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Effect of pre-pregnancy body mass index on adverse pregnancy outcome in north of China

  • Materno-fetal Medicine
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Archives of Gynecology and Obstetrics Aims and scope Submit manuscript



To investigate the effect of pre-pregnancy BMI on adverse maternal and neonatal outcomes in pregnancy women of northern China.


We conducted a retrospective population-based cohort study of 5,047 singleton nulliparous pregnancies. The subjects were categorized into four groups by BMI-underweight (BMI < 18.5 kg/m2), normal (BMI 18.5–24 kg/m2), overweight (BMI 24–28 kg/m2) and obese (BMI ≥ 28 kg/m2). Logistic regression was used to adjust the potential confounder. Maternal and neonatal outcomes were evaluated with relative risks and 95% confidence intervals.


11.5, 63.4, 18.3, and 6.8% of the subjects were underweight, normal BMI, overweight and obese, respectively. Compared with women of normal BMI, the risk of the following outcomes was significantly increased in overweight and obese women and expressed as [adjusted RR (95% confidence interval)] respectively: pre-eclampsia [2.99 (2.21–4.06), 5.68 (3.97–8.11)]; gestational diabetes [2.49 (1.82–3.39), 4.35 (3.00–6.31)]; premature rupture of the membranes [1.64 (1.20–2.23), 1.73 (1.11–2.72)]; abruption placentae [1.84 (1.19–2.87), 2.79 (1.60–4.83)]; cesarian section [1.47 (1.27–1.70), 2.51 (1.97–3.20)]; postpartum hemorrhage [2.31 (1.51–3.54), 3.73 (2.37–5.04)]; perineal rupture [2.89 (1.44–5.81), 3.36 (1.55–7.30)]; large-for-gestational age [1.46 (1.02–2.08), 1.91 (1.17–3.10)]. However, anemia (2.54, 1.15–5.63), small-for-gestational age (1.67, 1.07–2.61) were significantly more common in the underweight group.


The prevalence of overweight and obesity in women of northern China is much lower than in the Caucasian population or Chinese in Hong Kong. The increased maternal BMI is associated with many adverse pregnancy outcomes and its risk increases with the degree of obesity. Maternal underweight has a protective effect although increases the risk of having small-for-gestational age baby and anemia.

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  1. Hedley AA, Ogden CL, Johnson CL, Carroll MD, Curtin LR, Flegal KM (2004) Prevalence of overweight and obesity among US children, adolescents, and adults, 1999–2002. JAMA 291:2847–2850

    Article  CAS  PubMed  Google Scholar 

  2. Sebire NJ, Jolly M, Harris JP, Wadsworth J, Joffe M, Beard RW, Regan L, Robinson S (2001) Maternal obesity and pregnancy outcome: a study of 287, 213 pregnancies in London. Int J Obesity 25:1175–1182

    Article  CAS  Google Scholar 

  3. Rode L, Nilas L, Wojdemann K, Tabor A (2005) Obesity-related complications in Danish single cephalic term pregnancies. Obstet Gynecol 105:537–542

    Article  PubMed  Google Scholar 

  4. Kristensen J, Vestergaard M, Wisborg K, Kesmodel U, Secher NJ (2005) Pre-pregnancy weight and the risk of stillbirth and neonatal death. BJOG 112:403–408

    Article  PubMed  Google Scholar 

  5. Cedergren MI (2004) Maternal morbid obesity and the risk of adverse pregnancy outcome. Obstet Gynecol 103:219–224

    Article  PubMed  Google Scholar 

  6. Cnattingius S, Berfstrom R, Lipworth L, Kramer MS (1998) Prepregnancy weight and the risk of adverse pregnancy outcomes. N Engl J Med 338:147–152

    Article  CAS  PubMed  Google Scholar 

  7. Kiran UTS, Hemmadi S, Bethel J, Evans J (2005) Outcome of pregnancy in a woman with an increased body mass index. BJOG 112:768–772

    Article  Google Scholar 

  8. Smith GCS, Shah I, Pell JP, Crossley JA, Dobbie R (2007) Maternal obesity in early pregnancy and risk of spontaneous and elective preterm deliveries: a retrospective cohort study. Am J Public Health 97:157–162

    Article  PubMed  Google Scholar 

  9. Stothard KJ, Tennant PW, Bell R, Rankin J (2009) Maternal overweight and obesity and the risk of congenital anomalies: a systematic review and meta-analysis. JAMA 301(6):636–650

    Article  CAS  PubMed  Google Scholar 

  10. Sohinee B, Doris MC, William AL, Siladitya B (2007) Effect of Body Mass Index on pregnancy outcomes in nulliparous women delivering singleton babies. BMC Public Health 7:168

    Article  Google Scholar 

  11. Leung T, Leung T, Sahota D, Chan O, Chan L, Fung T, Lau T (2008) Trends in maternal obesity and associated risks of adverse pregnancy outcomes in a population of Chinese women. BJOG 115:1529–1537

    Article  CAS  PubMed  Google Scholar 

  12. Working Group on Obesity in China, Department of Disease Control, Ministry of Health (2004) The guildelines for prevention and control of overweight and obesity in Chinese adults. Biomed Environ Sci 17:1–35

    Google Scholar 

  13. Razak F, Anand SS, Shannon H, Vuksan V, Davis B, Jacobs R et al (2007) Defining obesity cut points in a multiethnic population. Circulation 115:2111–2118

    Google Scholar 

  14. Zhang XF, Attia J, D’Este K, Yu XH, Wu XG (2004) Prevalence and magnitude of classical risk factors for coronary heart disease in a cohort of 4400 Chinese steelworkers over 13.5 years follow-up. Eur J Cardiovasc Prev Rehabil 11:113–120

    Article  PubMed  Google Scholar 

  15. O’Brien TE, Ray JG, Chan WS (2003) Maternal body mass index and the risk of preeclampsia: a systematic review. Epidemiology 14:368–374

    Article  PubMed  Google Scholar 

  16. Torloni MR, Betran AP, Horta BL, Nakamura MU, Atallah AN, Moron AF, Valente O (2009) Prepregnancy BMI and the risk of gestational diabetes: a systematic review of the literature with meta-analysis. Obes Rev 10(2):194–203

    Article  CAS  PubMed  Google Scholar 

  17. Bastani P, Hamdi K, Najafi H (2008) Risk factors for preeclampsia in multigravida women. Res J Biol Sci 3(1):148–153

    Google Scholar 

  18. Haeri S, Guichard I, Baker AM, Saddlemire S, Boqqess KA (2009) The effect of teenage maternal obesity perinatal outcomes. Obstet Gynecol 113(2pt1):300–304

    PubMed  Google Scholar 

  19. Denison FC, Price J, Graham C et al (2008) Maternal obesity, length of gestation, risk of postdates pregnancy and spontaneous onset of labour at term. BJOG 115:720–725

    Article  CAS  PubMed  Google Scholar 

  20. Feng L, Yue Y (2002) Analysis on the 45-year caesarean section rate and its social factors. Med Soc 15:14–16

    Google Scholar 

  21. Lei H, Wen SW, Walker M (2003) Determinants of caesarean delivery among women hospitalized for childbirth in a remote population in China. J Obstet Gynaecol Can 25:937–943

    PubMed  Google Scholar 

  22. Chereshneva M, Hinkson L, Oteng-Ntim E (2008) The effects of booking body mass index on obstetric and neonatal outcomes in an inner city UK tertiary referral centre. Obstet Med 1:88–91

    Article  Google Scholar 

  23. Salihu HM, Lynch O, Alio AP et al (2009) Extreme obesity and risk of placental abruption. Hum Reprod 24(2):438–444

    Article  CAS  PubMed  Google Scholar 

  24. Abenheim HA, Kinch RA, Morin L, Benjamin A, Usher R (2007) Effect of prepregnancy body mass index categories on obstetrical and neonatal outcomes. Arch Gynecol Obstet 275:39–43

    Article  Google Scholar 

  25. Klimaviciute A, Calciolari J, Bertucci E, Abelin-Tornblomm S, Stjernhholm-Vladic Y, Bystrom B, Petraglia F, Ekman-Ordeberg G (2006) Corticotropin-releasing hormone, its binding protein and receptors in human cervical tissue at preterm and term labor in comparison to non-pregnancy state. Reprod Biol Endocrinol 31:4–29

    Google Scholar 

  26. Voiqt M, Straube S, Zyqmunt M, Krafczyk B, Schneider KT, Briese V (2008) Obesity and pregnancy—a risk profile. Z Geburtshilfe Neonatol 212(6):201–205

    Article  Google Scholar 

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We thank Prof Liu Yang for helping with collecting the data. We are grateful to M. D. Feng Wang for critical revision of the manuscript.

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We declare that we have no conflict of interest.

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Correspondence to Juan Du.

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Liu, X., Du, J., Wang, G. et al. Effect of pre-pregnancy body mass index on adverse pregnancy outcome in north of China. Arch Gynecol Obstet 283, 65–70 (2011).

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