Is obesity still increasing among pregnant women? Prepregnancy obesity trends in 20 states, 2003–2009

doi:10.1016/j.ypmed.2013.02.015

Preventive Medicine

Volume 56, Issue 6, June 2013, Pages 372-378

https://doi.org/10.1016/j.ypmed.2013.02.015 Get rights and content

Abstract

Objective

To estimate trends in prepregnancy obesity prevalence among women who delivered live births in the US during 2003–2009, by state, age, and race–ethnicity.

Methods

We used Pregnancy Risk Assessment Monitoring System (PRAMS) data from 2003, 2006, and 2009 to measure prepregnancy obesity (body mass index [BMI] ≥ 30 kg/m²) trends in 20 states. Trend analysis included 90,774 records from 20 US states with data for all 3 study years. We used a chi-square test for trend to determine the significance of actual and standardized trends, standardized to the age and race–ethnicity distribution of the 2003 sample.

Results

Prepregnancy obesity prevalence increased by an average of 0.5 percentage points per year, from 17.6% in 2003 to 20.5% in 2009 (P < 0.001). Obesity increased among women aged 20–24 (P < 0.001), 30–34 (P = 0.001) and 35 years or older (P = 0.003), and among non-Hispanic white (P < .001), non-Hispanic black (P = 0.02), Hispanic (P = 0.01), and other women (P = 0.03).

Conclusion

Overall, prepregnancy obesity prevalence continues to increase and varies by race–ethnicity and maternal age. These findings highlight the need to address obesity as a key component of preconception care, particularly among high-risk groups.

Highlights

► Prepregnancy obesity prevalence continued to increase overall in the US during 2003–2009. ► The rate of increase in prepregnancy obesity appears to be slowing over time. ► In 2009, more than one-fifth of women were obese upon entering pregnancy. ► Obesity should be addressed as a standard component of preconception care.

Introduction

Prepregnancy obesity (body mass index [BMI] ≥ 30 kg/m²) (World Health Organization, 2000) is a well-documented risk factor for obstetric complications, including gestational diabetes mellitus, hypertension, cesarean delivery, miscarriage, stillbirth, fetal macrosomia, preterm birth, and select birth defects (Cedergren, 2004, Chu et al., 2007a, Chu et al., 2007b, Chu et al., 2007c, Gilboa et al., 2010, Metwally et al., 2008, O'Brien et al., 2003, Rasmussen et al., 2008, Stothard et al., 2009, Torloni et al., 2009). However data about obesity trends among pregnant women in the US are limited. Recent evidence among non-pregnant women ages 20–39 years suggests that obesity prevalence has plateaued, but we do not know whether this is true among pregnant women (Flegal et al., 2010).

Two studies show an increasing trend in prepregnancy obesity (Hinkle et al., 2011, Kim et al., 2007); however, one only examined nine states during 1993–2003 (Kim et al., 2007), and the other was restricted to low-income women (Hinkle et al., 2011). We estimate recent trends in prepregnancy obesity prevalence among women who delivered live births in 20 states during 2003–2009.

Section snippets

Study population

We analyzed data from the Pregnancy Risk Assessment Monitoring System (PRAMS), an ongoing, state-based, population-based surveillance system collecting information about maternal behaviors before, during, and after pregnancies resulting in live births. Each month in each participating jurisdiction, PRAMS uses birth certificates to draw a stratified sample of 100–300 live births delivered within the previous 2–6 months. PRAMS uses stratified sampling to oversample certain high-risk populations.

Statistical analysis

We calculated the prevalence and standard error of each BMI category for each state contributing to each study year. We restricted trend analyses to the 20 states with PRAMS data for all 3 study years: 2003, 2006, and 2009. Previous studies indicate that prepregnancy obesity prevalence is associated with maternal age and race–ethnicity, and that the distribution of these demographics of pregnant women in the US is changing (Chu et al., 2009, Hinkle et al., 2011, Kim et al., 2007). We directly

Results

Across the study period, respondents were predominantly non-Hispanic white, married, post-high school, not enrolled in WIC or Medicaid, and nonsmokers before pregnancy (Table 1).

Overall, the standardized prepregnancy obesity prevalence increased during 2003–2009 (P-trend < 0.001), from 17.6% in 2003 to 20.5% in 2009 (Fig. 1). The standardized trend was similar to the crude trend (Supplementary Table 1). The rate of increase slowed over time, from a mean of 0.6 percentage points per year during

Discussion

These data show that the proportion of US women who are obese upon entering pregnancy continues to increase. The overall trend remained significant after standardizing to account for changing maternal age and race–ethnicity distributions over time. Overall, the rate of increase appears to be slowing; however, this varies by state, maternal age, and race–ethnicity. Nevertheless, prepregnancy obesity remains high; in 2009, more than one in five pregnant women were obese across almost every age

Conclusion

In conclusion, our results indicate that, overall, prepregnancy obesity prevalence is high and continues to increase in the US, with potentially substantial negative public and clinical health implications. The US Department of Health and Human Services has identified increasing the proportion of women who enter pregnancy at a healthy weight as a priority in its Healthy People 2020 initiative (US Department of Health and Human Services). Yet our data indicate that this trend is moving in the

Conflict of interest statement

The authors declare no conflicts of interest.

Funding/support

There was no external funding support for this study.

Disclaimer

The findings and conclusions in this paper are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention.

The following are the supplementary data related to this article.

. Prevalence of prepregnancy BMI categories by US state, maternal age group, and race–ethnicity, 2003, 2006, and 2009^a.

Acknowledgments

All data included in this study were collected at the state level by the following state collaborators and their staff: Alabama—Izza Afgan, MPH; Alaska—Kathy Perham-Hester, MS, MPH; Arkansas—Mary McGehee, PhD; Colorado—Alyson Shupe, PhD; Delaware—George Yocher, MS; Florida—Cynthia Ulysee, MPH; Georgia—Yan Li, MD, MPH; Hawaii—Emily Roberson, MA; Illinois—Theresa Sandidge, MA; Louisiana—Amy Zapata, MPH; Maine—Tom Patenaude, MPH; Maryland—Diana Cheng, MD; Massachusetts—Emily Lu, MPH;

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Is obesity still increasing among pregnant women? Prepregnancy obesity trends in 20 states, 2003–2009

Abstract

Objective

Methods

Results

Conclusion

Highlights

Introduction

Section snippets

Study population

Statistical analysis

Results

Discussion

Conclusion

Conflict of interest statement

Funding/support

Disclaimer

Acknowledgments

Am. J. Obstet. Gynecol.

Contraception

Am. J. Clin. Nutr.

Fertil. Steril.

Am. J. Obstet. Gynecol.

Obstet. Gynecol. Clin. North Am.

ACOG Committee Opinion number 313, September 2005. The importance of preconception care in the continuum of women's health care

Obstet. Gynecol.

Expert committee recommendations regarding the prevention, assessment, and treatment of child and adolescent overweight and obesity: summary report

Pediatrics

Maternal morbid obesity and the risk of adverse pregnancy outcome

Obstet. Gynecol.

Maternal obesity and risk of gestational diabetes mellitus

Diabetes Care

Maternal obesity and risk of cesarean delivery: a meta-analysis

Obes. Rev.

Association between obesity during pregnancy and increased use of health care

N. Engl. J. Med.

Prepregnancy obesity prevalence in the United States, 2004–2005

Matern. Child Health J.

Prepregnancy weight and the risk of adverse pregnancy outcomes

N. Engl. J. Med.

Prevention and management of obesity in nonpregnant women and adolescents: beliefs and practices of U.S. obstetricians and gynecologists

J. Women's Health

Fertility of American Women: June 2008, Current Population Reports

Prevalence and trends in obesity among US adults, 1999–2008

JAMA

Association between prepregnancy body mass index and congenital heart defects

Am. J. Obstet. Gynecol.