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.
This is a preview of subscription content, access via your institution
Access options
Subscribe to this journal
Receive 12 print issues and online access
$259.00 per year
only $21.58 per issue
Buy this article
- Purchase on Springer Link
- Instant access to full article PDF
Prices may be subject to local taxes which are calculated during checkout
Similar content being viewed by others
References
Gray LJ, Yates T, Davies MJ, Brady E, Webb DR, Sattar N et al. Defining obesity cut-off points for migrant south asians. PLoS ONE 2011; 6: e26464.
Chiu M, Austin PC, Manuel DG, Shah BR, Tu JV . Deriving ethnic-specific bmi cutoff points for assessing diabetes risk. Diabetes Care 2011; 34: 1741–1748.
Misra A . Revisions of cutoffs of body mass index to define overweight and obesity are needed for the Asian-ethnic groups. Int J Obes Relat Metab Disord 2003; 27: 1294–1296.
Razak F, Anand SS, Shannon H, Vuksan V, Davis B, Jacobs R et al. Defining obesity cut points in a multiethnic population. Circulation 2007; 115: 2111–2118.
Misra A, Chowbey P, Makkar BM, Vikram NK, Wasir JS, Chadha D et al. Consensus statement for diagnosis of obesity, abdominal obesity and the metabolic syndrome for asian indians and recommendations for physical activity, medical and surgical management. J Assoc Physicians India 2009; 57: 163–170.
National Institute for Health and Clinical Excellence (NICE). Preventing type 2 diabetes: population and community level interventions in high risk groups and the general population, London, 2011.
WHO expert consultation. Appropriate body-mass index for Asian populations and its implications for policy and intervention strategies. Lancet 2004; 363: 157–163.
Prospective Studies C. Body-mass index and cause-specific mortality in 900 000 adults: collaborative analyses of 57 prospective studies. Lancet 2009; 373: 1083–1096.
Pierce BL, Kalra T, Argos M, Parvez F, Chen Y, Islam T et al. A prospective study of body mass index and mortality in Bangladesh. Int J Epidemiol 2010; 39: 1037–1045.
Stevens J . Ethnic-specific revisions of body mass index cutoffs to define overweight and obesity in Asians are not warranted. Int J Obes Relat Metab Disord 2003; 27: 1297–1299.
Pednekar MS, Hakama M, Hebert JR, Gupta PC . Association of body mass index with all-cause and cause-specific mortality: findings from a prospective cohort study in Mumbai (Bombay), India. Int J Epidemiol 2008; 37: 524–535.
Lawlor DA, Relton C, Sattar N, Nelson SM . Maternal adiposity-a determinant of perinatal and offspring outcomes? Nat Rev Endocrinol 2012; 8: 679–688.
(CMACE) CfMaCE. Maternal obesity in the UK: Findings from a national project, London 2010.
National Institute of health and Clinical Excellence (NICE). Weight management before, during and after pregnancy, 2010. Contract No.: PH27.
Raynor P, Born in Bradford Collaborative Group. Born in Bradford, a cohort study of babies born in Bradford, and their parents: protocol for the recruitment phase. BMC Public Health 2008; 8: 327.
Wright J, Small N, Raynor P, Tuffnell D, Bhopal R, Cameron N et al. Cohort profile: the Born in Bradford multi-ethnic family cohort study. Int J Epidemiol 2012; 4: 119–135.
Office for National Statistics. Ethnic Group Statistics: A Guide for the Collection and Classification of Ethnicity Data The Stationary Office; HMSO Licensing Division: London 2003.
Brindle P, Jonathan E, Lampe F, Walker M, Whincup P, Fahey T et al. Predictive accuracy of the Framingham coronary risk score in British men:prospective cohort study. BMJ 2003; 327: 1267.
Empana JP, Ducimetière P, Arveiler D, Ferrières J, Evans A, Ruidavets JB et al. Are the Framingham and PROCAM coronary heart disease risk functions applicable to different European populations?: The PRIME Study. Eur Heart J 2003; 24: 1903–1911.
May M, Lawlor DA, Brindle P, Patel R, Ebrahim S . Cardiovascular disease risk assessment in older women: can we improve on Framingham? British Women’s Heart and Health prospective cohort study. Heart 2006; 92: 1396–1401.
Vangen S, Stoltenberg C, Holan S, Moe N, Magnus P, Harris JR et al. Outcome of pregnancy among immigrant women with diabetes. Diabetes Care 2003; 26: 327–332.
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.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Competing interests
The authors declare no conflict of interest.
Additional information
Supplementary Information accompanies this paper on International Journal of Obesity website
Rights and permissions
About this article
Cite this article
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
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1038/ijo.2013.117
Keywords
This article is cited by
-
Prevalence of Overweight and Obese Prepregnancy BMI and Excessive Gestational Weight Gain Using Asian-Specific Cutoffs Among Asian and Mixed-Asian Women Living in Hawaii: A Retrospective Cohort Study
Maternal and Child Health Journal (2023)
-
Child mental health and resilience in the context of socioeconomic disadvantage: results from the Born in Bradford cohort study
European Child & Adolescent Psychiatry (2020)
-
Using appropriate pre-pregnancy body mass index cut points for obesity in the Chinese population: a retrospective cohort study
Reproductive Biology and Endocrinology (2018)
-
A comparison of antenatal classifications of ‘overweight’ and ‘obesity’ prevalence between white British, Indian, Pakistani and Bangladeshi pregnant women in England; analysis of retrospective data
BMC Public Health (2017)
-
Epidemiology of hypertensive disorders in pregnancy: prevalence, risk factors, predictors and prognosis
Hypertension Research (2017)