Prepregnancy Obesity Trends in 20 States: Pregnancy Risk Assessment Monitoring System (PRAMS), 2003-2009 Open Access

Fisher, Sarah C. (2012)

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Context: Prepregnancy obesity is a well-documented risk factor for a broad range of obstetric
complications. Prepregnancy obesity prevalence increased in the US during 1993-2003.
Prepregnancy obesity trends have not been assessed since 2003.
Objective: To calculate the trend in prevalence of prepregnancy obesity among women who
delivered live births in the United States, by state, age, and race-ethnicity (non-Hispanic white,
non-Hispanic black, Hispanic, American Indian/Alaskan Native, Asian/Pacific Islander, other),
during 2003-2009.
Methods: We measured prepregnancy obesity (body mass index [BMI] ≥30 kg/m2) trends using
Pregnancy Risk Assessment Monitoring System (PRAMS) data from 2003, 2006, and 2009. We
included twenty states with data for all three study years in the trend analysis, providing a sample
of 90,774 women. We calculated BMI using self-reported height and weight from questionnaires
completed 3-6 months after delivery. We used a chi-square test for trend to determine
significance of actual and standardized trends, standardized to the age and race-ethnicity
distribution of the 2003 study population.
Results: Prepregnancy obesity prevalence increased by an average of +0.5 percentage points per
year, from 17.6% in 2003 to 20.7% in 2009 (p<0.001). Obesity increased among women ages 20-
24 (p<0.001), 30-34 (p=0.001), and ≥35 years (p=0.003), and among non-Hispanic white
(p<0.001), non-Hispanic black (p=0.02), Hispanic (p=0.01), and other women (p=0.03). Overall,
the mean rate of increase slowed from +0.6 percentage points per year during 2003-2006 to +0.4
percentage points per year during 2006-2009. Among non-Hispanic black women, however, the
mean rate of increase doubled from +0.4 percentage points per year during 2003-2006 to +0.8
percentage points per year during 2006-2009. In 2009, prepregnancy obesity prevalence was
highest among women ≥35 years (24.0%) and non-Hispanic black women (29.2%) and lowest
among women <20 years (11.4%) and Asian/Pacific Islanders (7.2%).
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.

Table of Contents

Chapter 1: Introduction
Chapter 2: Comprehensive Review of the Literature
Chapter 3: Manuscript
Chapter 4: Conclusion and Recommendations

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