Severe maternal morbidity and mortality during delivery hospitalization of class I, II, III, and super obese women
Open accessAbstract
Background Previous studies show that obesity predisposes patients to higher risks of adverse pregnancy outcomes. Data on the relationship between increasing degrees of obesity and risks of severe maternal morbidity, including mortality, are limited.Objective We examined the association of increasing classes of obesity, especially super obesity, with the risk of severe maternal morbidity and mortality at the time of delivery hospitalization.Study design Using New York City linked birth certificates and hospital discharge data, we conducted a retrospective cohort study. This study identified delivery hospitalizations for singleton, live births in 2008-2012. Women were classified as having obesity (class I, II, III, or super obesity), as opposed to normal weight or overweight, based on prepregnancy body mass index. Cases of severe maternal morbidity were identified based on International Classification of Diseases, Ninth Revision diagnosis and procedure codes according to Centers for Disease Control and Prevention criteria. Multivariable logistic regression was used to evaluate the association between obesity classes and severe maternal morbidity, adjusting for maternal sociodemographic characteristics.Results During 2008-2012, there were 570,997 live singleton births with available information on prepregnancy body mass index that met all inclusion criteria. After adjusting for maternal characteristics, women with class II (adjusted odds ratio, 1.14; 95% confidence interval, 1.05-1.23), class III (adjusted odds ratio, 1.34; 95% confidence interval, 1.21-1.49), and super obesity (adjusted odds ratio, 1.99; 95% confidence interval, 1.57-2.54) were all significantly more likely to have severe maternal morbidity than normal and overweight women. Super obesity was associated with specific severe maternal morbidity indicators, including renal failure, air and thrombotic embolism, blood transfusion, heart failure, and the need for mechanical ventilation.Conclusion There is a significant dose-response relationship between increasing obesity class and the risk of severe maternal morbidity at delivery hospitalization. The risks of severe maternal morbidity are highest for women with super obesity. Given that this is a modifiable risk factor, women with prepregnancy obesity should be counseled on the specific risks associated with pregnancy before conception to optimize their pregnancy outcomes.
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Death was significantly more likely in women with BMI greater than 35 kg/m2 than in women of ideal weight.
“An analysis of the outcomes of 571,000 pregnancies in New York City (2008–2012) found that death was significantly more likely in women with BMI > 35 kg m–2 than in women of ideal weight. 47”
From Overweight, obesity and excessive weight gain in pregnancy as risk factors for adverse pregnancy outcomes: A narrative review (2022) · cites this paper as [47]
The Results report 570,997 eligible births in 2008–2012 and significantly higher severe maternal morbidity for women with class II obesity (BMI 35–39.9), class III obesity, and super obesity. They do not establish that death itself was significantly more likely; death was one component of the composite morbidity measure. The comparison group was women with normal or overweight BMI, not only women of ideal weight. (LLM, conf=0.90)
Experimental — accuracy not yet measuredThe level of maternal death risk increased with severity of obesity (BMI 35-39.9 kg/m2, RR = 1.14, 95% CI = 1.05-1.23; BMI 40-49.9 kg/m2, RR = 1.34, 95% CI = 1.21-1.49; BMI greater than 50 kg/m2, RR = 1.99, 95% CI = 1.57-2.54).
“The level of risk increased with severity of obesity (BMI = 35–39.9 kg m–2, RR = 1.14, 95% CI = 1.05–1.23; BMI = 40–49.9 kg m–2, RR = 1.34, 95% CI = 1.21–1.49; BMI > 50 kg m–2, RR = 1.99, 95% CI = 1.57–2.54). 47”
From Overweight, obesity and excessive weight gain in pregnancy as risk factors for adverse pregnancy outcomes: A narrative review (2022) · cites this paper as [47]
The Abstract Results and Results sections report the quoted estimates for increasing obesity classes, but they are adjusted odds ratios for severe maternal morbidity during delivery hospitalization—not relative risks of maternal death. The Introduction discusses obesity and maternal mortality, but does not assign these estimates to deaths. Page numbers are unavailable in our copy. (LLM, conf=0.88)
Experimental — accuracy not yet measuredSevere obesity is a risk factor for maternal death in the perinatal period.
“Severe obesity is a risk factor for maternal death in the perinatal period.”
From Overweight, obesity and excessive weight gain in pregnancy as risk factors for adverse pregnancy outcomes: A narrative review (2022) · cites this paper as [47]
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References 29 · Cited by 31
- Authors
- Platner, M. H., Ackerman, C. M., Howland, R. E., Illuzzi, J., Reddy, U. M., Bourjeily, G., Xu, X., & Lipkind, H. S.
- Affiliations
- Emory University (US)
- Yale University (US)
- Columbia University (US)
- Brown University (US)
- Corresponding author
- Platner, Marissa H.
- Venue
- American Journal of Obstetrics & Gynecology MFM
- Publisher
- Elsevier BV
- Published
- 2021-09
- Volume
- 3
- Issue
- 5
- Pages
- 100420
- ISSN
- 2589-9333 (ISSN-L)
- PMC
- PMC9667816
- OpenAlex
- W3174038709
- Cited by
- 31
- References
- 29
- Citations by year
- 2026: 2 · 2025: 6 · 2024: 13 · 2023: 5 · 2022: 5
- FWCI
- 5.68
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Licence
- Locations
- American Journal of Obstetrics & Gynecology MFM (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Heart, Lung, and Blood Institute (R01HL130702)
- 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
- severe maternal morbidity, maternal mortality, obesity, super obesity, obesity class, pre-pregnancy body mass index, delivery hospitalizations, singleton live births, renal failure, blood transfusion, heart failure, mechanical ventilation, dose-response relationship, pregnancy counseling
- MeSH terms
- Female, Hospitalization, Humans, Obesity, Pregnancy, Retrospective Studies, Body Mass Index, Overweight
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