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Am J Perinatol. 2018 Jul;35(9):844-851. doi: 10.1055/s-0037-1621733. Epub 2018 Jan 24.

The Relationship between Body Mass Index in Pregnancy and Adverse Maternal, Perinatal, and Neonatal Outcomes in Rural India and Pakistan.

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Department of Obstetrics and Gynecology, Thomas Jefferson University, Philadelphia, Pennsylvania.
Center for Research on Women and Gender, University of Illinois, Chicago, Illinois.
Social, Statistical, and Environmental Health Sciences, RTI International, Durham, North Carolina.
Jawaharlal Nehru Medical College, KLE University, Belgaum, Karnataka, India.
Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan.
Department of Obstetrics and Gynecology, Columbia University Medical School, New York, New York.
Lata Medical Research Foundation, Nagpur, Maharashtra, India.
School of Public Health, Boston University, Boston, Massachusetts.
Instituto de Nutricion de Centroamerica y Panama, Guatemala City, Guatemala.
Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, Maryland.



The objective of this study was to describe the relationship between early pregnancy body mass index (BMI) and maternal, perinatal, and neonatal outcomes in rural India and Pakistan.


In a prospective, population-based pregnancy registry implemented in communities in Thatta, Pakistan and Nagpur and Belagavi, India, we obtained women's BMI prior to 12 weeks' gestation (categorized as underweight, normal, overweight, and obese following World Health Organization criteria). Outcomes were assessed 42 days postpartum.


The proportion of women with an adverse maternal outcome increased with increasing maternal BMI. Less than one-third of nonoverweight/nonobese women, 47.2% of overweight women, and 56.0% of obese women experienced an adverse maternal outcome. After controlling for site, maternal age and parity, risks of hypertensive disease/severe preeclampsia/eclampsia, cesarean/assisted delivery, and antibiotic use were higher among women with higher BMIs. Overweight women also had significantly higher risk of perinatal and early neonatal mortality compared with underweight/normal BMI women. Overweight women had a significantly higher perinatal mortality rate.


High BMI in early pregnancy was associated with increased risk of adverse maternal, perinatal, and neonatal outcomes in rural India and Pakistan. These findings present an opportunity to inform efforts for women to optimize weight prior to conception to improve pregnancy outcomes.

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