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Maternal prepregnancy obesity and cause-specific stillbirth
Lisa M Bodnar1, W Tony Parks2, Kiran Perkins3
1Department of Epidemiology, Graduate School of Public Health, Department of Obstetrics, Gynecology, and Reproductive Sciences, School of Medicine, and Magee-Womens Research Institute, Pittsburgh, PA; and lbodnar@pitt.edu.
The American Journal of Clinical Nutrition
|August 28, 2015
Summary
Maternal obesity significantly increases stillbirth risk, particularly from placental diseases and hypertension. Interventions should target these mechanisms to improve outcomes for obese mothers.
Area of Science:
- Obstetrics and Gynecology
- Reproductive Health
- Perinatal Medicine
Background:
- Maternal obesity is a leading modifiable risk factor for stillbirth in high-income nations.
- The specific pathways linking maternal obesity to stillbirth are not fully understood.
Purpose of the Study:
- To investigate the association between maternal pre-pregnancy body mass index (BMI) and stillbirth risk.
- To identify pathophysiological contributors and causes of stillbirth in relation to maternal BMI.
Main Methods:
- A case-cohort study design was employed, including 658 stillbirths and a random sample of 1829 deliveries from 68,437 total deliveries.
- Stillbirths were classified by probable causes, including maternal conditions, obstetric complications, fetal abnormalities, placental diseases, and infection.
- Proportional hazards models were used to estimate adjusted stillbirth risk associated with maternal BMI.
Main Results:
- Stillbirth rates increased with maternal BMI, from 7.7 per 1000 in lean women to 17.3 per 1000 in severely obese women.
- Overweight, obese, and severely obese women had significantly higher adjusted stillbirth risks (HRs 1.4, 1.8, and 2.0, respectively) compared to lean women.
- Obesity was linked to stillbirth from placental diseases, hypertension, fetal anomalies, and umbilical cord issues, but not placental abruption, obstetric conditions, or infection.
Conclusions:
- Multiple biological mechanisms connect maternal obesity to stillbirth.
- Interventions aimed at reducing stillbirth in obese mothers should focus on preventing hypertension and placental diseases, which are common causes of fetal death in this population.
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