Maternal and Child Health Journal

, Volume 22, Issue 6, pp 893–902 | Cite as

Maternal Obesity and Risk of Preterm Birth and Low Birthweight in Hawaii PRAMS, 2000–2011

  • Alana C. Ju
  • Melvin B. Heyman
  • Andrea K. Garber
  • Janet M. WojcickiEmail author


Objective Maternal obesity is a risk factor for preterm birth, a leading cause of infant morbidity and mortality. Native Hawaiian and other Pacific Islanders (NHOPI) have high rates of poor birth outcomes. Despite the high rates of obesity in NHOPI in Hawaii, the association with preterm birth has not been examined in this population. Methods We performed a retrospective cohort study of 20,061 women using data collected by Hawaii’s Pregnancy Risk Assessment Monitoring System (PRAMS) from 2000 to 2011. We investigated the contribution of maternal age, pre-pregnancy BMI, gestational diabetes, hypertension, race, socioeconomic status, and smoking to our primary outcomes of preterm birth and low birthweight using multivariable logistic regression, stratified by NHOPI versus non-NHOPI race. Results Pre-pregnancy obesity was more common in NHOPI than non-NHOPI women (23.9 and 10.5%, respectively; p < 0.01). Overall, the risk for preterm birth increased with maternal obesity (BMI ≥ 30.0; aOR = 1.24, 95% CI 1.06–1.45, p < 0.01), compared with normal weight women. Among NHOPI women, the prevalence of preterm birth was elevated compared with non-NHOPI women although the prevalence of low birth weight was lower. After adjusting for confounders, risk for preterm birth and low birth weight were elevated in NHOPI women compared with White women. Maternal obesity did not significantly affect the risk of prematurity within the NHOPI group. Conclusions for Practice Our study demonstrates an association between maternal pre-pregnancy obesity and preterm deliveries in Hawaii. NHOPI have high rates of pre-pregnancy obesity as well as increased risk of both preterm delivery and low birthweight when compared to White women. Further data are needed to assess interactions between race, maternal health, and neonatal morbidity, and to identify ways to improve birth outcomes for minority populations in the state of Hawaii.


Obesity Hawaii Native Hawaiian Prematurity Preterm birth Low birthweight PRAMS 



Pregnancy Risk Assessment Monitoring System


Native Hawaiian and Other Pacific Islander


Low birthweight


Author Contributors

Dr. Ju conceptualized and designed the study, carried out the data analysis, drafted the initial manuscript, and approved the final manuscript as submitted. Dr. Wojcicki advised on study design and data analysis, reviewed and revised the manuscript, and approved the final manuscript as submitted. Drs. Heyman and Garber critically reviewed the manuscript and approved the final manuscript as submitted.


Alana Ju is supported by the UCSF Pathway to Discovery Program in Clinical and Translational Research. Dr. Garber’s time was supported in part by the Maternal and Child Health Bureau, Leadership and Education in Adolescent Health Training Grant, Project #5T71MC0000. Dr. Wojcicki is supported by an NIH NIDDK 080825 award. The project was supported by the Centers for Disease Control and Prevention (CDC) and Hawaii PRAMS. The funding was provided by UCSF Pathway to Discovery Program in Clinical Research, Maternal and Child Health Bureau (Grant No. 5T71MC0000).

Compliance with Ethical Standards

Conflict of interest

The authors have no conflicts of interest relevant to this article to disclose.


  1. Aviram, A., Hod, M., & Yogev, Y. (2011). Maternal obesity: implications for pregnancy outcome and long-term risks: A link to maternal nutrition. International Journal of Gynecology & Obstetrics, 115, S6-10.CrossRefGoogle Scholar
  2. Blomberg, M. (2013). Maternal obesity, mode of delivery, and neonatal outcome. Obstet Gynecol, 122, 50–55.CrossRefPubMedGoogle Scholar
  3. Casey, P. H. (2008). Growth of low birth weight preterm children. Seminars in Perinatology, 32, 20–27.CrossRefPubMedGoogle Scholar
  4. CDC. (2013). Health Behaviors of Adults: United States, 2008–2010. Table 6.1. Online. Available:
  5. Cnattingius, S., Villamor, E., Johansson, S., et al. (2013). Maternal obesity and risk of preterm delivery. JAMA, 309, 2362–2370.CrossRefPubMedGoogle Scholar
  6. Flegal, K. M., Carroll, M. D., Kit, B. K., & Ogden, C. L. (2012). Prevalence of obesity and trends in the distribution of body mass index among US adults, 1999–2010. JAMA, 307, 491–497.CrossRefPubMedGoogle Scholar
  7. Gluckman, P. D., Hanson, M. A., Cooper, C., & Thornburg, K. L. (2008). Effect of in utero and early-life conditions on adult health and disease. NEJM, 359, 61–73.CrossRefPubMedPubMedCentralGoogle Scholar
  8. Hayes, D., Shor, R., Pieron, P., Roberson, E., & Fuddy, L. (2010). Premature birth fact health. Honolulu, HI: Hawai’I Department of Health, Family Health Services Division.Google Scholar
  9. Hayes, D. K., Mitchell, K. M., Donohoe-Mather, C., Zaha, R. L., Melcher, C., & Fuddy, L. J. (2014). Predictors of exclusive breastfeeding at least 8 weeks among Asian and Native Hawaiian or other Pacific Islander race subgroups in Hawaii, 2004–2008. Maternal and Child Health Journal, 18, 1215–1223.CrossRefPubMedPubMedCentralGoogle Scholar
  10. Hayes, D. K., Ta, V. M., Hurwitz, E. L., Mitchell-Box, K. M., & Fuddy, L. J. (2010). Disparities in self-reported postpartum depression among Asian, Hawaiian, and Pacific Islander women in Hawaii: Pregnancy Risk Assessment Monitoring System (PRAMS), 2004–2007. Maternal and Child Health Journal, 14, 765–773.CrossRefPubMedGoogle Scholar
  11. Hirai, A. H., Hayes, D. K., Taualii, M. M., Singh, G. K., & Fuddy, L. J. (2013). Excess infant mortality among Native Hawaiians: Identifying determinants for preventive action. American Journal of Public Health, 103, e88-95.CrossRefPubMedGoogle Scholar
  12. Hixon, L., Hepler, B. B., & Kim, M. O. (2010).The Native Hawaiian and Other Pacific Islander Population. US. Census Bureau Briefs, 2012. Available
  13. Ikeda, N. (2016) Validity of Self-Reports of Height and Weight among the General Adult Population in Japan: Findings for National Household Surveys, 1986. PLoS ONE, 11(2), e0148297.CrossRefPubMedPubMedCentralGoogle Scholar
  14. Kulie, T., Slattengren, A., Redmer, J., Counts, H., Eglash, A., & Schrager, S. (2011). Obesity and women’s health: An evidence-based review. Journal of the American Board of Family Medicine, 24, 75–85.CrossRefPubMedGoogle Scholar
  15. Lo, W., Rai, R., Hameed, A., Brailsford, S. R., Al-Ghamdi, A. A., & Regan, L. (2012). The effect of body mass index on the outcome of pregnancy in women with recurrent miscarriage. Journal of Family & Community Medicine, 19, 167–171.CrossRefGoogle Scholar
  16. Madan, A., Archambeau, O. G., Milsom, V. A., et al. (2012). More than Black and White: Differences in predictors of obesity among Native Hawaiian/Pacific Islanders and European Americans. Obesity, 20, 1325–1328.CrossRefPubMedPubMedCentralGoogle Scholar
  17. McDonald, S. D., Han, Z., Mulla, S., Beyene, J., & Knowledge Synthesis Group. (2010) Overweight and obesity in mothers and risk of preterm birth and low birth weight infants: Systematic review and meta-analyses. BMJ. 341, c3428.CrossRefPubMedPubMedCentralGoogle Scholar
  18. Moy, K. L., Sallis, J. F., & David, K. J. (2010). Health indicators of Native Hawaiian and Pacific Islanders in the Unted States. Journal of Community Health, 35, 81–92.CrossRefPubMedGoogle Scholar
  19. National Center for Health Statistics (NCHS). Final natality data. Online. Retrieved January 14, 2014, from
  20. Nodine, P. M., & Hastings-Tolsma, M. (2012). Maternal obesity: Improving pregnancy outcomes. MCN: The American Journal of Maternal/Child Nursing, 37, 110–115.Google Scholar
  21. Paré, E., Parry, S., McElrath, T. F., Pucci, D., Newton, A., & Lim, K. H. (2014). Clinical risk factors for preeclampsia in the 21st century. Obstetrics & Gynecology, 124, 763–770.CrossRefGoogle Scholar
  22. Qin, C., & Gould, J. B. (2010). Maternal nativity status and birth outcomes in Asian immigrants. Journal of Immigrant and Minority Health, 12, 798–805.CrossRefPubMedGoogle Scholar
  23. Schempf, A. H., Mendola, P., Hamilton, B. E., Hayes, D. K., & Makuc, D. M. (2010). Perinatal outcomes for Asian, Native Hawaiian, and other Pacific Islander mothers of single and multiple race/ethnicity: California and Hawaii, 2003–2005. American Journal of Public Health, 100, 877–887.CrossRefPubMedPubMedCentralGoogle Scholar
  24. Sharifzadeh, F., Kashanian, M., Jouhari, S., & Sheikhansari, N. (2014) Relationship between pre-pregnancy maternal BMI with spontaneous preterm delivery. Journal of Obstetrics and Gynaecology. 10, 1–4.Google Scholar
  25. Shulman, H. B., Gilbert, B. C., & Lansky, A. (2006). The Pregnancy Risk Assessment Monitoring System (PRAMS): Current methods and evaluation of 2001 response rates. Public Health Reports, 121, 74–83.CrossRefPubMedPubMedCentralGoogle Scholar
  26. Simmons, D. (2011). Diabetes and obesity in pregnancy. Best Practice & Research Clinical Obstetrics & Gynaecology, 25(1), 25–36.CrossRefGoogle Scholar
  27. Tang, W., Aggarwal, A., Moudon, A. V., & Drewnowski, A. (2016). Self-reported and measured weights and heights among Seattle and King County. BMC Obesity, 3, 11.CrossRefPubMedPubMedCentralGoogle Scholar
  28. Torloni, M. R., Betran, A. P., Daher, S., Widmer, M., Dolan, S. M., Menon, R., Bergel, E., Allen, T., & Merialdi, M. (2009). Maternal BMI and preterm birth: A systematic review of the literature with meta-analysis. Journal of Maternal-Fetal and Neonatal Medicine, 22, 957–970.CrossRefPubMedGoogle Scholar
  29. Tsai, P. J., Roberson, E., & Dye, T. (2013). Gestational diabetes and macrosomia by race/ethnicity in Hawaii. BMC Research Notes, 6, 395.CrossRefPubMedPubMedCentralGoogle Scholar
  30. Vasylyeva, T. L., Barche, A., Chennasamudram, S. P., Sheehan, C., Singh, R., & Okogbo, M. E. (2013). Obesity in prematurely born children and adolescents: Follow up in pediatric clinic. Nutrition Journal, 12, 150.CrossRefPubMedPubMedCentralGoogle Scholar
  31. Yogev, Y., & Catalano, P. M. (2009). Pregnancy and Obesity. Obstetrics & Gynecology Clinics of North America, 36, 285–300.CrossRefGoogle Scholar
  32. Yu, Z., Han, S., Zhu, J., Sun, X., Ji, C., & Guo, X. (2013). Pre-pregnancy body mass index in relation to infant birth weight and offspring overweight/obesity: A systemic review and meta-analysis. PLoS ONE, 8, e61627.CrossRefPubMedPubMedCentralGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  • Alana C. Ju
    • 1
  • Melvin B. Heyman
    • 1
  • Andrea K. Garber
    • 1
    • 2
  • Janet M. Wojcicki
    • 1
    Email author
  1. 1.Department of PediatricsUniversity of California San FranciscoSan FranciscoUSA
  2. 2.University of California Berkeley School of Public HealthBerkeleyUSA

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