Phyllis Reed

Prevalence of Obesity in Women Who Gave Birth in Washington State, 2003 and the Risk of Selected Birth OutcomesPhyllis Reed, BA, CPHUniversity of Washington, Extended Degree Program-Public HealthWashington State Department of Health / Center for Health Statistics: 

Prevalence of Obesity in Women Who Gave Birth in Washington State, 2003 and the Risk of Selected Birth Outcomes Phyllis Reed, BA, CPH University of Washington, Extended Degree Program-Public Health Washington State Department of Health / Center for Health Statistics Objectives To describe the prevalence of obesity in women who gave birth in Washington State in 2003 using the First Steps database, and To assess the risk of Cesarean Section and Macrosomia (birthweight andgt; 4000g) by maternal poverty status, BMI, Race, and Maternal Age. Background National obesity and overweight rates, as defined by the body mass index (BMI), are rapidly increasing and often referred to by public health officials as the 'obesity epidemic'. Data from the National Health and Nutrition Examination Survey (NHANES) reveals that the mean BMI for women ages 20-74 has increased from 24.9 in 1960-62 to 28.2 in 1999-2002. The rise in BMI among women of childbearing age raises concerns as to the potential impact on infants who are born to mothers classified as obese or overweight. In addition, difficult labor and delivery due to fetal macrosomia are also associated with overweight/obesity. In addition, a study conducted by Baeten JM et al. using Washington State birth certificates from 1992-1996, concluded that among nulliparous women, not only pre-pregnancy obesity but also overweight increase the risk of pregnancy complications and adverse pregnancy outcomes, and the risk of cesarean delivery increases with each level of increasing BMI. Methods This cohort study looks at women who gave birth in Washington State in 2003 and categorizes the women based on Medicaid eligibility using the First Steps Database. Associated risk factors for adverse birth outcomes included in the multi-variable regression model using SAS Proc Logistic are: Maternal BMI, level of education, race, age, smoking, diabetes (gestational or chronic), and marital status. Results (continued) No significant difference was observed in the odds of having a cesarean section or macrosomia in relation to maternal income level. Controlling for poverty, education, BMI, Race, and maternal age the risk for a cesarean section increased significantly when BMI andgt; 25 (OR=1.5), Black (OR=1.3), and maternal age andgt;30 (OR=1.5). Significant risk factors for Macrosomia: BMI andgt; 25 (OR=1.5), Native Am. (OR=1.3), age andgt; 30 (OR=1.2). Acknowledgements: I am grateful to Teresa Jennings, MPA, State Registrar and Director, WA State Dept. of Health/Center for Health Statistics, for fully supporting my research project with DSHS/RDA. I am also grateful to Laurie Cawthon, MD, MPH, manager of the First Steps Database, for her guidance and input into my research project in addition to the opportunity to use the First Steps Database as my resource for this project. Discussion Across all income categories, over 50% of women who gave birth in WA State in 2003 are overweight/obese. Not only is pre-pregnancy BMI an important risk factor for intervention, but weight gain during pregnancy is also a modifiable risk factor which may decrease the risk of adverse birth outcomes. This study suggests maternal obesity influences birth outcomes and that public health officials and primary care providers need to address the obesity epidemic by developing intervention strategies. Results Overall, in Washington State more than 50% of women in every income category are overweight/obese (BMI andgt; 25). Non-Medicaid women have the lowest prevalence of overweight/obesity (54.1%), and TANF women have the highest (63.4%). Among women who gave birth in 2003 in Washington State, Asian women have the lowest proportion (41.3%) of overweight/obese (BMI andgt; 25), and Pacific Islander women have the highest (75.4%). Data Sources: 2003 Washington State birth certificate data in the First Steps database which is linked to Medicaid data to identify women who received publicly funded maternity care. Additional information on study design and methods contact: phyllis.reed@doh.wa.gov