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Maternal Obesity and Risk of Infant Death From Florida Birth Records 2004

Maternal Obesity and Risk of Infant Death From Florida Birth Records 2004. Dan Thompson, MPH* Cheryl Clark, MPH, RHIA* Betsy Wood, BSN, MPH* Mary Beth Zeni, ScD** *Florida Department of Health, Division of Family Health Services Bureau of Family and Community Health

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Maternal Obesity and Risk of Infant Death From Florida Birth Records 2004

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  1. Maternal Obesity and Risk of Infant DeathFrom Florida Birth Records 2004 Dan Thompson, MPH* Cheryl Clark, MPH, RHIA* Betsy Wood, BSN, MPH* Mary Beth Zeni, ScD** *Florida Department of Health, Division of Family Health Services Bureau of Family and Community Health **Florida State University, College of Nursing

  2. Background Nationally, and in Florida, Infant Mortality rates decreased until about 1998 and have been essentially level since then

  3. Infant Mortality RatesFlorida and U.S., 1975 to 2005 Source: FDOH CHARTS & NCHS Reports

  4. Obesity Prevalence Results of the 2003-04 National Health and Nutrition Examination Survey (NHANES): • 17.1 % of US adults aged 20 and older overweight • 16.5 % were obese • 33.6 percent either overweight or obese

  5. Obesity Prevalence Goal Healthy People 2010 Goal: To reduce the proportion of adults (20 years and older) who are overweight or obese to 15%.

  6. Research Questions What is the relationship between pre-pregnancy Maternal body mass Index (BMI) and infant death in Florida? Is higher Maternal BMI associated with higher risk of infant death?

  7. Methods Data:Florida resident birth records for March – December, 2004 Linked to infant death records Earlier birth records were excluded, because prior to March, 2004, maternal pre-pregnancy height and weight were not recorded on the birth record

  8. Methods (continued) Outcome: Infant death (death of a live born infant before first birthday) Analysis variables: BMI Categories: Underweight (BMI < 18.5) Normal weight (BMI 18.6 - 24.9) - referent Overweight (BMI 25.0 - 29.9) Obese (BMI 30.0 - 39.9) Morbidly obese (BMI 40+)

  9. Methods (continued) BMI is a measure of weight relative to height The formula for BMI is: [(weight in pounds) / (height in inches) 2] X 703

  10. Methods (continued) Results were adjusted for associations between Analysis Variables and: • maternal race • age • marital status • education • tobacco use • first birth • trimester of entry into prenatal care (these are on the birth record)

  11. Methods (continued) • Logistic regression was used to compute adjusted odds ratios and confidence intervals for infant death • SPSS software was used

  12. Results • 183,618 total resident birth records were linked to 1,288 resident infant death records. • 17,317 (9.4%) records excluded due to missing data • 273 infant death records were linked to the excluded records and were also excluded. • 166,301 (90.6%) birth records linked to 1,015 (78.8%) infant death records were used for the analysis

  13. Results (continued) Births and Infant Death Rates by Maternal BMI Category for Florida Infants Born in March Through December 2004

  14. Results (continued) Infant Death Odds Ratios for Infants Born in March Through December 2004 by Maternal BMI

  15. Results (continued) Infant Death Adjusted* Odds Ratios for Infants Born in March Through December 2004 by Maternal BMI

  16. Results (continued) Infant Death Odds Ratios for Infants Born in March Through December 2004 by Maternal BMI and Race

  17. Results (continued) Infant Death Odds Ratios for Infants Born in March Through December 2004 by Maternal BMI and Race

  18. Limitations Bias may result from excluding records due to missing data: 9% of birth records and 21% of infant death records were excluded There may be reporting bias associated with maternal height and weight as recorded on the birth record

  19. Conclusions Maternal obesity is associated with Increased risk of infant death The increase in risk is evident after adjusting for: maternal race, age, marital status, education, tobacco use, first birth, and trimester of entry into prenatal care.

  20. Conclusions (continued) The pattern of increased risk associated with maternal obesity may be different for Black women and non-Black women

  21. Conclusions (continued) • Further investigation is needed to determine if a direct association exists between maternal weight and infant death. • Additional studies could explore underlying factors and specific mechanisms. • Other important factors should be investigated, including poverty levels of women at risk of experiencing poor pregnancy outcomes. • States that have added maternal height and prepregnancy weight to the certificate of birth could replicate the study.

  22. Conclusions (continued) The results indicate that pre-conceptual and inter-conceptual counseling aimed at reducing obesity, may reduce risk of infant death.

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