Prepregnancy body mass index in a first uncomplicated pregnancy and outcomes of a second pregnancy

Maya Tabet, Louise H. Flick, Methodius G. Tuuli, George A. Macones, Jen Jen Chang

Research output: Contribution to journalArticlepeer-review

19 Scopus citations


Objective This study examined the effect of body mass index (BMI) before a first uncomplicated pregnancy on maternal and fetal outcomes in a subsequent pregnancy, including preterm births, preeclampsia, cesarean delivery, small for gestational age, large for gestational age, and neonatal deaths. Study Design We conducted a population-based cohort study (n = 121,092) using the Missouri maternally linked birth registry (1989 through 2005). Multivariable binary logistic regression models were fit to estimate odds ratios and 95% confidence intervals for the parameters of interest after controlling for sociodemographic and pregnancy-related confounders in the second pregnancy. Results Compared to women with a normal BMI in their first pregnancy, those who were underweight prepregnancy had increased odds for preterm birth by 20% and small for gestational age by 40% in their second pregnancy, while those with prepregnancy obesity had increased odds for large for gestational age, preeclampsia, cesarean delivery, and neonatal deaths in their second pregnancy by 54%, 156%, 85%, and 37%, respectively. Conclusion Women starting a first pregnancy with suboptimal BMI may be at risk of adverse maternal and fetal outcomes in a subsequent pregnancy, even if their first pregnancy was uncomplicated or if they reached a normal weight by their second pregnancy. The long-term consequences of suboptimal BMI carry considerable public health implications.

Original languageEnglish
Pages (from-to)548.e1-548.e7
JournalAmerican journal of obstetrics and gynecology
Issue number4
StatePublished - Oct 1 2015


  • fetal outcomes
  • maternal outcomes
  • prepregnancy body mass index
  • subsequent pregnancy
  • uncomplicated pregnancy


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