ArticlePaediatric and perinatal epidemiology2020
Risk of severe maternal morbidity in relation to prepregnancy body mass index: Roles of maternal co-morbidities and caesarean birth.
Article in Paediatric and perinatal epidemiology, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 21 papers, 1 of them a synthesis that pooled it.
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Who cites it
21 citing papers in PubMed, 1 synthesis or guideline pooled it.
- Global trends in prevalence of maternal overweight and obesity: A systematic review and meta-analysis of routinely collected data retrospective cohorts.International journal of population data science · 2024Pooled it
- Motivations for and experience with labor induction at 39 weeks in women with obesity-A qualitative study.Acta obstetricia et gynecologica Scandinavica · 2025Trial
- Maternal Obesity and Obstetric Outcomes in a Socially Vulnerable Region Within Brazil's Unified Health System.Cureus · 2025Article
- Obesity and cesarean section rate among low-risk primiparous women in Victoria, Australia: A population-based study.Acta obstetricia et gynecologica Scandinavica · 2025Article
- Antihypertensive Medication Use before and during Pregnancy and the Risk of Severe Maternal Morbidity in Individuals with Prepregnancy Hypertension.American journal of perinatology · 2024Article
- Neighborhood gentrification, displacement, and severe maternal morbidity in California.Social science & medicine (1982) · 2023Article
- Remapping racial and ethnic inequities in severe maternal morbidity: The legacy of redlining in California.Paediatric and perinatal epidemiology · 2023Article
- Postpartum Hospital Readmissions With and Without Severe Maternal Morbidity Within 1 Year of Birth, Oregon, 2012-2017.American journal of epidemiology · 2023Article
- Severe maternal morbidity in Scotland.Anaesthesia · 2022Article
- Association of Prepregnancy Body Mass Index With Risk of Severe Maternal Morbidity and Mortality Among Medicaid Beneficiaries.JAMA network open · 2022Article
- Interpregnancy weight change: associations with severe maternal morbidity and neonatal outcomes.American journal of obstetrics & gynecology MFM · 2022Observational
- Induction of labour at 39 weeks versus expectant management in low-risk obese women: study protocol for a randomised controlled study.BMJ open · 2022Article
- Antepartum severe maternal morbidity: A population-based study of risk factors and delivery outcomes.Paediatric and perinatal epidemiology · 2022Article
- Development and validation of a risk prediction index for severe maternal morbidity based on preconception comorbidities among infertile patients.Fertility and sterility · 2021Observational
- Municipality-Level Variation in Severe Maternal Morbidity and Association With Municipal Expenditures in New Jersey.JAMA network open · 2021Article
- Severe Maternal Morbidity: A Comparison of Definitions and Data Sources.American journal of epidemiology · 2021Article
- A scoping review of severe maternal morbidity: describing risk factors and methodological approaches to inform population-based surveillance.Maternal health, neonatology and perinatology · 2021Article
- Severe maternal morbidity among U.S.- and foreign-born Asian and Pacific Islander women in California.Annals of epidemiology · 2020Article
- An Expanded Obstetric Comorbidity Scoring System for Predicting Severe Maternal Morbidity.Obstetrics and gynecology · 2020Article
- Weight gain during pregnancy and the risk of severe maternal morbidity by prepregnancy BMI.The American journal of clinical nutrition · 2020Article
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5 authors.
Funding
Abstract
backgroundAn association between prepregnancy body mass index (BMI) and severe maternal morbidity (SMM) has been reported, but evidence has been mixed and potential explanations have not been examined.
objectiveTo evaluate the association between prepregnancy BMI and SMM in a large, diverse birth cohort and assess potential mediation by obesity-related co-morbidities and caesarean birth.
methodsThis cohort study used linked birth certificate and hospitalisation discharge records from Californian births during 2007-2012. We assessed associations between prepregnancy BMI and SMM, and used inverse probability weighting for multiple mediators to estimate relative and absolute natural direct and indirect effects accounting for mediation by co-morbidities (hypertensive conditions, diabetes, asthma) and caesarean birth.
resultsAmong 2 650 182 births, the prevalence of SMM was 1.42%. Adjusted risk ratios for the total association between prepregnancy BMI category and SMM were 1.12 (95% confidence interval [CI] 1.07, 1.18) for underweight, 1.02 (95% CI 0.99, 1.04) for overweight, 1.04 (95% CI 1.00, 1.07) for obesity class 1, 1.14 (95% CI 1.09, 1.20) for obesity class 2, and 1.28 (95% CI 1.22, 1.36) for obesity class 3 compared to women with normal weight. After accounting for mediation by co-morbidity and caesarean birth, the risk ratios were 1.19 (95% CI 1.14, 1.26) for underweight, 0.91 (95% CI 0.89, 0.94) for overweight, 0.86 (95% CI 0.84, 0.89) for obesity class 1, 0.88 (95% CI 0.84, 0.92) for obesity class 2, and 0.89 (95% CI 0.83, 0.95) for obesity class 3.
conclusionsCo-morbidities and caesarean birth explained an association between high prepregnancy BMI and SMM. These findings suggest that promotion of healthy prepregnancy weight, along with management of co-morbidities and support of vaginal birth in pregnant women with high BMI, could reduce the risk of SMM. However, these mediators did not reduce the elevated risk of SMM observed in women with low BMI.
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