Association between Obesity during Pregnancy and Increased Use of Health Care
Open accessAbstract
BACKGROUND: In the United States, obesity during pregnancy is common and increases obstetrical risks. An estimate of the increase in use of health care services associated with obesity during pregnancy is needed. METHODS: We used electronic data systems of a large U.S. group-practice health maintenance organization to identify 13,442 pregnancies among women 18 years of age or older at the time of conception that resulted in live births or stillbirths. The study period was between January 1, 2000, and December 31, 2004. We assessed associations between measures of use of health care services and body-mass index (BMI, defined as the weight in kilograms divided by the square of the height in meters) before pregnancy or in early pregnancy. The women were categorized as underweight (BMI <18.5), normal (BMI 18.5 to 24.9), overweight (BMI 25.0 to 29.9), obese (BMI 30.0 to 34.9), very obese (BMI 35.0 to 39.9), or extremely obese (BMI > or =40.0). The primary outcome was the mean length of hospital stay for delivery. RESULTS: After adjustment for age, race or ethnic group, level of education, and parity, the mean (+/-SE) length of hospital stay for delivery was significantly (P<0.05) greater among women who were overweight (3.7+/-0.1 days), obese (4.0+/-0.1 days), very obese (4.1+/-0.1 days), and extremely obese (4.4+/-0.1 days) than among women with normal BMI (3.6+/-0.1 days). A higher-than-normal BMI was associated with significantly more prenatal fetal tests, obstetrical ultrasonographic examinations, medications dispensed from the outpatient pharmacy, telephone calls to the department of obstetrics and gynecology, and prenatal visits with physicians. A higher-than-normal BMI was also associated with significantly fewer prenatal visits with nurse practitioners and physician assistants. Most of the increase in length of stay associated with higher BMI was related to increased rates of cesarean delivery and obesity-related high-risk conditions. CONCLUSIONS: Obesity during pregnancy is associated with increased use of health care services.
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The ENDES had a multistage cross-sectional design in which each analysis unit does not have the same probability of having participated in the study sample.
“La ENDES tuvo un diseño transversal multietápico en donde cada unidad de análisis no presenta la misma probabilidad de haber participado en la muestra del estudio (18) .”
From Tendencias de la frecuencia de obesidad en mujeres en edad fértil. Estudio basado en la Encuesta Demográfica y de Salud Familiar-ENDES, Perú, 2005-2018 (2024) · cites this paper as [18]
The Sources of Data section describes pregnancy records from Kaiser Permanente Northwest, not ENDES. Searches for ENDES and for multistage sampling or unequal selection probabilities found no passage addressing the claimed ENDES design. (LLM, conf=0.78)
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- Authors
- Chu, S. Y., Bachman, D. J., Callaghan, W. M., Whitlock, E. P., Dietz, P. M., Berg, C. J., O'Keeffe-Rosetti, M., Bruce, F. C., & Hornbrook, M. C.
- Affiliations
- Centers for Disease Control and Prevention (US)
- Kaiser Permanente (US)
- Venue
- New England Journal of Medicine
- Publisher
- Massachusetts Medical Society
- Published
- 2008-04-03
- Volume
- 358
- Issue
- 14
- Pages
- 1444-1453
- ISSN
- 0028-4793 (ISSN-L)
- 1533-4406
- OpenAlex
- W2011106249
- Cited by
- 242
- References
- 16
- Citations by year
- 2026: 3 · 2025: 2 · 2024: 7 · 2023: 4 · 2022: 6 · 2021: 10 · 2020: 8 · 2019: 11 · 2018: 8 · 2017: 9 · 2016: 10 · 2015: 26 · 2014: 22 · 2013: 18 · 2012: 9
- FWCI
- 34.29
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- New England Journal of Medicine (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Obstetrics and Gynecology › Gestational Diabetes Research and Management
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Obesity, Physical Activity, Diet
- Health Sciences › Health Professions › General Health Professions › Maternal and Neonatal Healthcare
- Keywords
- health care utilization, body mass index, length of hospital stay, cesarean section, prenatal care, antenatal care visits, high-risk pregnancy, overweight in pregnancy
- MeSH terms
- Adolescent, Adult, Female, Health Services, Humans, Length of Stay, Obesity, Pregnancy, Pregnancy Complications, Pregnancy Outcome, Prenatal Care, Thinness, United States, Body Mass Index, Overweight
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