The DOI matches its Crossref record; 36 of the 38 references it cites were found in a registry or an index.
Association Between Prepregnancy Body Mass Index and Severe Maternal Morbidity
Open accessAbstract
Importance: Although high body mass index (BMI) is associated with adverse birth outcomes, the association with severe maternal morbidity is unclear. Objective: To examine the association between prepregnancy BMI and severe maternal morbidity. Design, Setting, and Participants: Retrospective population-based cohort study including all singleton hospital births in Washington State, 2004-2013. Demographic data and morbidity diagnoses were obtained from linked birth certificates and hospitalization files. Exposures: Prepregnancy BMI (weight in kilograms divided by height in meters squared) categories included underweight (<18.5), normal BMI (18.5-24.9), overweight (25.0-29.9), obesity class 1 (30.0-34.9), obesity class 2 (35.0-39.9), and obesity class 3 (≥40). Main Outcomes and Measures: Composite severe maternal morbidity or mortality included life-threatening conditions and conditions leading to serious sequelae (eg, amniotic fluid embolism, hysterectomy), complications requiring intensive care unit admission, and maternal death. Logistic regression was used to obtain adjusted odds ratios (ORs) and adjusted rate differences with 95% confidence intervals, adjusted for confounders (eg, maternal age and parity). Results: Overall, 743 630 women were included in the study (mean age, 28.1 [SD, 6.0] years; 41.4% nulliparous). Prepregnancy BMI was distributed as follows: underweight, 3.2%; normal weight, 47.5%; overweight, 25.8%; obesity class 1, 13.1%; obesity class 2, 6.2%; and obesity class 3, 4.2%. Rates of severe maternal morbidity or mortality were 171.5, 143.2, 160.4, 167.9, 178.3 and 202.9 per 10 000 women, respectively. Adjusted ORs were 1.2 (95% CI, 1.0-1.3) for underweight women; 1.1 (95% CI, 1.1-1.2) for overweight women; 1.1 (95% CI, 1.1-1.2) for women with class 1 obesity; 1.2 (95% CI, 1.1-1.3) for women with class 2 obesity; and 1.4 (95% CI, 1.3-1.5) for women with class 3 obesity compared with women with normal BMI. Absolute risk increases (adjusted rate differences per 10 000 women, compared with women with normal BMI) were 28.8 (95% CI, 12.2-47.2) for underweight women, 17.6 (95% CI, 10.5-25.1) for overweight women, 24.9 (95% CI, 15.7-34.6) for women with class 1 obesity, 35.8 (95% CI, 23.1-49.5) for women with class 2 obesity, and 61.1 (95% CI, 44.8-78.9) for women with class 3 obesity. Conclusions and Relevance: Among pregnant women in Washington State, low and high prepregnancy BMI, compared with normal BMI, were associated with a statistically significant but small absolute increase in severe maternal morbidity or mortality.
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“In the US, ART has been associated with an elevated risk of maternal mortality [43, 44]”
From Age-related disparities in national maternal mortality trends: A population-based study (2025) · cites this paper as [43]
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“its use may have contributed to the elevated maternal mortality observed in our study among older women”
From Age-related disparities in national maternal mortality trends: A population-based study (2025) · cites this paper as [43]
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Cites
Prevalence of Obesity Among Adults and Youth: United States, 2015-2016.
Hales, C. M., Carroll, M. D., Fryar, C. D., & Ogden, C. L. (2017) · PubMed · Cited by 3,889
Trends in Obesity Among Adults in the United States, 2005 to 2014
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Obesity and Kidney Disease: Hidden Consequences of the Epidemic
Kovesdy, C. P., Furth, S. L., & Zoccali, C. (2017) · American Journal of Nephrology · doi:10.1159/000458467 · Cited by 2,239
Overadjustment bias and unnecessary adjustment in epidemiologic studies.
Schisterman, E. F., Cole, S. R., & Platt, R. W. (2009) · Epidemiology · doi:10.1097/ede.0b013e3181a819a1 · Cited by 2,096
Association of Gestational Weight Gain With Maternal and Infant Outcomes
Goldstein, R. F., Abell, S. K., Ranasinha, S., Misso, M. L., Boyle, J. A., Black, M. H., Li, N., Hu, G., Corrado, F., Rode, L., et al. (2017) · JAMA · doi:10.1001/jama.2017.3635 · Cited by 1,754
Maternal obesity and pregnancy outcome: a study of 287 213 pregnancies in London
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Prepregnancy Weight and the Risk of Adverse Pregnancy Outcomes
Cnattingius, S., Bergström, R., Lipworth, L., & Kramer, M. S. (1998) · New England Journal of Medicine · doi:10.1056/nejm199801153380302 · Cited by 1,046
Maternal Body Mass Index and the Risk of Preeclampsia: A Systematic Overview
O'Brien, T., Ray, J. G., & Chan, W. (2003) · Epidemiology · doi:10.1097/00001648-200305000-00020 · Cited by 908
Self-citationSuzuki, E., Mathers, C. D., Moller, A., Alkema, L., Say, L., Gemmill, A., Mills, S. L., Chou, D., & Hogan, D. R. (2014) · Cited by 680
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Szczerba, M., Hejnosz, A., Katarzyna, F., Urban, A., Kacperczyk-Bartnik, J. P., & Romejko-Wolniewicz, E. (2026) · Archives of Gynecology and Obstetrics · doi:10.1007/s00404-026-08527-8
Mekonnen, A., Teale, G. R., Vasilevski, V., & Sweet, L. P. (2026) · Obesity Research & Clinical Practice · doi:10.1016/j.orcp.2026.07.002
Schroeder, B. E., Kuller, J. A., Craig, A. M., Dotters-Katz, S. K., & Ashana, D. C. (2026) · Obstetrical & Gynecological Survey · doi:10.1097/ogx.0000000000001576
Zhao, Q., Hu, W., Xi, X., Wu, L., Hu, S., Liu, Y., & Chen, Y. (2026) · Frontiers in Nutrition · doi:10.3389/fnut.2026.1907985
Ribeiro, D. D. S., Marques, L., & Marson, F. A. L. (2026) · Medical Sciences · doi:10.3390/medsci14060688
Weight Gain During Pregnancy and Severe Maternal Morbidity
Khademioore, S., Darling, E. K., D'Souza, R. D., Muraca, G. M., Guo, Y., & Anderson, L. N. (2026) · JAMA Network Open · doi:10.1001/jamanetworkopen.2026.40027
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Metadata
- Authors
- Lisonkova, S., Muraca, G. M., Potts, J., Liauw, J., Chan, W.-S., Skoll, A., & Lim, K. I.
- Affiliations
- University of British Columbia (CA)
- Corresponding author
- Lisonkova, Sarka
- ORCID
- Venue
- JAMA
- Publisher
- American Medical Association (AMA)
- Published
- 2017-11-14
- Volume
- 318
- Issue
- 18
- Pages
- 1777
- ISSN
- 0002-9955 (ISSN-L)
- 0098-7484
- PMC
- PMC5820710
- OpenAlex
- W2769427421
- Cited by
- 210
- References
- 38
- Citations by year
- 2026: 13 · 2025: 13 · 2024: 31 · 2023: 23 · 2022: 32 · 2021: 29 · 2020: 23 · 2019: 30 · 2018: 15 · 2017: 1
- FWCI
- 20.61
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- JAMA (publishedVersion)
- Europe PMC (PubMed Central) (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Canadian Institutes of Health Research
- Topics
- Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Maternal and fetal healthcare
- Health Sciences › Medicine › Obstetrics and Gynecology › Gestational Diabetes Research and Management
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Obesity, Physical Activity, Diet
- Keywords
- pre-pregnancy body mass index, severe maternal morbidity, maternal mortality, maternal obesity, maternal underweight, maternal overweight, amniotic fluid embolism, hysterectomy, intensive care unit admission, singleton births, Washington State, maternal outcomes, parity, maternal age, hospital birth, birth certificates, hospitalization records, health disparities, health equity
- MeSH terms
- Adolescent, Adult, Female, Humans, Maternal Mortality, Pregnancy, Pregnancy Complications, Retrospective Studies, Risk Factors, Thinness, Washington, Body Mass Index, Logistic Models, Overweight, Young Adult
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