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Morbid obesity increases chance of extreme preemie by 3X (low vitamin D not mentioned) – June 2013

Maternal obesity and risk of preterm delivery.

JAMA. 2013 Jun 12;309(22):2362-70. doi: 10.1001/jama.2013.6295.
Cnattingius S, Villamor E, Johansson S, Edstedt Bonamy AK, Persson M, Wikström AK, Granath F.
Clinical Epidemiology Unit, T2, Department of Medicine Solna, Karolinska University Hospital, Karolinska Institutet, SE-171 76 Stockholm, Sweden. sven.cnattingius at ki.se

IMPORTANCE: Preterm birth is a leading cause of infant mortality, morbidity, and long-term disability, and these risks increase with decreasing gestational age. Obesity increases the risk of preterm delivery, but the associations between overweight and obesity and subtypes of preterm delivery are not clear.

OBJECTIVE: To study the associations between early pregnancy body mass index (BMI) and risk of preterm delivery by gestational age and by precursors of preterm delivery.

DESIGN, SETTING, AND PARTICIPANTS: Population-based cohort study of women with live singleton births in Sweden from 1992 through 2010. Maternal and pregnancy characteristics were obtained from the nationwide Swedish Medical Birth Register.

MAIN OUTCOMES AND MEASURES: Risks of preterm deliveries (extremely, 22-27 weeks; very, 28-31 weeks; and moderately, 32-36 weeks). These outcomes were further characterized as spontaneous (related to preterm contractions or preterm premature rupture of membranes) and medically indicated preterm delivery (cesarean delivery before onset of labor or induced onset of labor). Risk estimates were adjusted for maternal age, parity, smoking, education, height, mother's country of birth, and year of delivery.

RESULTS: Among 1,599,551 deliveries with information on early pregnancy BMI, 3082 were extremely preterm, 6893 were very preterm, and 67,059 were moderately preterm. Risks of extremely, very, and moderately preterm deliveries increased with BMI and the overweight and obesity-related risks were highest for extremely preterm delivery. Among normal-weight women (BMI 18.5-<25), the rate of extremely preterm delivery was 0.17%. As compared with normal-weight women, rates (%) and adjusted odds ratios (ORs [95% CIs]) of extremely preterm delivery were as follows:

  • BMI 25 to less than 30 (0.21%; OR, 1.26; 95% CI, 1.15-1.37),
  • BMI 30 to less than 35 (0.27%; OR, 1.58; 95% CI, 1.39-1.79),
  • BMI 35 to less than 40 (0.35%; OR, 2.01; 95% CI, 1.66-2.45), and
  • BMI of 40 or greater (0.52%; OR, 2.99; 95% CI, 2.28-3.92).

Risk of spontaneous extremely preterm delivery increased with BMI among obese women (BMI≥30). Risks of medically indicated preterm deliveries increased with BMI among overweight and obese women.

CONCLUSIONS AND RELEVANCE: In Sweden, maternal overweight and obesity during pregnancy were associated with increased risks of preterm delivery, especially extremely preterm delivery. These associations should be assessed in other populations.

Comment in: Obesity: effect of maternal obesity on neonatal outcomes. [Nat Rev Endocrinol. 2013]

PMID: 23757084


See also VitaminDWiki

See also web

  • Losing weight for baby: Mom's obesity linked to extreme preemies NBC News on this study: Sept 2013
    extremely premature birth — babies born between 22 and 27 weeks
    “When a baby is born earlier than it should be born, the potential for all the organs not being fully developed is increased,”
    “When it comes to being obese and being pregnant, the risk factors for things going wrong multiply very quickly,” Cooper told NBC News. “Along with that comes gestational diabetes, hypertension, and preeclampsia, which can eventually lead to eclampsia, which is a condition where seizures occur.”
    Note by VitaminDWiki - all of those health problems are associated with low vitamin D
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