Journal
OBESITY REVIEWS
Volume 18, Issue 3, Pages 293-308Publisher
WILEY
DOI: 10.1111/obr.12489
Keywords
BMI; gestational age; maternal; obesity
Categories
Funding
- South Tees Hospitals NHS Foundation Trust
- Gateshead NHS Foundation Trust
- Medical Research Council
- Newcastle University Faculty of Medical Sciences Doctoral Training award
- Medical Research Council [MR/K02325X/1, 1367735] Funding Source: researchfish
- National Institute for Health Research [PDF-2011-04-034] Funding Source: researchfish
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Post-term birth is a preventable cause of perinatal mortality and severe morbidity. This review examined the association between maternal body mass index (BMI) and post-term birth at >= 42 and >= 41 weeks' gestation. Five databases, reference lists and citations were searched from May to November 2015. Observational studies published in English since 1990 were included. Linear and nonlinear dose-response meta-analyses were conducted by using random effects models. Sensitivity analyses assessed robustness of the results. Meta-regression and sub-group meta-analyses explored heterogeneity. Obesity classes were defined as I (30.0-34.9 kg m(-2)), II (35.0-39.9 kg m(-2)) and III (>= 40 kg m(-2); IIIa 40.0-44.9 kg m(-2), IIIb >= 45.0 kg m(-2)). Searches identified 16,375 results, and 39 studies met the inclusion criteria (n = 4,143,700 births). A nonlinear association 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) respectively. BMI was linearly associated with births >= 41 weeks: odds ratio is 1.13 (95% confidence interval 1.05-1.21) for each 5-unit increase in BMI. The strength of the association between BMI and 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 the difference in risk between obesity classes.
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