S, Hanafusa T, Matsuzawa Y: Plasma concentrations of a novel, adipose-specific protein, adiponectin, in type 2 diabetic patients. Arterioscler Thromb Vasc Biol 2000;20:1595–1599.
  58. Saigal S, Doyle LW: An overview of mortality and sequelae of preterm birth from infancy to adulthood. Lancet 2008;371:261–269.
  59. Centre for Maternal and Child Enquiries (CMACE): Perinatal Mortality 2008: United Kingdom. London, CMACE, 2010.
  60. Celik E, To M, Gajewska K, Smith GC, Nicolaides KH; Fetal Medicine Foundation Second Trimester Screening Group: Cervical length and obstetric history predict spontaneous preterm birth: development and validation of a model to provide individualized risk assessment. Ultrasound Obstet Gynecol 2008;31:549–554.
  61. Crane SS, Wojtowycz MA, Dye TD, Aubry RH, Artal R: Association between pre-pregnancy obesity and the risk of cesarean delivery. Obstet Gynecol 1997;89:213–216.
  62. Young TK, Woodmansee B: Factors that are associated with cesarean delivery in a large private practice: the importance of prepregnancy body mass index and weight gain. Am J Obstet Gynecol 2002;187:312–318.
  63. Poobalan AS, Aucott LS, Gurung T, Smith WC, Bhattacharya S: Obesity as an independent risk factor for elective and emergency caesarean delivery in nulliparous women-systematic review and meta-analysis of cohort studies. Obes Rev 2009;10:28–35.
  64. Gardosi J, Francis A: Adverse pregnancy outcome and association with small for gestational age birthweight by customized and population-based percentiles. Am J Obstet Gynecol 2009;201:28.e1–e8.

    External Resources

  65. Gardosi J, Clausson B, Francis A: The value of customised centiles in assessing perinatal mortality risk associated with parity and maternal size. BJOG 2009;116:1356–1363.

  

Author Contacts

Prof. K.H. Nicolaides
Harris Birthright Research Centre for Fetal Medicine, King’s College Hospital
Denmark Hill
London SE5 9RS (UK)
Tel. +44 203 299 8256, E-Mail

Copyright / Drug Dosage / Disclaimer

Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher or, in the case of photocopying, direct payment of a specified fee to the Copyright Clearance Center.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in goverment regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.

Abstract

Objective: To examine the association between body mass index (BMI) at 11–13 weeks’ gestation and a wide range of adverse pregnancy outcomes after adjustment for confounding factors in obstetric history and maternal characteristics. Methods: This was a prospective screening study for adverse obstetric outcomes in women with singleton pregnancies attending for their first routine hospital visit at 11+0–13+6 weeks of gestation. The maternal weight and height were measured and the BMI was calculated. Regression analysis was performed to examine the association between BMI and each of the adverse pregnancy outcomes. Results: We examined 41,577 pregnancies with a live fetus at 11–13 weeks. There was a significant contribution from maternal BMI, in addition to maternal characteristics and obstetric history, in the prediction of subsequent miscarriage, stillbirth, preeclampsia, gestational hypertension, gestational diabetes mellitus, delivery of small and large for gestational age neonates, and both elective and emergency cesarean section, but not spontaneous preterm delivery. The risk for each pregnancy complication increased exponentially with BMI, except for delivery of small for gestational age neonates which decreased with BMI. Conclusions: Maternal BMI at 11–13 weeks can be combined with other maternal characteristics and obstetric history to estimate patient-specific risks for many pregnancy complications.

© 2011 S. Karger AG, Basel


  

Author Contacts

Prof. K.H. Nicolaides
Harris Birthright Research Centre for Fetal Medicine, King’s College Hospital
Denmark Hill
London SE5 9RS (UK)
Tel. +44 203 299 8256, E-Mail

Article / Publication Details

First-Page Preview
Abstract of Original Paper

Received: 11/17/2010
Accepted: 4/5/2011
Published online: 11/8/2011
Issue release date: December 2011

Number of Print Pages: 16
Number of Figures: 11
Number of Tables: 5

ISSN: 1015-3837 (Print)
eISSN: 1421-9964 (Online)

For additional information: http://www.karger.com/FDT


Copyright / Drug Dosage

Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher or, in the case of photocopying, direct payment of a specified fee to the Copyright Clearance Center.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in goverment regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.

References

  1. Sebire NJ, Jolly M, Harris JP, Wadsworth J, Joffe M, Beard RW, Regan L, Robinson S: Maternal obesity and pregnancy outcome: a study of 287,213 pregnancies in London. Int J Obesity 2001;25:1175–1182.
  2. O’Brien TE, Ray JG, Chan WS: Maternal body mass index and the risk of preeclampsia: a systematic overview. Epidemiology 2003;14:368–374.
  3. Cedergren MI: Maternal morbid obesity and the risk of adverse pregnancy outcome. Obstet Gynecol 2004;103:219–224.
  4. Chu SY, Kim SY, Schmid CH, Dietz PM, Callaghan WM, Lau J, Curtis KM: Maternal obesity and risk of cesarean delivery: a meta-analysis. Obes Rev 2007;8:385–394.
  5. Chu SY, Callaghan WM, Kim SY, Schmid CH, Lau J, England LJ, Dietz PM: Maternal obesity and risk of gestational diabetes mellitus. Diabetes Care 2007;30:2070–2076.
  6. Chu SY, Kim SY, Lau J, Schmid CH, Dietz PM, Callaghan WM, Curtis KM: Maternal obesity and risk of stillbirth: a metaanalysis. Am J Obstet Gynecol 2007;197:223–228.
  7. Mc Donald SD, Han Z, Mulla S, Beyene J; Knowledge Synthesis Group: Overweight and obesity in mothers and risk of preterm birth and low birth weight infants: systematic review and meta-analyses. BMJ 2010;341:c3428.

    External Resources

  8. Robinson HP, Fleming JE: A critical evaluation of sonar crown rump length measurements. Br J Obstet Gynaecol 1975;182:702–710.
  9. Snijders RJ, Noble P, Sebire NJ, Souka AP, Nicolaides KH: UK multicentre project on assessment of risk of trisomy 21 by maternal age and fetal nuchal-translucency thickness at 10–14 weeks of gestation. Fetal Medicine Foundation First Trimester Screening Group. Lancet 1998;352:343–346.
  10. Syngelaki A, Chelemen T, Dagklis T, Allan L, Nicolaides KH: Challenges in the diagnosis of fetal non-chromosomal abnormalities at 11–13 weeks. Prenat Diagn 2011;31:90–102.
  11. Brown MA, Lindheimer MD, de Swiet M, Van Assche A, Moutquin JM: The classification and diagnosis of the hypertensive disorders of pregnancy: statement from the international society for the study of hypertension in pregnancy (ISSHP). Hypertens Pregnancy 2001;20:IX–XIV.
  12. World Health Organization: Definition and Diagnosis of Diabetes Mellitus and Intermediate Hyperglycaemia. Report of a WHO/IDF consultation. Geneva, WHO, 2006, pp 1–46 (www.who.int).
  13. Poon LC, Karagiannis G, Staboulidou I, Shafiei A, Nicolaides KH: Reference range of birth weight with gestation and first-trimester prediction of small-for-gestation neonates. Prenat Diagn 2011;31:58–65.
  14. Cnattingius S, Bergstrom R, Lipworth L, Kramer MS: Prepregnancy weight and the risk of adverse pregnancy outcomes. N Engl J Med 1998;338:147–152.
  15. Kristensen J, Vestergaard M, Wisborg K, Kesmodel U, Secher NJ: Pre-pregnancy weight and the risk of stillbirth and neonatal death. BJOG 2005;112:403–408.
  16. Callaway LK, Prins JB, Chang AM, McIntyre HD: The prevalence and impact of overweight and obesity in an Australian obstetric population. Med J Aust 2006;184:56–59.
  17. Raatikainen K, Heiskanen N, Heinonen S: Transition from overweight to obesity worsens pregnancy outcome in a BMI-dependent manner. Obesity (Silver Spring) 2006;14:165–171.
  18. Bhattacharya S, Campbell DM, Liston WA, Bhattacharya S: Effect of body mass index on pregnancy outcomes in nulliparous women delivering singleton babies. BMC Public Health 2007;7:168.
  19. Sahu MT, Agarwal A, Das V, Pandey A: Impact of maternal body mass index on obstetric outcome. J Obstet Gynaecol Res 2007;33:655–659.
  20. Salihu HM, Dunlop AL, Hedayatzadeh M, Alio AP, Kirby RS, Alexander GR: Extreme obesity and risk of stillbirth among black and white gravidas. Obstet Gynecol 2007;110:552–557.
  21. Hauger MS, Gibbons L, Vik T, Belizán JM: Prepregnancy weight status and the risk of adverse pregnancy outcome. Acta Obstet Gynecol Scand 2008;87:953–959.
  22. Aydin C, Baloglu A, Yavuzcan A, Inci A: The effect of body mass index value during labor on pregnancy outcomes in Turkish population (obesity and pregnancy outcomes). Arch Gynecol Obstet 2010;281:49–54.
  23. Crane JMG, White J, Murphy P, Burrage L, Hutchens D: The effect of gestational weight gain by body mass index on maternal and neonatal outcomes. J Obstet Gynaecol Can 2009;31:28–35.

    External Resources

  24. Khashan AS, Kenny LC: The effects of maternal body mass index on pregnancy outcome. Eur J Epidemiol 2009;24:697–705.
  25. Beyer DA, Amari F, Lüdders DW, Diedrich K, Weichert J: Obesity decreases the chance to deliver spontaneously. Arch Gynecol Obstet 2011;283:981–988.
  26. Sibai BM, Ewell M, Levine RJ, Klebanoff MA, Esterlitz J, Catalano PM, Goldenberg RL, Joffe G: Risk factors associated with preeclampsia in healthy nulliparous women. The Calcium for Preeclampsia Prevention (CPEP) Study Group. Am J Obstet Gynecol 1997;177:1003–1010.
  27. Thadhani R, Stampfer MJ, Hunter DJ, Manson JE, Solomon CG, Curhan GC: High body mass index and hypercholesterolemia: risk of hypertensive disorders of pregnancy. Obstet Gynecol 1999;94:543–550.
  28. Conde-Agudelo A, Belizán JM: Risk factors for pre-eclampsia in a large cohort of Latin American and Caribbean women. BJOG 2000;107:75–83.
  29. Baeten JM, Bukusi EA, Lambe M: Pregnancy complications and outcomes among overweight and obese nulliparous women. Am J Public Health 2001;91:436–440.
  30. Ramos GA, Caughey AB: The interrelationship between ethnicity and obesity on obstetric outcomes. Am J Obstet Gynecol 2005;193:1089–1093.
  31. Rode L, Nilas L, Wojdemann K, Tabor A: Obesity-related complications in Danish single cephalic term pregnancies. Obstet Gynecol 2005;105:537–542.
  32. Vahratian A, Zhang J, Troendle JF, Savitz DA, Siega-Riz AM: Maternal pre-pregnancy overweight and obesity and the pattern of labor progression in term nulliparous women. Obstet Gynecol 2004;104:943–951.
  33. Sukalich S, MingioneMJ, Glantz JC: Obstetric outcomes in overweight and obese adolescents. Am J Obstet Gynecol 2006;195:851–855.
  34. Driul L, Cacciaguerra G, Citossi A, Martina MD, Peressini L, Marchesoni D: Prepregnancy body mass index and adverse pregnancy outcomes. Arch Gynecol Obstet 2008;278:23–26.
  35. Smith GC, Shah I, Pell JP, Crossley JA, 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.
  36. Athukorala C, Rumbold AR, Willson KJ, Crowther CA: The risk of adverse pregnancy outcomes in women who are overweight or obese. BMC Pregnancy Childbirth 2010;10:56.
  37. Dye TD, Knox KL, Artal R, Aubry RH, Wojtowycz MA: Physical activity, obesity, and diabetes in pregnancy. Am J Epidemiol 1997;146:961–965.
  38. Solomon CG, Willett WC, Carey VJ, Rich-Edwards J, Hunter DJ, Colditz GA, Stampfer MJ, Speizer FE, Spiegelman D, Manson JE: A prospective study of pregravid determinants of gestational diabetes mellitus. JAMA 1997;278:1078–1083.
  39. Di Cianni G, Volpe L, Lencioni C, Miccoli R, Cuccuru I, Ghio A, Chatzianagnostou K, Bottone P, Teti G, Del Prato S, Benzi L: Prevalence and risk factors for gestational diabetes assessed by universal screening. Diabetes Res Clin Pract 2003;62:131–137.
  40. Jensen DM, Damm P, Sorensen B, Molsted-Pedersen L, Westergaard JG, Ovesen P, Beck-Nielsen H: Pregnancy outcome and prepregnancy body mass index in 2459 glucose-tolerant Danish women. Am J Obstet Gynecol 2003;189:239–244.
  41. Gilboa SM, Correa A, Alverson CJ: Use of spline regression in an analysis of maternal prepregnancy body mass index and adverse birth outcomes: does it tell us more than we already know? Ann Epidemiol 2008;18:196–205.
  42. Young TK, Woodmansee B: Factors that are associated with cesarean delivery in a large private practice: the importance of prepregnancy body mass index and weight gain. Am J Obstet Gynecol 2002;187:312–318.
  43. Ehrenberg HM, Durnwald CP, Catalano P, Mercer BM: The influence of obesity and diabetes on the risk of cesarean delivery. Am J Obstet Gynecol 2004;191:969–974.
  44. Barau G, Robillard PY, Hulsey TC, Dedecker F, Laffite A, Gérardin P, Kauffmann E: Linear association between maternal pre-pregnancy body mass index and risk of caesarean section in term deliveries. BJOG 2006;113:1173–1177.
  45. Siega-Riz AM, Adair LS, Hobel CJ: Maternal underweight status and inadequate rate of weight gain during the third trimester of pregnancy increases the risk of preterm delivery. J Nutr 1996;126:146–153.
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    External Resources

  65. Gardosi J, Clausson B, Francis A: The value of customised centiles in assessing perinatal mortality risk associated with parity and maternal size. BJOG 2009;116:1356–1363.