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Risk of major congenital malformations in relation to maternal overweight and obesity severity: cohort study of 1.2 million singletons.

Abstract Objective To estimate the risks of major congenital malformations in the offspring of mothers who are underweight (body mass index (BMI) <18.5), overweight (BMI 25 to <30), or in obesity classes I (BMI 30 to <35), II (35 to <40), or III (≥40) compared with offspring of normal weight mothers (BMI 18.5 to <25) in early pregnancy.Design Population based cohort study.Setting Nationwide Swedish registries.Participants 1 243 957 liveborn singleton infants from 2001 to 2014 in Sweden. Data on maternal and pregnancy characteristics were obtained by individual record linkages.Exposure Maternal BMI at the first prenatal visit.Main outcome measures Offspring with any major congenital malformation, and subgroups of organ specific malformations diagnosed during the first year of life. Risk ratios were estimated using generalised linear models adjusted for maternal factors, sex of offspring, and birth year.Results A total of 43 550 (3.5%) offspring had any major congenital malformation, and the most common subgroup was for congenital heart defects (n=20 074; 1.6%). Compared with offspring of normal weight mothers (risk of malformations 3.4%), the proportions and adjusted risk ratios of any major congenital malformation among the offspring of mothers with higher BMI were: overweight, 3.5% and 1.05 (95% confidence interval 1.02 to 1.07); obesity class I, 3.8% and 1.12 (1.08 to 1.15), obesity class II, 4.2% and 1.23 (1.17 to 1.30), and obesity class III, 4.7% and 1.37 (1.26 to 1.49). The risks of congenital heart defects, malformations of the nervous system, and limb defects also progressively increased with BMI from overweight to obesity class III. The largest organ specific relative risks related to maternal overweight and increasing obesity were observed for malformations of the nervous system. Malformations of the genital and digestive systems were also increased in offspring of obese mothers.Conclusions Risks of any major congenital malformation and several subgroups of organ specific malformations progressively increased with maternal overweight and increasing severity of obesity. For women who are planning pregnancy, efforts should be encouraged to reduce adiposity in those with a BMI above the normal range.
PMID
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Authors

Mayor MeshTerms

Mothers

Keywords
Journal Title bmj (clinical research ed.)
Publication Year Start




PMID- 28615173
OWN - NLM
STAT- MEDLINE
DA  - 20170615
DCOM- 20170626
LR  - 20170626
IS  - 1756-1833 (Electronic)
IS  - 0959-535X (Linking)
VI  - 357
DP  - 2017 Jun 14
TI  - Risk of major congenital malformations in relation to maternal overweight and
      obesity severity: cohort study of 1.2 million singletons.
PG  - j2563
LID - 10.1136/bmj.j2563 [doi]
AB  - Objective To estimate the risks of major congenital malformations in the
      offspring of mothers who are underweight (body mass index (BMI) &lt;18.5),
      overweight (BMI 25 to &lt;30), or in obesity classes I (BMI 30 to &lt;35), II (35 to
      &lt;40), or III (&gt;/=40) compared with offspring of normal weight mothers (BMI 18.5
      to &lt;25) in early pregnancy.Design Population based cohort study.Setting
      Nationwide Swedish registries.Participants 1 243 957 liveborn singleton infants
      from 2001 to 2014 in Sweden. Data on maternal and pregnancy characteristics were 
      obtained by individual record linkages.Exposure Maternal BMI at the first
      prenatal visit.Main outcome measures Offspring with any major congenital
      malformation, and subgroups of organ specific malformations diagnosed during the 
      first year of life. Risk ratios were estimated using generalised linear models
      adjusted for maternal factors, sex of offspring, and birth year.Results A total
      of 43 550 (3.5%) offspring had any major congenital malformation, and the most
      common subgroup was for congenital heart defects (n=20 074; 1.6%). Compared with 
      offspring of normal weight mothers (risk of malformations 3.4%), the proportions 
      and adjusted risk ratios of any major congenital malformation among the offspring
      of mothers with higher BMI were: overweight, 3.5% and 1.05 (95% confidence
      interval 1.02 to 1.07); obesity class I, 3.8% and 1.12 (1.08 to 1.15), obesity
      class II, 4.2% and 1.23 (1.17 to 1.30), and obesity class III, 4.7% and 1.37
      (1.26 to 1.49). The risks of congenital heart defects, malformations of the
      nervous system, and limb defects also progressively increased with BMI from
      overweight to obesity class III. The largest organ specific relative risks
      related to maternal overweight and increasing obesity were observed for
      malformations of the nervous system. Malformations of the genital and digestive
      systems were also increased in offspring of obese mothers.Conclusions Risks of
      any major congenital malformation and several subgroups of organ specific
      malformations progressively increased with maternal overweight and increasing
      severity of obesity. For women who are planning pregnancy, efforts should be
      encouraged to reduce adiposity in those with a BMI above the normal range.
CI  - Published by the BMJ Publishing Group Limited. For permission to use (where not
      already granted under a licence) please go to
      http://group.bmj.com/group/rights-licensing/permissions.
FAU - Persson, Martina
AU  - Persson M
AD  - Department of Medicine, Solna, Clinical Epidemiology Unit, Karolinska Institutet,
      SE-171 76 Stockholm, Sweden [email protected]
AD  - Department of Diabetes and Endocrinology, Sachsska Children's Hospital,
      Sodersjukhuset, Stockholm, Sweden.
FAU - Cnattingius, Sven
AU  - Cnattingius S
AD  - Department of Medicine, Solna, Clinical Epidemiology Unit, Karolinska Institutet,
      SE-171 76 Stockholm, Sweden.
FAU - Villamor, Eduardo
AU  - Villamor E
AD  - Department of Medicine, Solna, Clinical Epidemiology Unit, Karolinska Institutet,
      SE-171 76 Stockholm, Sweden.
AD  - Department of Epidemiology, School of Public Health and Center for Human Growth
      and Development, University of Michigan, Ann Arbor, MI, USA.
FAU - Soderling, Jonas
AU  - Soderling J
AD  - Department of Medicine, Solna, Clinical Epidemiology Unit, Karolinska Institutet,
      SE-171 76 Stockholm, Sweden.
FAU - Pasternak, Bjorn
AU  - Pasternak B
AD  - Department of Medicine, Solna, Clinical Epidemiology Unit, Karolinska Institutet,
      SE-171 76 Stockholm, Sweden.
AD  - Department of Epidemiology Research, Statens Serum Institut, Copenhagen, Denmark.
FAU - Stephansson, Olof
AU  - Stephansson O
AD  - Department of Medicine, Solna, Clinical Epidemiology Unit, Karolinska Institutet,
      SE-171 76 Stockholm, Sweden.
AD  - Division of Obstetrics and Gynecology, Department of Women's and Children's
      Health, Karolinska Institutet, Stockholm, Sweden.
FAU - Neovius, Martin
AU  - Neovius M
AD  - Department of Medicine, Solna, Clinical Epidemiology Unit, Karolinska Institutet,
      SE-171 76 Stockholm, Sweden.
LA  - eng
PT  - Journal Article
DEP - 20170614
PL  - England
TA  - BMJ
JT  - BMJ (Clinical research ed.)
JID - 8900488
SB  - AIM
SB  - IM
MH  - Adult
MH  - Body Mass Index
MH  - Cohort Studies
MH  - Congenital Abnormalities/*epidemiology/etiology
MH  - Female
MH  - Humans
MH  - Infant
MH  - Infant, Newborn
MH  - *Mothers
MH  - Odds Ratio
MH  - Overweight/complications/*epidemiology/physiopathology
MH  - Pregnancy
MH  - Pregnancy Complications/*epidemiology/etiology/physiopathology
MH  - Sentinel Surveillance
MH  - Sweden/epidemiology
MH  - Thinness/complications/*epidemiology/physiopathology
PMC - PMC5470075
COI - Competing interests: All authors have completed the ICMJE uniform disclosure form
      at www.icmje.org/coi_disclosure.pdf and declare: no support from any organisation
      for the submitted work; no financial relationships with any organizations that
      might have an interest in the submitted work in the previous three years; no
      other relationships or activities that could appear to have influenced the
      submitted work. MN reports being a member of the scientific advisory board for
      Itrim (&lt;$5000 ( pound3876; euro4430)/year).
EDAT- 2017/06/16 06:00
MHDA- 2017/06/27 06:00
CRDT- 2017/06/16 06:00
PST - epublish
SO  - BMJ. 2017 Jun 14;357:j2563. doi: 10.1136/bmj.j2563.