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Association of BMI and interpregnancy BMI change with birth outcomes in an Australian obstetric population: a retrospective cohort study
  1. Catherine R Knight-Agarwal1,
  2. Lauren T Williams2,
  3. Deborah Davis3,
  4. Rachel Davey4,
  5. Tom Cochrane4,
  6. Huanhua Zhang1,
  7. Peter Rickwood5
  1. 1School of Public Health and Nutrition, The University of Canberra, Canberra, Australian Capital Territory, Australia
  2. 2School of Allied Health Sciences, Griffith University, Gold Coast Campus, Southport, Queensland, Australia
  3. 3Department of Midwifery, The University of Canberra, Canberra, Australian Capital Territory, Australia
  4. 4Centre for Research and Action in Public Health, The University of Canberra, Canberra, Australian Capital Territory, Australia
  5. 5Institute for Sustainable Futures, The University of Technology Sydney, Broadway, New South Wales, Australia
  1. Correspondence to Catherine R Knight-Agarwal; Cathy.Knight-Agarwal{at}


Objective To assess maternal and neonatal outcomes associated with increasing body mass index (BMI) and interpregnancy BMI changes in an Australian obstetric population.

Methods A retrospective cohort study from 2008 to 2013 was undertaken. BMI for 14 875 women was categorised as follows: underweight (≤18 kg/m2); normal weight (19–24 kg/m2); overweight (25–29 kg/m2); obese class I (30–34 kg/m2); obese class II (35–39 kg/m2) and obese class III (40+ kg/m2). BMI categories and maternal, neonatal and birthing outcomes were examined using logistic regression. Interpregnancy change in BMI and the risk of adverse outcomes in the subsequent pregnancy were also examined.

Results Within this cohort, 751 (5.1%) women were underweight, 7431 (50.0%) had normal BMI, 3748 (25.1%) were overweight, 1598 (10.8%) were obese class I, 737 (5.0%) were obese class II and 592 (4.0%) were obese class III. In bivariate adjusted models, obese women were at an increased risk of caesarean section, gestational diabetes, hypertensive disorders of pregnancy and neonatal morbidities including macrosomia, large for gestational age (LGA), hypoglycaemia, low 5 min Apgar score and respiratory distress. Multiparous women who experienced an interpregnancy increase of ≥3 BMI units had a higher adjusted OR (AOR) (CI) of the following adverse outcomes in their subsequent pregnancy: low 5-min Apgar score 3.242 (1.557 to 7.118); gestational diabetes mellitus (GDM) 3.258 (1.129 to 10.665) and hypertensive disorders of pregnancy 3.922 (1.243 to 14.760). These women were more likely to give birth vaginally 2.030 (1.417 to 2.913). Conversely, women whose parity changed from 0 to 1 and who experienced an interpregnancy increase of ≥3 BMI units had a higher AOR (CI) of caesarean section in their second pregnancy 1.806 (1.139 to 2.862).

Conclusions Women who are overweight or obese have a significantly increased risk of various adverse outcomes. Interpregnancy weight gain, regardless of parity and baseline BMI, also increases various adverse outcomes. Effective weight management strategies are needed.

  • Obesity
  • antenatal care
  • gestational weight

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