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Population attributable fractions of perinatal outcomes for nulliparous women associated with overweight and obesity, 1990–2014

Kate Cheney, Rachel Farber, Alexandra L Barratt, Kevin McGeechan, Bradley de Vries, Robert Ogle and Kirsten I Black
Med J Aust 2018; 208 (3): 119-125. || doi: 10.5694/mja17.00344

Abstract

Objective: To examine the prevalence across 25 years of overweight and obesity among nulliparous Australian women during early pregnancy; to estimate the proportions of adverse perinatal outcomes attributable to overweight and obesity in this population.

Design: Cohort study; retrospective analysis of electronic maternity data.

Setting, participants: 42 582 nulliparous women with singleton pregnancies giving birth at the Royal Prince Alfred Hospital, an urban teaching hospital in Sydney, January 1990 – December 2014.

Main outcome measures: Maternal body mass index (BMI), socio-demographic characteristics, and selected maternal, birth and neonatal outcomes; the proportion of adverse perinatal outcomes that could be averted by reducing the prevalence of overweight and obesity in women prior to first pregnancies (population attributable fraction, PAF).

Results: The prevalence of overweight among nulliparous pregnant women increased from 12.7% (1990–1994) to 16.4% (2010–2014); the prevalence of obesity rose from 4.8% to 7.3% in the same period, while the proportion with normal range BMIs fell from 73.5% to 68.2%. The PAFs for key adverse maternal and neonatal outcomes increased across the study period; during 2010–2014, 23.8% of pre-eclampsia, 23.4% of fetal macrosomia, and 17.0% of gestational diabetes were attributable to overweight and obesity. Were overweight and obese women to have moved down one BMI category during 2010–2014, 19% of pre-eclampsia, 15.9% of macrosomia, 14.2% of gestational diabetes, 8.5% of caesarean deliveries, 7.1% of low for gestational age birthweight, 6.8% of post partum haemorrhage, 6.5% of admissions to special care nursery, 5.8% of prematurity, and 3.8% of fetal abnormality could have been averted.

Conclusions: Over the past 25 years, the proportions of adverse perinatal outcomes attributable to overweight and obesity have risen with the increasing prevalence of maternal overweight and obesity. A substantial proportion of these outcomes might be averted with obesity prevention strategies that reduce pre-pregnancy maternal weight.

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  • Kate Cheney1
  • Rachel Farber2
  • Alexandra L Barratt2
  • Kevin McGeechan2
  • Bradley de Vries1,3
  • Robert Ogle1
  • Kirsten I Black1,3

  • 1 Royal Prince Alfred Hospital, Sydney, NSW
  • 2 Sydney School of Public Health, University of Sydney, Sydney, NSW
  • 3 University of Sydney, Sydney, NSW


Competing interests:

No relevant disclosures.

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