HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Salihu, H. M. Articles by Alexander, G. R. Search for Related Content PubMed PubMed Citation Articles by Salihu, H. M. Articles by Alexander, G. R.

Extreme Obesity and Risk of Stillbirth Among Black and White Gravidas

From the ¹Departments of Epidemiology and Biostatistics, ²Obstetrics and Gynecology, and ⁷Pediatrics, University of South Florida, Tampa, Florida; ³Department of Preventive and Family Medicine, Emory University, Atlanta, Georgia; ⁵Council of African American Affairs, Washington, DC; ⁶Department of Maternal and Child Health, University of Alabama at Birmingham, Birmingham, Alabama; and ⁴Department of Obstetrics and Gynecology, Robert Wood Johnson Medical School, New Brunswick, New Jersey.

OBJECTIVE: To estimate the risk for stillbirth among three generally accepted obesity subtypes based on severity.

METHODS: We used the Missouri maternally linked cohort data containing births from 1978 to 1997. Using prepregnancy weight and height, mothers were classified on the basis of calculated body mass index (BMI) above 30 into three subsets: class I (30–34.9), class II (35–39.9), and extreme obesity (greater than or equal to 40). Using normal-weight, white women (18.5–24.9) as a reference, we applied Cox proportional hazard regression models to estimate risks for stillbirth.

RESULTS: The prevalence of obesity in pregnant women was 9.5% (12.8% among blacks and 8.9% among whites). Overall, obese mothers were about 40% more likely to experience stillbirth compared with nonobese gravidas (adjusted hazard ratio 1.4; 95% confidence interval [CI] 1.3–1.5). The risk for stillbirth increased in a dose-dependent fashion with increase in BMI: class I (adjusted hazard ratio 1.3; 95% CI 1.2–1.4); class II (adjusted hazard ratio 1.4; 95% CI 1.3–1.6) and extreme obesity (adjusted hazard ratio 1.9; 95% CI 1.6–2.1; P for trend <.01). Obese black mothers experienced more stillbirths than their white counterparts (adjusted hazard ratio 1.9; 95% CI 1.7–2.1 compared with adjusted hazard ratio 1.4; 95% CI 1.3–1.5). The black disadvantage in stillbirth widened with increase in BMI, with the greatest difference observed among extremely obese black mothers (adjusted hazard ratio 2.3; 95% CI 1.8–2.9).

CONCLUSION: Obesity is a risk factor for stillbirth, particularly among extremely obese, black mothers. Strategies to reduce black–white disparities in birth outcomes should consider targeting obese, black women.

LEVEL OF EVIDENCE: II

This article has been cited by other articles:

				Maternal Obesity Is a Risk Factor for Stillbirth Journal Watch (General), September 27, 2007; 2007(927): 6 - 6. [Full Text]

				M. Terplan Beyond Nature Versus Nurture: Race Matters, but How? Obstet. Gynecol., September 1, 2007; 110(3): 550 - 551. [Full Text] [PDF]