Body Mass Index and Pregnancy Outcome: Results from the revised birth certificate Sharon Kirmeyer, Ph. D. Statistician/Demographer, Division of Vital Statistics National Center for Health Statistics, Centers for Disease Control and Prevention James Rubertone Statistician, Bureau of Health Statistics and Research Pennsylvania Department of Health 2008 NAPHSIS Annual Meeting Celebrating 75 Years of Excellence Orlando, FL June 1 st – 5 th, 2008
Introduction n Presenting findings on Body Mass Index and pregnancy outcome, using new data from revised certificate n Historically, concern with underweight mothers and pregnancy outcome n Recently, concern also with overweight and obesity and pregnancy outcome 2008 NAPHSIS Annual Meeting Celebrating 75 Years of Excellence Orlando, FL June 1 st – 5 th, 2008
Obesity trends n Maps show why there is concern with obesity in U. S. n Increase in adult obesity in 20 years: from being essentially non-existent to a prevalence of >25 % in half of states n Example of obese woman= 5’ 4” and at least 30 pounds overweight 2008 NAPHSIS Annual Meeting Celebrating 75 Years of Excellence Orlando, FL June 1 st – 5 th, 2008
Obesity Trends* Among U. S. Adults BRFSS, 1985 No Data <10% 10%– 14% 2008 NAPHSIS Annual Meeting Celebrating 75 Years of Excellence Orlando, FL June 1 st – 5 th, 2008
Obesity Trends* Among U. S. Adults BRFSS, 1986 No Data <10% 10%– 14% 2008 NAPHSIS Annual Meeting Celebrating 75 Years of Excellence Orlando, FL June 1 st – 5 th, 2008
Obesity Trends* Among U. S. Adults BRFSS, 1987 No Data <10% 10%– 14% 2008 NAPHSIS Annual Meeting Celebrating 75 Years of Excellence Orlando, FL June 1 st – 5 th, 2008
Obesity Trends* Among U. S. Adults BRFSS, 1988 No Data <10% 10%– 14% 2008 NAPHSIS Annual Meeting Celebrating 75 Years of Excellence Orlando, FL June 1 st – 5 th, 2008
Obesity Trends* Among U. S. Adults BRFSS, 1989 No Data <10% 10%– 14% 2008 NAPHSIS Annual Meeting Celebrating 75 Years of Excellence Orlando, FL June 1 st – 5 th, 2008
Obesity Trends* Among U. S. Adults BRFSS, 1990 No Data <10% 10%– 14% 2008 NAPHSIS Annual Meeting Celebrating 75 Years of Excellence Orlando, FL June 1 st – 5 th, 2008
Obesity Trends* Among U. S. Adults BRFSS, 1991 No Data <10% 10%– 14% 2008 NAPHSIS Annual Meeting Celebrating 75 Years of Excellence Orlando, FL June 1 st – 5 th, 2008 15%– 19%
Obesity Trends* Among U. S. Adults BRFSS, 1992 No Data <10% 10%– 14% 2008 NAPHSIS Annual Meeting Celebrating 75 Years of Excellence Orlando, FL June 1 st – 5 th, 2008 15%– 19%
Obesity Trends* Among U. S. Adults BRFSS, 1993 No Data <10% 10%– 14% 2008 NAPHSIS Annual Meeting Celebrating 75 Years of Excellence Orlando, FL June 1 st – 5 th, 2008 15%– 19%
Obesity Trends* Among U. S. Adults BRFSS, 1994 No Data <10% 10%– 14% 2008 NAPHSIS Annual Meeting Celebrating 75 Years of Excellence Orlando, FL June 1 st – 5 th, 2008 15%– 19%
Obesity Trends* Among U. S. Adults BRFSS, 1995 No Data <10% 10%– 14% 2008 NAPHSIS Annual Meeting Celebrating 75 Years of Excellence Orlando, FL June 1 st – 5 th, 2008 15%– 19%
Obesity Trends* Among U. S. Adults BRFSS, 1996 No Data <10% 10%– 14% 2008 NAPHSIS Annual Meeting Celebrating 75 Years of Excellence Orlando, FL June 1 st – 5 th, 2008 15%– 19%
Obesity Trends* Among U. S. Adults BRFSS, 1997 No Data <10% 10%– 14% 2008 NAPHSIS Annual Meeting Celebrating 75 Years of Excellence Orlando, FL June 1 st – 5 th, 2008 15%– 19% ≥ 20%
Obesity Trends* Among U. S. Adults BRFSS, 1998 No Data <10% 10%– 14% 2008 NAPHSIS Annual Meeting Celebrating 75 Years of Excellence Orlando, FL June 1 st – 5 th, 2008 15%– 19% ≥ 20%
Obesity Trends* Among U. S. Adults BRFSS, 1999 No Data <10% 10%– 14% 2008 NAPHSIS Annual Meeting Celebrating 75 Years of Excellence Orlando, FL June 1 st – 5 th, 2008 15%– 19% ≥ 20%
Obesity Trends* Among U. S. Adults BRFSS, 2000 No Data <10% 10%– 14% 2008 NAPHSIS Annual Meeting Celebrating 75 Years of Excellence Orlando, FL June 1 st – 5 th, 2008 15%– 19% ≥ 20%
Obesity Trends* Among U. S. Adults BRFSS, 2001 No Data <10% 10%– 14% 2008 NAPHSIS Annual Meeting Celebrating 75 Years of Excellence Orlando, FL June 1 st – 5 th, 2008 15%– 19% 20%– 24% ≥ 25%
Obesity Trends* Among U. S. Adults BRFSS, 2002 No Data <10% 10%– 14% 2008 NAPHSIS Annual Meeting Celebrating 75 Years of Excellence Orlando, FL June 1 st – 5 th, 2008 15%– 19% 20%– 24% ≥ 25%
Obesity Trends* Among U. S. Adults BRFSS, 2003 No Data <10% 10%– 14% 2008 NAPHSIS Annual Meeting Celebrating 75 Years of Excellence Orlando, FL June 1 st – 5 th, 2008 15%– 19% 20%– 24% ≥ 25%
Obesity Trends* Among U. S. Adults BRFSS, 2004 No Data <10% 10%– 14% 2008 NAPHSIS Annual Meeting Celebrating 75 Years of Excellence Orlando, FL June 1 st – 5 th, 2008 15%– 19% 20%– 24% ≥ 25%
Obesity Trends* Among U. S. Adults BRFSS, 2005 No Data <10% 29% ≥ 30% 10%– 14% 2008 NAPHSIS Annual Meeting Celebrating 75 Years of Excellence Orlando, FL June 1 st – 5 th, 2008 15%– 19% 20%– 24% 25%–
Obesity Trends* Among U. S. Adults BRFSS, 2006 No Data <10% 29% ≥ 30% 10%– 14% 2008 NAPHSIS Annual Meeting Celebrating 75 Years of Excellence Orlando, FL June 1 st – 5 th, 2008 15%– 19% 20%– 24% 25%–
What Is Body Mass Index? n Based upon height and weight Formula: BMI = Weight (lb) / [height (in)]2 x 703 n Does not measure fat directly n Used to identify possible weight problems 2008 NAPHSIS Annual Meeting Celebrating 75 Years of Excellence Orlando, FL June 1 st – 5 th, 2008
Methods n 18 states collected 2006 data using revised birth certificate with mother’s height and weight data n Limited to singleton births (approx. 95% of all births) n Excluded records which did not have mother’s height or weight n Total 1. 4 million births NOTE: All 2006 data considered preliminary 2008 NAPHSIS Annual Meeting Celebrating 75 Years of Excellence Orlando, FL June 1 st – 5 th, 2008
Selected New Items on 2003 Certificate 2008 NAPHSIS Annual Meeting Celebrating 75 Years of Excellence Orlando, FL June 1 st – 5 th, 2008
States Using Revised Birth Certificate in 2006 WA MT ME ND MN OR VT NH ID WI SD NY WY CT RI MI PA IA NE NV IL DE MD IN CO WV KS MO VA KY OK NM DC NC TN AZ NJ OH UT CA MA AR SC MS AL GA 2003 to 2006 TX LA FL 2007 or later AK HI NOTE: New York State, but not New York City 2008 NAPHSIS Annual Meeting Celebrating 75 Years of Excellence Orlando, FL June 1 st – 5 th, 2008 Does not report height and weight
BMI Category Definitions SOURCE: National Heart, Lung, and Blood Institute (1998). 2008 NAPHSIS Annual Meeting Celebrating 75 Years of Excellence Orlando, FL June 1 st – 5 th, 2008
BMI distribution of Mothers 18 State Reporting Area - 2006 (preliminary) Average Overweight Underweight 2008 NAPHSIS Annual Meeting Celebrating 75 Years of Excellence Orlando, FL June 1 st – 5 th, 2008 Obese
Distribution of Mothers by BMI Category 18 State Reporting Area - 2006 (preliminary) Overweight -- -- Obese -- Underweight -- Average 2008 NAPHSIS Annual Meeting Celebrating 75 Years of Excellence Orlando, FL June 1 st – 5 th, 2008
BMI Distribution by Race of Mother 18 State Reporting Area - 2006 (preliminary) Obese Overweight Average Underweight NH=Non-Hispanic AI/AN=American Indian/Alaska Native 2008 NAPHSIS Annual Meeting Celebrating 75 Years of Excellence Orlando, FL June 1 st – 5 th, 2008 A/PI=Asian/Pacific Islander
Percent Preterm and Low Birthweight Infants by BMI Category 18 State Reporting Area - 2006 (preliminary) Preterm 2008 NAPHSIS Annual Meeting Celebrating 75 Years of Excellence Orlando, FL June 1 st – 5 th, 2008 Low Birthweight
Percent Very Preterm and Very Birthweight by BMI Category 18 State Reporting Area – 2006 (preliminary) Very Low Birthweight percent Very Preterm 2008 NAPHSIS Annual Meeting Celebrating 75 Years of Excellence Orlando, FL June 1 st – 5 th, 2008
Percent of Women with 4000+ Gram Infants by BMI Category 18 State Reporting Area - 2006 (preliminary) % 4000+ Gram Infants and Mother’s Pre-pregnancy Diabetes Status percent 4000+ g. infant /No prepregnancy diabetes percent 4000+ g. infant / With prepregnancy diabetes 2008 NAPHSIS Annual Meeting Celebrating 75 Years of Excellence Orlando, FL June 1 st – 5 th, 2008
Gestational Diabetes/Hypertension by BMI Category 18 State Reporting Area – 2006 (preliminary) Gestational Diabetes 2008 NAPHSIS Annual Meeting Celebrating 75 Years of Excellence Orlando, FL June 1 st – 5 th, 2008 Gestational Hypertension
Breech Fetal Presentation by BMI Category 18 State Reporting Area – 2006 (preliminary) // 0. 0 2008 NAPHSIS Annual Meeting Celebrating 75 Years of Excellence Orlando, FL June 1 st – 5 th, 2008
Cesarean Delivery by BMI Category 18 State Reporting Area – 2006 (preliminary) 2008 NAPHSIS Annual Meeting Celebrating 75 Years of Excellence Orlando, FL June 1 st – 5 th, 2008
Unplanned Procedures by BMI Category 18 State Reporting Area – 2006 (preliminary) Unplanned Procedure Rates // 0. 0 2008 NAPHSIS Annual Meeting Celebrating 75 Years of Excellence Orlando, FL June 1 st – 5 th, 2008
Average Pre-Pregnancy Weight Gain by BMI Category 18 State Reporting Area - 2006 (preliminary) Underweight Average Overweight Obese // 0 2008 NAPHSIS Annual Meeting Celebrating 75 Years of Excellence Orlando, FL June 1 st – 5 th, 2008
Average Pre-Pregnancy Weight Gain by BMI Category and Race/Ethnicity 18 State Reporting Area - 2006 (preliminary) Non-Hispanic White Underweight Non-Hispanic Black Hispanic Average Overweight Obese // 0 2008 NAPHSIS Annual Meeting Celebrating 75 Years of Excellence Orlando, FL June 1 st – 5 th, 2008
Summary § ½ women with singleton live births in 2006 reporting area were overweight or obese § § Black and AI/AN women more likely to be obese § Risk of giving birth to macrosomic (4000+ g. ) infant elevated for obese women § Rates of many pregnancy risk factors, complications in delivery, and C-sections higher for obese women Risk of preterm and low birthweight elevated for infants of underweight mothers 2008 NAPHSIS Annual Meeting Celebrating 75 Years of Excellence Orlando, FL June 1 st – 5 th, 2008
Conclusion § New BMI data are very useful to show associations with maternal-infant outcomes § § Can translate findings into prepregnancy practice § We look forward to working together on a paper giving more detail on this topic Slides demonstrate power of states and federal DVS working together 2008 NAPHSIS Annual Meeting Celebrating 75 Years of Excellence Orlando, FL June 1 st – 5 th, 2008
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