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A comparison of South Asian specific and established BMI thresholds for determining obesity prevalence in pregnancy and predicting pregnancy complications: findings from the Born in Bradford cohort

Abstract

Objective:

To describe how maternal obesity prevalence varies by established international and South Asian specific body mass index (BMI) cut-offs in women of Pakistani origin and investigate whether different BMI thresholds can help to identify women at risk of adverse pregnancy and birth outcomes.

Design:

Prospective bi-ethnic birth cohort study (the Born in Bradford (BiB) cohort).

Setting:

Bradford, a deprived city in the North of the UK.

Participants:

A total of 8478 South Asian and White British pregnant women participated in the BiB cohort study.

Main outcome measures:

Maternal obesity prevalence; prevalence of known obesity-related adverse pregnancy outcomes: mode of birth, hypertensive disorders of pregnancy (HDP), gestational diabetes, macrosomia and pre-term births.

Results:

Application of South Asian BMI cut-offs increased prevalence of obesity in Pakistani women from 18.8 (95% confidence interval (CI) 17.6–19.9) to 30.9% (95% CI 29.5–32.2). With the exception of pre-term births, there was a positive linear relationship between BMI and prevalence of adverse pregnancy and birth outcomes, across almost the whole BMI distribution. Risk of gestational diabetes and HDP increased more sharply in Pakistani women after a BMI threshold of at least 30 kg m−2, but there was no evidence of a sharp increase in any risk factors at the new, lower thresholds suggested for use in South Asian women. BMI was a good single predictor of outcomes (area under the receiver operating curve: 0.596–0.685 for different outcomes); prediction was more discriminatory and accurate with BMI as a continuous variable than as a binary variable for any possible cut-off point.

Conclusion:

Applying the new South Asian threshold to pregnant women would markedly increase those who were referred for monitoring and lifestyle advice. However, our results suggest that lowering the BMI threshold in South Asian women would not improve the predictive ability for identifying those who were at risk of adverse pregnancy outcomes.

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Acknowledgements

We are grateful to all the families who took part in this study, midwives for their help in recruiting them, pediatricians and health visitors, and the BiB team, which included interviewers, data managers, laboratory staff, clerical workers, research scientists, volunteers and managers. This work was funded by an NIHR CLAHRC implementation grant and an NIHR applied programme grant (RP-PG-0407-10044). This paper presents independent research commissioned by the National Institute for Health Research (NIHR) under the CLAHRC programme. The views expressed are those of the authors and not necessarily those of the National Health Service, the NIHR or the Department of Health. No funding bodies had any role in study design, data collection and analysis, decision to publish or preparation of the manuscript.

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Correspondence to M Bryant.

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Supplementary Information accompanies this paper on International Journal of Obesity website

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Bryant, M., Santorelli, G., Lawlor, D. et al. A comparison of South Asian specific and established BMI thresholds for determining obesity prevalence in pregnancy and predicting pregnancy complications: findings from the Born in Bradford cohort. Int J Obes 38, 444–450 (2014). https://doi.org/10.1038/ijo.2013.117

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