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The impact of pre-pregnancy body mass index and gestational weight gain on placental abruption risk: a systematic review and meta-analysis



The aim of this systematic review was to evaluate the associations between pre-pregnancy body mass index and gestational weight gain and placental abruption.


Relevant studies were identified from PubMed, EMBASE, Scopus and CINAHL. Unpublished findings from analyses of linked population-based data sets from Western Australia (2012–2015, n = 114,792) were also included. Studies evaluating pre-pregnancy body mass index and/or gestational weight gain and placental abruption were included. Two independent reviewers evaluated studies for inclusion and quality. Data including odds ratios (ORs) and 95% confidence intervals (CIs) were extracted and analysed by random effects meta-analysis.


21 studies were included, of which 15 were eligible for meta-analyses. The summary ORs for the association of being underweight, overweight and obese, and placental abruption, compared to normal weight women, were 1.4 (95% CI 1.1, 1.7), 0.8 (95% CI 0.8, 0.9) and 0.8 (95% CI 0.7, 0.9), respectively. These findings remained unchanged when each study was eliminated from the analysis and in subgroup analyses. Although data were scarce, women with gestational weight gain below the Institute of Medicine recommendations appeared to be at greater risk of abruption compared with women who had optimal weight gain.


Mothers that are underweight prior to or in early pregnancy are at a moderately increased risk of placental abruption.

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We would like to acknowledge the Data Linkage Branch (Western Australian Government Department of Health), the Midwives’ Notification System and the Hospital Morbidity Data Collection for providing data for this project.


This research was supported by funding from an Australian National Health and Medical Research Council (NHMRC) Project Grant (APP1127265) which funded AAA, CCJS, FJL and HDB. BMF is also funded by an NHRMC Project Grant (APP1098844). The funding bodies had no part in either the study design, conduct, analysis or interpretation of this study nor the decision to submit this study for publication.

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AAA, HDB, CCJS and FJL designed and conceptualised the study. AAA performed the database searches, data extraction, evaluation and analyses and drafted the manuscript. HDB participated in data extraction, evaluation and analyses. HDB, CCJS, BMF, FJL and SWW critically revised the manuscript. All authors reviewed and approved the final version.

Corresponding author

Correspondence to Akilew A. Adane.

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For the review part, ethics approval was not required. All procedures performed in studies involving human participants were in accordance with the ethical standards of the WA Aboriginal Health Ethics Committee (project 797) and the WA Department of Health Human Research Ethics Committee (project 2016/51) and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

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Adane, A.A., Shepherd, C.C.J., Lim, F.J. et al. The impact of pre-pregnancy body mass index and gestational weight gain on placental abruption risk: a systematic review and meta-analysis. Arch Gynecol Obstet 300, 1201–1210 (2019).

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  • Placental abruption
  • Maternal obesity
  • Underweight
  • Gestational weight gain
  • Systematic review
  • Meta-analysis