Modeling the potential public health impact of prepregnancy obesity on adverse fetal and infant outcomes

National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA, USA.
Obesity (Impact Factor: 3.73). 06/2013; 21(6):1276-83. DOI: 10.1002/oby.20156
Source: PubMed


Approximately one-third of US reproductive-aged women are obese, and prepregnancy obesity is a strong risk factor for adverse fetal and infant outcomes. The annual number of preventable adverse fetal and infant outcomes associated with prepregnancy obesity in the U.S. was estimated.

Design and methods:
Adverse fetal and infant outcomes for which statistically significant associations with prepregnancy obesity had been reported by peer-reviewed meta-analyses, which included fetal deaths and nine different major birth defects, were assessed. The true prevalence of prepregnancy obesity was estimated by multiplying self-reported prepregnancy obesity by a bias factor based on the difference between measured and self-reported obesity in U.S. adult women. A Monte Carlo simulation approach was used to model the attributable fraction and preventable number, accounting for uncertainty in the estimates for: strength of the association with obesity, obesity prevalence, and outcome prevalence.

Eliminating the impact of prepregnancy obesity would potentially prevent the highest numbers of four outcomes: fetal deaths (6,990; uncertainty interval [UI] 4,110-10,080), congenital heart defects (2,850; UI 1,035-5,065), hydrocephalus (490; UI 150-850), and spina bifida (405; UI 305-505). If 10% of women with prepregnancy obesity achieved a healthy weight before pregnancy or otherwise mitigated the impact of obesity, nearly 300 congenital heart defects and 700 fetal deaths per year could potentially be prevented.

This simulation suggests that effective prevention strategies to reduce prepregnancy obesity or the risk associated with obesity could have a measurable impact on infant health in the US.

Download full-text


Available from: Sohyun Park,
1 Follower
27 Reads
  • Source
    • "Congenital hydrocephalus is generally diagnosed prenatally or at birth, but it can also remain undiagnosed until later in life (Van Landingham et al., 2009). A pooled prevalence estimate from birth defects surveillance data collected in Arkansas, California, Georgia, Iowa, Massachusetts, New York, North Carolina, Texas, and Utah indicates that congenital hydrocephalus occurs in 6.73 per 10,000 live births (Honein et al., 2012). "
    [Show abstract] [Hide abstract]
    ABSTRACT: Background: Congenital hydrocephalus is a condition characterized by accumulation of cerebrospinal fluid in the ventricles of the brain. Prenatal infections are risk factors for some birth defects. This pilot study investigated whether residual dried blood spots (DBS) could be used to assess infections as risk factors for birth defects by examining the associations between prenatal infection with Toxoplasma gondii (T. gondii) or cytomegalovirus (CMV) with congenital hydrocephalus. Methods: Case-infants with hydrocephalus (N=410) were identified among live-born infants using birth defects surveillance systems in California, North Carolina, and Texas. Control-infants without birth defects were randomly selected from the same geographic areas and time periods as case-infants (N=448). We tested residual DBS from case- and control-infants for T. gondii immunoglobulin M and CMV DNA. When possible, we calculated crude odds ratios (cORs) and confidence intervals (CIs). Results: Evidence for prenatal T. gondii infection was more common among case-infants (1.2%) than control-infants (0%; p=0.11), and evidence for prenatal CMV infection was higher among case-infants (1.5%) than control-infants (0.7%; cOR: 2.3; 95% CI: 0.48, 13.99). Conclusions: Prenatal infections with T. gondii and CMV occurred more often among infants with congenital hydrocephalus than control-infants, although differences were not statistically significant. This pilot study highlighted some challenges in using DBS to examine associations between certain infections and birth defects, particularly related to reduced sensitivity and specimen storage conditions. Further study with increased numbers of specimens and higher quality specimens should be considered to understand better the contribution of these infections to the occurrence of congenital hydrocephalus.
    Birth Defects Research Part A Clinical and Molecular Teratology 07/2013; 97(7). DOI:10.1002/bdra.23138 · 2.09 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Low-income women are at risk for excessive gestational weight gain. Inactive lifestyle and lack of regular moderate exercise may contribute to the risk of weight gain. This study was conducted to (1) determine the rate and characteristics of low-income pregnant women who exercised regularly and met the American College of Obstetricians and Gynecologists recommendation and (2) describe how these women spent time for other physical activities compared with those who did not exercise regularly. Medicaid-recipient or uninsured pregnant women (n = 816) were asked to complete a physical activity questionnaire at rural and urban county health departments located in North Carolina. Twenty percent of low-income women met the American College of Obstetricians and Gynecologists recommendation for moderate exercise (≥10 METs-h/wk [metabolic equivalent task-hours per week]). The women who met the recommendation spent 3 hours 45 minutes per week walking as exercise, whereas those who did not meet the recommendation spent 1 hour per week (P < .0001). Women who exercised regularly spent longer hours at work (4.25 vs 1.75 hours per day; P = .019) and on household tasks (5.25 vs 4.0 hours per day; P = .002) than women who did not exercise regularly. Time spent on domestic and occupation activities does not seem to prohibit low-income women from engaging in moderate exercise on a regular basis.
    The Journal of perinatal & neonatal nursing 01/2014; 28(1):17-25. DOI:10.1097/JPN.0000000000000000 · 1.10 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Objective: We aimed to study whether prenatal vitamin (PNV) use protects against low 25-hydroxyvitamin D (25[OH]D) levels in all women and particularly in obese and black women who are both at risk of vitamin D deficiency and poor pregnancy outcomes. Study design: We studied 1019 women enrolled in a prospective study at Brigham and Women's Hospital in Boston, from 2007 to 2009. We used multivariable logistic regression to analyze associations of PNV use and odds of vitamin D deficiency defined as 25[OH]D levels <50 nmol l(-1). Result: In all, 56% of black and 86% of white women reported pre- and/or postconceptional PNV use. In the first trimester, 75% of black and 19% of white women were vitamin D deficient. Lack of PNV use among black women was not associated with vitamin D deficiency (adjusted odds ratio (OR) 1.0, 95% confidence interval (CI) 0.4, 2.3) but was among white women (OR 3.5, 95% CI 2.1, 5.8) (interaction P<0.01). Conclusions: Ongoing trials of vitamin D supplementation during pregnancy should consider potential effect modification by race/ethnicity.
    Journal of perinatology: official journal of the California Perinatal Association 10/2014; 35(4). DOI:10.1038/jp.2014.198 · 2.07 Impact Factor
Show more