Body Mass Index and Pregnancy Outcome:

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Body Mass Index and Pregnancy Outcome
Results from the revised birth certificate
Sharon Kirmeyer, Ph.D.Statistician/Demographer,
Division of Vital StatisticsNational Center for
Health Statistics, Centers for Disease Control
and Prevention
James RubertoneStatistician, Bureau of Health
Statistics and ResearchPennsylvania Department
of Health
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Introduction

• Presenting findings on Body Mass Index and
  pregnancy outcome, using new data from revised
  certificate
• Historically, concern with underweight mothers
  and pregnancy outcome
• Recently, concern also with overweight and
  obesity and pregnancy outcome

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Obesity trends

• Maps show why there is concern with obesity in
  U.S.
• Increase in adult obesity in 20 years from being
  essentially non-existent to a prevalence of 25
  in half of states
• Example of obese woman
• 54 and at least 30 pounds overweight

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Obesity Trends Among U.S. AdultsBRFSS, 1985
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Obesity Trends Among U.S. AdultsBRFSS, 1986
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Obesity Trends Among U.S. AdultsBRFSS, 1987
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Obesity Trends Among U.S. AdultsBRFSS, 1988
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Obesity Trends Among U.S. AdultsBRFSS, 1989
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Obesity Trends Among U.S. AdultsBRFSS, 1990
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Obesity Trends Among U.S. AdultsBRFSS, 1991
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Obesity Trends Among U.S. AdultsBRFSS, 1992
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Obesity Trends Among U.S. AdultsBRFSS, 1993
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Obesity Trends Among U.S. AdultsBRFSS, 1994
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Obesity Trends Among U.S. AdultsBRFSS, 1995
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Obesity Trends Among U.S. AdultsBRFSS, 1996
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Obesity Trends Among U.S. AdultsBRFSS, 1997
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Obesity Trends Among U.S. AdultsBRFSS, 1998
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Obesity Trends Among U.S. AdultsBRFSS, 1999
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Obesity Trends Among U.S. AdultsBRFSS, 2000
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Obesity Trends Among U.S. AdultsBRFSS, 2001
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Obesity Trends Among U.S. AdultsBRFSS, 2002
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Obesity Trends Among U.S. AdultsBRFSS, 2003
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Obesity Trends Among U.S. AdultsBRFSS, 2004
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Obesity Trends Among U.S. AdultsBRFSS, 2005
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Obesity Trends Among U.S. AdultsBRFSS, 2006
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What Is Body Mass Index?

• Based upon height and weight
• Formula
• BMI Weight (lb) / height (in)2 x 703
• Does not measure fat directly
• Used to identify possible weight problems

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Methods

• 18 states collected 2006 data using revised birth
  certificate with mothers height and weight data
• Limited to singleton births (approx. 95 of all
  births)
• Excluded records which did not have mothers
  height or weight
• Total 1.4 million births
• NOTE All 2006 data considered preliminary

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Selected New Items on 2003 Certificate
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States Using Revised Birth Certificate in 2006
NOTE New York State, but not New York City
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BMI Category Definitions
SOURCE National Heart, Lung, and Blood Institute
(1998).
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BMI distribution of Mothers18 State Reporting
Area - 2006 (preliminary)
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Distribution of Mothers by BMI Category18 State
Reporting Area - 2006 (preliminary)
-- Obese
Overweight --
-- Underweight
-- Average
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BMI Distribution by Race of Mother18 State
Reporting Area - 2006 (preliminary)
NHNon-Hispanic AI/ANAmerican Indian/Alaska
Native A/PIAsian/Pacific Islander
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Percent Preterm and Low Birthweight Infants by
BMI Category18 State Reporting Area - 2006
(preliminary)
Preterm
Low Birthweight
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Percent Very Preterm and Very Birthweight by BMI
Category18 State Reporting Area 2006
(preliminary)
Very Preterm
Very Low Birthweight
percent
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Percent of Women with 4000 Gram Infants by BMI
Category18 State Reporting Area - 2006
(preliminary)
4000 Gram Infants
percent
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Gestational Diabetes/Hypertension by BMI
Category18 State Reporting Area 2006
(preliminary)
Gestational Hypertension
Gestational Diabetes
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Breech Fetal Presentation by BMI Category18
State Reporting Area 2006 (preliminary)
//
0.0
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Cesarean Delivery by BMI Category18 State
Reporting Area 2006 (preliminary)
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Unplanned Procedures by BMI Category18 State
Reporting Area 2006 (preliminary)
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Average Pre-Pregnancy Weight Gain by BMI Category
18 State Reporting Area - 2006 (preliminary)
Underweight
Average
Overweight
Obese
//
0
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Average Pre-Pregnancy Weight Gain by BMI
Category and Race/Ethnicity18 State Reporting
Area - 2006 (preliminary)
Non-Hispanic White
Underweight
Non-Hispanic Black
Hispanic
Average
Overweight
Obese
//
0
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Summary

• ½ women with singleton live births in 2006
  reporting area were overweight or obese
• Black and AI/AN women more likely to be obese
• Risk of preterm and low birthweight elevated for
  infants of underweight mothers
• Risk of giving birth to macrosomic (4000 g.)
  infant elevated for obese women
• Rates of many pregnancy risk factors,
  complications in delivery, and C-sections higher
  for obese women

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Conclusion

• New BMI data are very useful to show
• associations with maternal-infant outcomes
• Can translate findings into prepregnancy practice
• Slides demonstrate power of states and federal
  DVS working together
• We look forward to working together on a paper
  giving more detail on this topic

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Contacts and Links

• Contacts
• Sharon Kirmeyer SKirmeyer_at_cdc.gov
• James Rubertone JRubertone_at_state.pa.us
• Links
• http//www.mayoclinic.com/health/bmi-calculator/NU
  00597
• http//www.nytimes.com/ref/health/bmi.html
• http//www.cdc.gov/nccdphp/dnpa/bmi/
• http//www.iom.edu/
• http//www.cdc.gov/nccdphp/dnpa/obesity/trend/maps
  /
• DATA SOURCE FOR PRESENTATION National Vital
  Statistics System, NCHS, CDC