Maternal and Child Health Journal

, Volume 20, Issue 3, pp 655–664 | Cite as

Prepregnancy Obesity and Birth Outcomes

  • Susan L. AverettEmail author
  • Erin K. Fletcher


Objective To investigate the association between prepregnancy obesity and birth outcomes using fixed effect models comparing siblings from the same mother. Methods A total of 7496 births to 3990 mothers from the National Longitudinal Survey of Youth 1979 survey are examined. Outcomes include macrosomia, gestational length, incidence of low birthweight, preterm birth, large and small for gestational age (LGA, SGA), c-section, infant doctor visits, mother’s and infant’s days in hospital post-partum, whether the mother breastfed, and duration of breastfeeding. Association of outcomes with maternal pre-pregnancy obesity was examined using Ordinary Least Squares (OLS) regression to compare across mothers and fixed effects to compare within families. Results In fixed effect models we find no statistically significant association between most outcomes and prepregnancy obesity with the exception of LGA, SGA, low birth weight, and preterm birth. We find that prepregnancy obesity is associated with a with lower risk of low birthweight, SGA, and preterm birth but controlling for prepregnancy obesity, increases in GWG lead to increased risk of LGA. Conclusions Contrary to previous studies, which have found that maternal obesity increases the risk of c-section, macrosomia, and LGA, while decreasing the probability of breastfeeding, our sibling comparison models reveal no such association. In fact, our results suggest a protective effect of obesity in that women who are obese prepregnancy have longer gestation lengths, and are less likely to give birth to a preterm or low birthweight infant.


Infant health Birth outcomes BMI Maternal obesity Gestational weight gain 


  1. 1.
  2. 2.
    McDonald, S. D., Han, Z., Mulla, S., & Beyene, J. (2010). Overweight and obesity in mothers and risk of preterm birth and low birth weight infants: systematic review and meta-analyses. BMJ: British Medical Journal. pp. 341–359.Google Scholar
  3. 3.
    Lu, G. C., Rouse, D. J., DuBard, M., Cliver, S., Kimberlin, D., & Hauth, J. C. (2001). The effect of increasing prevalence of maternal obesity on perinatal morbidity. American Journal of Obstetrics & Gynecology, pp. 845–849.Google Scholar
  4. 4.
    Rowlands, I., Graves, N., De Jersey, S., McIntyre, H. D., & Callaway, L. (2001). Obesity in pregnancy: outcomes and economics. Seminars in Fetal and Neonatal Medicine, 15(2), 94–99. WB Saunders..CrossRefGoogle Scholar
  5. 5.
    Institute of Medicine (US) and National Research Council (US). (2009). Committee to reexamine IOM pregnancy weight guidelines. In K. M. Rasmussen, & A. L. Yaktine (Eds.), Weight gain during pregnancy: reexamining the guidelines. Washington: National Academies Press (US); Summary.
  6. 6.
    Catalano, P. M. (2003). Obesity and pregnancy—the propagation of a viscous cycle? The Journal of Clinical Endocrinology and metabolism, 88, 8.CrossRefGoogle Scholar
  7. 7.
    Ludwig, D. S., & Currie, J. (2010). The association between pregnancy weight gain and birth weight: A within-family comparison. Lancet, 376(9745), 984–990.PubMedCentralCrossRefPubMedGoogle Scholar
  8. 8.
    Lawlor, D. A., Lichtenstein, P., Fraser, A., & Långström, N. (2011). Does maternal weight gain in pregnancy have long-term effects on offspring adiposity? A sibling study in a prospective cohort of 146,894 men from 136,050 families. The American Journal of Clinical Nutrition, 94(1), 142–148.PubMedCentralCrossRefPubMedGoogle Scholar
  9. 9.
    Ehrenberg, H. M., Mercer, B. M., & Catalano, P. M. (2004). The influence of obesity and diabetes on the prevalence of macrosomia. American Journal of Obstetrics & Gynecology, 191, 964–968.CrossRefGoogle Scholar
  10. 10.
    Siega-Riz, A. M., & Laraia, B. (2000). The implications of maternal overweight and obesity on the course of pregnancy and birth outcomes. Maternal and Child Health Journal, 10(1), 153–156.Google Scholar
  11. 11.
    Yu, Z., Han, S., Zhu, J., Sun, X., Ji, C., & Guo, X. (2013). Prepregnancy body mass index in relation to infant birth weight and offspring overweight/obesity: A systematic review and meta-analysis. PLoS ONE, 8(4), e61627. doi: 10.1371/journal.pone.0061627.PubMedCentralCrossRefPubMedGoogle Scholar
  12. 12.
    Margerison-Zilko, C., Rehkopf, D., & Abrams, B. (2010). Association of maternal gestational weight gain with short- and long-term maternal and child health outcomes. American Journal of Obstetrics & Gynecology, 202, 574, e.1-8.CrossRefGoogle Scholar
  13. 13.
    Thompson, L. A., Zhang, S., Black, E., Das, R., Ryngaert, M., Sullivan, S., & Roth, J. (2013). The association of maternal prepregnancy body mass index with breastfeeding initiation. Maternal and Child Health Journal, 17(10), 1842–1851.CrossRefPubMedGoogle Scholar
  14. 14.
    Mamun, A. A., Callaway, L. K., O’Callaghan, M. J., Williams, G. M., Najman, J. M., Alati, R., & Lawlor, D. A. (2011). Associations of maternal prepregnancy obesity and excess pregnancy weight gains with adverse pregnancy outcomes and length of hospital stay. BMC Pregnancy and Childbirth, 11(1), 62.PubMedCentralCrossRefPubMedGoogle Scholar
  15. 15.
    Nohr, E. A., Vaeth, M., Baker, J. L., Sorensen, T. A., Olsen, J., & Rasmussen, K. M. (2008). Combined associations of prepregnancy body mass index and gestational weight gain with the outcome of pregnancy. American Journal of Clinical Nutrition, 87, 170–1759.Google Scholar
  16. 16.
    Weiss, J., Malone, F. D., Emig, D., Ball, R. H., Nyberg, D. A., Comstock, C. H., et al. (2004). Obesity, obstetric complications and cesarean delivery rate—A population-based screening study. American Journal of Obstetrics & Gynecology, 190, 1091–1097.CrossRefGoogle Scholar
  17. 17.
    Cnattingius, S., Villamor, E., Johansson, S., Bonamy, A. K. E., Persson, M., Wikström, A. K., & Granath, F. (2013). Maternal obesity and risk of preterm delivery. Journal of the American Medical Association, 309(22), 2362–2370.CrossRefPubMedGoogle Scholar
  18. 18.
    Hauff, L. E., Leonard, S. A., & Rasmussen, K. M. (2014). Associations of maternal obesity and psychosocial factors with breastfeeding intention, initiation, and duration. The American Journal of Clinical Nutrition, ajcn-071191.Google Scholar
  19. 19.
    Baker, P., Keck, C., Mott, F., & Quinlan, S. (1993). NLSY child handbook: A guide to the NLSY child data. Columbus: Center for Human Resource Research, Ohio State University.Google Scholar
  20. 20.
    Wu, L. L., & Allen Li, J. C. (2005). Children of the NLSY79: A unique data resource. Monthly Labor Review, 128, 59–62.Google Scholar
  21. 21.
    Goodman, E., Hinden, B. R., & Khandelwal, S. (2003). Accuracy of teen and parental reports of obesity and body mass index. Pediatrics, 106, 52–58.CrossRefGoogle Scholar
  22. 22.
    Stotland, N. E., Caughey, A. B., Breed, E. M., & Escobar, G. J. (2004). Risk factors and obstetric complications associated with macrosomia. International Journal of Gynecology & Obstetrics, 87(3), 220–226.CrossRefGoogle Scholar
  23. 23.
    American College of Obstetricians and Gynecologists. (2000). Fetal macrosomia. ACOG Practice Bulletin 22. Washington (DC): ACOG, pp. 1–11.Google Scholar
  24. 24.
    Oken, E., Kleinman, K. P., Rich-Edwards, J., & Gillman, M. (2003). A nearly continuous measure of birth weight for gestational age using a United States national reference. BMC Pediatrics,. doi: 10.1186/1471-2431-3-6.PubMedCentralPubMedGoogle Scholar
  25. 25.
    MacDorman, M. F., Menacker, F., & Declercq, E. (2008). Cesarean birth in the United States: Epidemiology, trends, and outcomes. Clinics in Perinatology, 35(2), 293–307.CrossRefPubMedGoogle Scholar
  26. 26.
    Oddy, W. H., Li, J., Whitehouse, A. J., Zubrick, S. R., & Malacova, E. (2011). Breastfeeding duration and academic achievement at 10 years. Pediatrics, 127(1), e137–e145.CrossRefPubMedGoogle Scholar
  27. 27.
    Yang, S., Platt, R. W., & Kramer, M. S. (2010). Variation in child cognitive ability by week of gestation among healthy term births. American Journal of Epidemiology, 171, 399–406.PubMedCentralCrossRefPubMedGoogle Scholar
  28. 28.
    Noble, K. G., Fifer, W. P., Rauh, V. A., Nomura, Y., & Andrews, H. F. (2012). Academic achievement varies with gestational age among children born at term. Pediatrics, 130(2), e257–e264.PubMedCentralCrossRefPubMedGoogle Scholar
  29. 29.
    Conley, D., & Bennett, N. G. (2001). Birth weight and income: Interactions across generations. Journal of Health and Human Behavior, 42, 450–465.CrossRefGoogle Scholar
  30. 30.
    Case, A., Fertig, A., & Paxson, C. (2005). The lasting impact of childhood health and circumstance. Journal of Health Economics, 24(2), 365–389.CrossRefPubMedGoogle Scholar
  31. 31.
    Rees, D. I., & Sabia, J. J. (2009). The effect of breastfeeding on educational attainment: Evidence from sibling data. University of Colorado Working Paper No. 09-03.Google Scholar
  32. 32.
    Cesur, R., & Kelly, I. R. (2010). From cradle to classroom: high birth weight and cognitive outcomes. Forum for Health Economics & Policy (Vol. 13, No. 2).Google Scholar
  33. 33.
    Cheadle, J. E., & Goosby, B. J. (2010). Birth weight, cognitive development, and life chances: A comparison of siblings from childhood into early adulthood. Social Science Research, 39(4), 570–584.CrossRefGoogle Scholar
  34. 34.
    Colen, C. G., & Ramey, D. M. (2014). Is Breast Truly Best? Estimating the effects of breastfeeding on long-term child health and wellbeing in the United States using sibling comparisons. Social Science and Medicine, 109, 55–65.PubMedCentralCrossRefPubMedGoogle Scholar
  35. 35.
    Tanda, R., Salsberry, P. J., Reagan, P. B., & Fang, M. Z. (2013). The impact of prepregnancy obesity on children’s cognitive test scores. Maternal and Child Health Journal, 17(2), 222–229.PubMedCentralCrossRefPubMedGoogle Scholar
  36. 36.
    Huynh, L., McCoy, M., Law, A., Tran, K. N., Knuth, S., Lefebvre, P., et al. (2013). Systematic literature review of the costs of pregnancy in the US. PharmacoEconomics, 31(11), 1005–1030.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2015

Authors and Affiliations

  1. 1.Department of EconomicsLafayette College and IZAEastonUSA
  2. 2.Harvard Kennedy School of GovernmentCambridgeUSA

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