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Ethnic disparity in spontaneous preterm birth and maternal pre-pregnancy body mass index

  • Maternal-Fetal Medicine
  • Published:
Archives of Gynecology and Obstetrics Aims and scope Submit manuscript

Abstract

Purpose

To investigate differences in pre-pregnancy BMI status in patients with spontaneous preterm birth (PTB) compared with term birth and assess the role of ethnicity as a risk modifier in BMI-associated PTB.

Methods

A case–control study involving self-reported African American and Caucasian women delivering singletons in Nashville, TN, USA, 2003–2009. Maternal pre-pregnancy BMI was recorded in 447 PTB-cases (African American = 145, Caucasian = 302) and 1315 term-birth controls (African American = 522; Caucasian = 793). Crude and adjusted odds ratio (OR and AOR) for PTB were calculated using normal BMI (18.5–24.9 kg/m2) as reference. Age, education, marital status, income, smoking, parity, previous PTB and pregnancy weight gain were included as covariates in logistic regression.

Results

No significant differences were noted in the OR for PTB among different BMI categories when women of different ethnicity were combined. Odds of PTB were greater in obese than in normal weight Caucasian women, even after adjusting for confounders (AOR = 1.84, 95%CI [1.15, 2.95]). Obese African American women had a decreased crude OR for PTB, although this was not significant after adjusting for confounders (AOR = 0.72, 95%CI [0.38, 1.40]). The odds for early PTB (<32 weeks) were decreased in obese compared with normal weight African American women (OR = 0.23, 95%CI [0.08, 0.70]), whereas they were increased in obese compared with normal weight Caucasian women (OR = 2.30, 95%CI [1.32, 4.00]).

Conclusion

The risk for PTB in women with different pre-pregnancy BMI categories differs according to ethnicity.

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Acknowledgments

We thank Dr. Silvia Daher, São Paulo Federal University, for her suggestions and comments on the manuscript. This work was supported by grants from Thrasher Research Funds (grant number 02818-3; PI–SJF and March of Dimes grant number 21FY08-557; PI-RM).

Conflict of interest

The authors of this manuscript report no declarations of interest.

Author information

Authors and Affiliations

  1. Obstetrics Department, São Paulo Federal University, São Paulo, Brazil

    Maria Regina Torloni

  2. Perinatal Research Center, Centennial Women’s Hospital, Nashville, TN, USA

    Stephen J. Fortunato & Cayce Owens Drobek

  3. Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland

    Ana Pilar Betrán & Mario Merialdi

  4. Center for Human Genetics Research, Vanderbilt University, Nashville, TN, USA

    Scott Williams

  5. Department of Epidemiology, Emory University, Atlanta, GA, USA

    Lina Brou

  6. Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine Perinatal Research, The University of Texas Medical Branch at Galveston, Galveston, TX, USA

    Ramkumar Menon

Authors
  1. Maria Regina Torloni
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  4. Scott Williams
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  5. Lina Brou
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  6. Cayce Owens Drobek
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  7. Mario Merialdi
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  8. Ramkumar Menon
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Corresponding author

Correspondence to Maria Regina Torloni.

Appendices

Appendix 1: Formula used to calculate rate of weight gain in 2nd and 3rd trimester

$$ \begin{gathered} {\text{Rate }}\left( {{\text{lbs}}/{\text{wk}}} \right) = \frac{{\left[ {{\text{Pregnancy weight }}\,( {\text{lbs}}) - {\text{Pre - Pregnancy weight }}\,( {\text{lbs}})} \right] - 2. 7 5 {\text{ lbs}}^{\text{a}} }}{{[{\text{Gestational age}}\,( {\text{days}}) - 9 8 {\text{ days}}^{\text{b}} ] \, / 7 {\text{ days}}^{\text{c}} }}\hfill \\ \hfill \\ {\text{a. Mean presumed}} {\text{ 1}}^{\text{st}} {\text{ trimester weight gain [(1.1 + 4.4 lbs) / 2]}} \hfill \\ {\text{b. Number of days in the}} {\text{ 1}}^{\text{st}} {\text{ trimester of pregnancy (7 days x 14 weeks=98 days)}} \hfill \\ {\text{c. To transform the total duration of pregnancy from days to weeks}}\hfill \\ \end{gathered} $$

where a is the mean presumed 1st trimester weight gain [(1.1 + 4.4 lbs)/2], b is the number of days in the 1st trimester of pregnancy (7 days × 14 weeks = 98 days) and c is to transform the total duration of pregnancy from days to weeks.

Appendix 2: Recommendations for weight gain during pregnancy, by pre-pregnancy BMI. (IOM criteria, 2009)

   
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Torloni, M.R., Fortunato, S.J., Betrán, A.P. et al. Ethnic disparity in spontaneous preterm birth and maternal pre-pregnancy body mass index. Arch Gynecol Obstet 285, 959–966 (2012). https://doi.org/10.1007/s00404-011-2102-8

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