Maternal body mass index and post-term birth: a systematic review and meta-analysis.

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obesity 1441 between maternal BMI and births ≥42 weeks was identified; odds ratios and 95% confidence intervals for obesity classes I–IIIb were 1.42 (1.27–1.58), 1.55 (1.37–1.75), 1.65 (1.44–1.87) and 1.75 (1.50–2.04)
obesity 1868 post‐term birth increases with increasing BMI. Odds are greatest for births ≥42 weeks among class III obesity . Targeted interventions to prevent the adverse outcomes associated with post‐term birth should consider
obesity 2013 the adverse outcomes associated with post‐term birth should consider the difference in risk between obesity classes.Heslehurst, N., Vieira, R., Hayes, L., Crowe, L., Jones, D., Robalino, S., Slack, E., and Rankin,
obesity 3804 estimation of gestational age 10 and allows exploration of the ‘true’ post‐term risks.Maternal obesity (i.e. pre‐pregnancy body mass index [BMI] ≥30 kg m−2) impacts on daily clinical practice due
obesity 4007 practice due to the international rise in its prevalence and the complexity of its comorbidities. Maternal obesity is a complex condition strongly associated with socio‐economic status and ethnicity inequalities,
obesity 4269 to being a priority area for clinical practice. For example, socio‐economic status varies between obesity classes, and pregnant women in the highest obesity class (class III, BMI ≥40 kg m−2) are significantly
obesity 4320 example, socio‐economic status varies between obesity classes, and pregnant women in the highest obesity class (class III, BMI ≥40 kg m−2) are significantly more likely to reside in deprived locations
obesity 4516 deprived locations (odds ratio [OR] 4.7, 95% confidence interval [CI] 3.2–6.9) compared with women in obesity class I (BMI 30.0–34.9 kg m−2; OR 2.2, 95% CI 2.1–2.3) 11. Disparities are also seen with maternal
obesity 5099 most significant modifiable risk factor for stillbirth, with up to 100% increased risk for women with obesity 22. There is increasing evidence that maternal BMI influences gestational age at delivery. Robust meta‐analysis
obesity 5473 post‐term birth 19, 20, 21, there is a lack of robust evidence from meta‐analyses.Both maternal obesity and post‐term birth are preventable, and therefore warrant intervention to prevent associated adverse
obesity 5632 therefore warrant intervention to prevent associated adverse outcomes. Challenges to investigating maternal obesity and post‐term birth include interventions to expedite birth, such as induction of labour and caesarean
obesity 6350 interchangeably to describe gestational ages beyond term 4.Investigation of the association between maternal obesity and post‐term birth adds additional complexity. Maternal obesity is associated with a significantly
obesity 6417 the association between maternal obesity and post‐term birth adds additional complexity. Maternal obesity is associated with a significantly increased risk of developing the comorbidities which lead to early
obesity 7059 (recommended weight), 25.0–29.9 kg m−2 (overweight) and ≥30.0 kg m−2 (obese), with further obesity sub‐classes of class I 30.0–34.9 kg m−2, class II 35.0–39.9 kg m−2 and class III ≥40 kg m−2
obesity 7179 sub‐classes of class I 30.0–34.9 kg m−2, class II 35.0–39.9 kg m−2 and class III ≥40 kg m−2 obesity 23. For Asian populations, the BMI criteria are reduced (recommended weight 18.5–23 kg m−2, overweight
obesity 8166 systematic review and meta‐analyses aimed to establish the strength of the association between maternal obesity and post‐term birth. It specifically investigated the dose–response association between BMI and
obesity 26653 increase for overweight and obese BMIs (Table 2). The odds of birth ≥42 weeks increased within obesity classes, with 42%, 55%, 65% and 75% increased odds for BMI classes I, II, IIIa and IIIb respectively
obesity 29439 obese BMIs (Table 2 and Fig. 4b). This increasing linear association was also observed within the obesity classes, although to a lesser extent than for births ≥42 weeks (26%, 39% and 52% increased odds for
obesity 33187 summaryStudyCountry of studySample sizeMaternal weight exposure variable*Post‐term variableResultsAssociation with obesity Primary reason not included in meta‐analysisAbenhaim et al. 200741Canada18,633R: BMI 20 to 24.9; O1:
obesity 35824 association increases in strength as BMI increases, with a substantial difference in effect size between obesity classifications: a difference of 33% in odds of post‐term birth ≥42 weeks and 26% for ≥41 weeks
obesity 35951 difference of 33% in odds of post‐term birth ≥42 weeks and 26% for ≥41 weeks when comparing obesity classes I and III. This substantial increase in post‐term birth and associated risks for mothers in
obesity 36073 III. This substantial increase in post‐term birth and associated risks for mothers in the highest obesity class presents a double burden of inequality. Women facing the greatest socio‐economic disadvantage
obesity 36268 socio‐economic disadvantage 11 also have the highest level of pregnancy‐related risk, confirming that maternal obesity is both a clinical and public health priority for the wellbeing of women and their babies.The mechanisms
obesity 36920 progesterone, prostaglandins and oxytocin 45. Additionally, it is well established that women with obesity have increased inflammation, circulating leptin concentrations, insulin resistance, lipolysis and dyslipidaemia.
obesity 37739 the reduced contractility in addition to a small but significant difference in myometrial mass 46. As obesity and diabetes are closely related, further exploration of myometrial contractility between women of different
obesity 37949 different weight status' could provide further evidence for causal mechanisms of post‐term birth and obesity .The heterogeneity in the relationship between degree of obesity and risk of post‐term birth is an
obesity 38013 mechanisms of post‐term birth and obesity.The heterogeneity in the relationship between degree of obesity and risk of post‐term birth is an important message for researchers, practitioners and policy makers.
obesity 38245 using one criterion to define the obese population is an attenuation of the true risk for the higher obesity classes. Despite the differences between obesity classes, pregnancy outcome data are often reported
obesity 38294 is an attenuation of the true risk for the higher obesity classes. Despite the differences between obesity classes, pregnancy outcome data are often reported for one obese category. When pregnancy outcomes are
obesity 38417 pregnancy outcome data are often reported for one obese category. When pregnancy outcomes are reported by obesity class, a similar pattern is often reported. For example, the odds of pre‐term birth were reported
obesity 38626 to increase twofold from 1.6 (95% CI 1.4–1.8) for class I to 3.0 (95% CI, 2.3–3.9) for class III obesity 47. Similarly, the odds of GDM increased from 3.0 (95% CI 2.3–3.9) for class I to 5.6 (95% CI 4.3–7.2)
obesity 38755 odds of GDM increased from 3.0 (95% CI 2.3–3.9) for class I to 5.6 (95% CI 4.3–7.2) for class III obesity 14. However, differentiating between obesity classes can be challenging. Although class III obesity
obesity 38800 2.3–3.9) for class I to 5.6 (95% CI 4.3–7.2) for class III obesity 14. However, differentiating between obesity classes can be challenging. Although class III obesity is increasing at the most rapid rate over time
obesity 38855 obesity 14. However, differentiating between obesity classes can be challenging. Although class III obesity is increasing at the most rapid rate over time 11, it only represents approximately 1% of pregnancies
obesity 39134 for statistical significance, the sample size needs to be sufficient to detect enough cases in each obesity class. Our sub‐group meta‐analyses suggest that 100 cases of post‐term birth ≥42 weeks and
obesity 39381 required to detect significance, which may not always be feasible, even in national‐level datasets. When obesity classifications have to be combined for statistical power, there should be cautious interpretation of
obesity 39517 combined for statistical power, there should be cautious interpretation of the results reflecting ‘ obesity ’ without consideration of the heterogeneous nature of obesity classifications. Additionally, the use
obesity 39581 interpretation of the results reflecting ‘obesity’ without consideration of the heterogeneous nature of obesity classifications. Additionally, the use of Asian‐specific rather than general population BMI criteria
obesity 40932 categories. The conversion of categorical BMI was necessary due to limited reporting of directly comparable obesity categories: 17 studies combined data for obesity classes I–III 19, 34, 35, 38, 42, 43, 44, 48, 49,
obesity 40981 necessary due to limited reporting of directly comparable obesity categories: 17 studies combined data for obesity classes I–III 19, 34, 35, 38, 42, 43, 44, 48, 49, 50, 51, 52, 53, 54, 55, 56, 57, three reported obesity
obesity 41088 classes I–III 19, 34, 35, 38, 42, 43, 44, 48, 49, 50, 51, 52, 53, 54, 55, 56, 57, three reported obesity classes I–III separately 58, 59, 60, four combined obesity classes I and II 20, 41, 61, 62, six combined
obesity 41149 52, 53, 54, 55, 56, 57, three reported obesity classes I–III separately 58, 59, 60, four combined obesity classes I and II 20, 41, 61, 62, six combined classes II and III 39, 40, 63, 64, 65, 66, seven had further
obesity 46674 did explore country of study, and this did not impact on overall heterogeneity of results.Maternal obesity is increasing internationally, and the daily challenges for clinical and public health practice will
obesity 46939 systematic review and meta‐analyses add to the evidence‐base of increased risks associated with maternal obesity and can be used to inform preconception and pregnancy care. Policy makers should emphasize the importance
obesity 48043 post‐term birth and associated risks should be informed by the dose–response association between the obesity classes. Further research which utilizes maternal BMI should also consider the heterogeneity within
obesity 48151 classes. Further research which utilizes maternal BMI should also consider the heterogeneity within obesity populations and the need for adequately powered studies to explore pregnancy outcomes in the higher,
obesity 48276 the need for adequately powered studies to explore pregnancy outcomes in the higher, less prevalent, obesity classes.ConclusionsMaternal obesity is having a significant impact on daily clinical practice. The association
obesity 48312 studies to explore pregnancy outcomes in the higher, less prevalent, obesity classes.ConclusionsMaternal obesity is having a significant impact on daily clinical practice. The association between maternal BMI and
obesity 48507 maternal BMI and post‐term birth increases with increasing BMI, with the greatest odds among women in obesity class III and with post‐term birth ≥42 weeks. Pregnancies which progress beyond 42 weeks have
obesity 48761 outcomes, including perinatal mortality. This presents a double burden of disease among women with morbid obesity , which is also associated with the highest levels of socio‐economic disadvantage compared with other
obesity 48904 highest levels of socio‐economic disadvantage compared with other BMI categories. Future maternal obesity research should consider the heterogeneity between obesity classes. Healthcare policy and practice should
obesity 48963 with other BMI categories. Future maternal obesity research should consider the heterogeneity between obesity classes. Healthcare policy and practice should ensure that necessary interventions are in place to prevent
obesity 49182 adverse outcomes associated with post‐term birth, considering the increased risk among the higher obesity classes.Conflict of interest statementDr Heslehurst has nothing to disclose.Dr Vieira has nothing to

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