ReviewObstetricsMaternal obesity and risk of stillbirth: a metaanalysis
Section snippets
Search process
Using recommendations from the Meta-analysis of Observational Studies in Epidemiology guidelines,6 we identified studies for possible inclusion in this analysis using 3 sources. First, we searched PubMed from January 1980 to September 2005 using the following criteria: overweight or obesity or body mass index (BMI) or weight gain AND pregnancy or prepregnancy AND risks or effects or complications. From this search, we retrieved the full text for abstracts that mentioned a relationship between
Results
Figure 1 shows the flow diagram of the literature search results. The PubMed search identified 7112 studies; 127 abstracts reported a finding on the relationship between maternal obesity and pregnancy complications from a case-control or cohort study; these articles were retrieved for detailed examination. Of the retrieved articles, 15 studies mentioned stillbirth, fetal death, or perinatal death as an outcome. After reviewing the reference lists of the 127 studies that were retrieved, we
Comment
Based on metaanalysis of the literature, we estimate that the risk of stillbirth is almost twice as high among obese pregnant women compared with normal-weight pregnant women. Because obesity is a modifiable risk with a substantial prevalence in the United States5 and other developed countries, the impact of reducing that exposure can be considerable.
A biologic pathway for the increased risk of stillbirth related to obesity has not been established, but several mechanisms have been proposed.
Acknowledgment
We thank Mark Klebanoff, MD, National Institute of Child Health and Human Development, National Institutes of Health, for his thoughtful review and helpful comments.
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The findings and conclusions in this report are those of the authors and do not necessarily represent the views of the Centers for Disease Control and Prevention.