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

Abstract

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.

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“…The report by Cheney and colleagues in this issue of the MJA clearly shows the increasing contribution by the effects of overweight and obesity during pregnancy to adverse perinatal outcomes 1 . The authors analysed pregnancy outcomes at a large teaching hospital in central Sydney, and found that the population attributable fractions (PAFs) of pre‐eclampsia, gestational diabetes, and fetal macrosomia associated with overweight and obesity (defined by maternal body mass index [BMI] categories) have risen significantly during the past 25 years.…”

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“…The rising burden of obesity has resulted in an increasing number of overweight and obese women entering pregnancy (Huda, Brodie, & Sattar, 2010)]. These mothers are more likely to have infants with increased birth weight, macrosomia, higher neonatal fat mass at birth and a host of other adverse neonatal outcomes (Cheney et al, 2018). Eventually, these children carry a greater risk of being obese and developing related metabolic disorders such as diabetes and cardiovascular diseases later in life (Gaillard, 2015) (Glastras, Chen, Pollock, & Saad, 2018).…”

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“…Preconception health has a direct impact on maternal and fetal outcomes, as well as longer-term health outcomes for mothers and their children (1,2). The need for improved preconception care has been brought into focus by rising rates of complications associated with maternal overweight and obesity (3) and an increased prevalence of preterm births (4,5). Preconception can be broadly defined as encompassing all women of reproductive age.…”