|
| Study | Race | Period | Study design | Population | Setting | Sample size (overall) | Sample size in each obesity class | Source of BMI | Adjustment by factors | Adjusted OR (95% CI) |
|
| Beyerlein et al. (2011) [20] | Bavarian (Europe) | 2000–2007 | Retrospective cohort study | Women with singleton deliveries in Bavarian obstetric units | Bavarian Working Group on Clinical Quality Assessment | Total n of samples = 709575; 2214 (only those weight loss); total n of obese women = 73128 | Obese Class I: 49240 | Measured | Gestational and pregestational diabetes; smoking during pregnancy; gender parity; maternal age | OR 1.36 (1.20–1.55) |
| Obese Class I |
| Obese Class II: 16673 | 1.68 (1.37–2.06) |
| Obese Class II |
| Obese Class III: 7215 | 1.45 (1.12–1.89) |
| Obese Class III 1.31 (0.96–1.79) |
|
| Bogaerts et al. (2015) [21] | Belgium | 2009–2011 | Retrospective cohort study | All liveborn singleton term (37 weeks of gestation or greater) births in obese women in Flanders (the northern part of Belgium) | The Flemish Study Center for Perinatal Epidemiology database | Total n of samples = 18065; 8467 (5120 gained within; 3347 gained below guidelines); total n of obese women = 18053 | NR | Self-reported | Maternal and gestational age; parity | OR 1.34 (1.18–1.51) |
| Obese Class I |
| 1.28 (1.08–1.52) |
| Obese Class II |
| 1.33 (0.98–1.79) |
| Obese Class III |
| 1.17 (0.74–1.87) |
|
| Cox Bauer et al. (2016) [22] | United States | 1/2008–12/2013 | Retrospective cohort study | Women in the study who gave birth at any of 12 hospitals in a single, regional healthcare system | Women in the study who gave birth at any of 12 hospitals in a single, regional health-care system | Total n of samples = 17244; 4703 (3833 gained within; 870 gained below guidelines); total n of obese women = 10734 | NR | Calculated | NR | OR 1.53 (1.32–1.76) |
|
| Class et al. (2021) [23] | United States | 2000–2015 | Retrospective cohort study | The sample was limited to primiparous singleton pregnancies | Electronic medical records (EMR) at the University of Illinois Hospital, Chicago | Total n of samples = 25604; total n of obese women = 15753 | Obese Class I: 7191 | Self-reported | Maternal age, year of birth, gestational age at delivery, GD, and PIH | Obese Class II 1.3 (1.04–1.63) |
| Obese Class II: 5512 |
| Obese Class III: 4102 |
|
| Devlieg-er et al. (2020) [16] | Belgium | 2009–2014 | Retrospective cohort study | Women delivering a singleton term (≥37 weeks) live birth | The data from Flemish study Center for Perinatal Epidemiology (SPE) | Total n of samples = 337590; 17345 (10381 gained within; 6964 gained below guidelines); total n of obese women = 36791 | Obese Class I: 26488 | Measured | Parity, maternal age, mode of conception (spontaneous and assisted), gestational age, and year of delivery | OR 1 (0.75–1.33) |
| Obese Class I |
| 1.29 (1.12–1.47) |
| Obese Class II: 7748 | Obese Class II |
| 1.48 (1.18–1.86) |
| Obese Class III: 2555 | Obese Class III |
| 1.22 (0.83–1.79) |
|
| Durie et al. (2011) [24] | New York | 2004–2008 | Retrospective cohort study | Singleton live birth ≥20 weeks | Five Lakes Region Perinatal Data System | Total n of samples = 73977; 7575 (2850 gained within; 4675 gained below); total n of obese women = 17517 | Obese Class I: 9389 | Prepregnancy BMI was calculated using the patient-reported prepregnancy weight and height as documented on the birth certificate | Maternal race/ethnicity; maternal education; tobacco use; nulliparity; chronic hypertension; preexisting diabetes | OR 1.38 (1.08–1.75) |
| Obese Class I |
| 1.72 (1.02–2.92) |
| Obese Class II: 4728 | Obese Class II |
| 1.40 (0.97–2.02) |
| Obese Class III: 3400 | Obese Class III |
| 1.19 (0.80–1.75) |
|
| Durst et al. (2016) [25] | United States | 2000–12/2014 | Retrospective cohort study | Obese women with singleton pregnancies delivering | University of Alabama at Birmingham | Total n of samples = 5651; 2830 (1352 gained within; 1478 gained below guidelines); total n of obese women = 5651 | Obese Class III: 1558 | Maternal BMI was determined from the height and weight recorded at the first prenatal visit | Adjusted for prior cesarean, age, race, parity, gestational age, payor status, and tobacco use | OR 3.94 (2.04–7.61) |
|
| El Rafei et al. (2016) [26] | Lebano-n | 2001–2012 | Retrospective cohort study | Singleton livebirths with gestational age between 28 and 42 weeks | The NCPNN network | Total n of samples = 170428; 4122 (2310 gained within; 1812 gained below guidelines); total n of obese women = 11274 | NR | Calculated | Body mass index (kg/m2), maternal education, maternal age, paternal age, smoking during pregnancy, newborn sex, consanguinity, and parity | OR 1.01 (0.64–1.61) |
|
| Feghali et al. (2019) [27] | United States | 2012–2014 | Retrospective cohort study | We included women who had at least one measured weight between 24 and 28 weeks of gestation and documented prenatal care in the general obstetrics, midwifery, and maternal–fetal medicine clinics in our hospital system | Magee-Womens Hospital of UPMC (University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania) | Total n of samples = 5814; total n of obese women = 2875 | Obese Class I: 1551 | Measured | NR | OR 1.62 (1.06–2.46) |
| Obese Class I |
| 1.40 (0.90–2.14) |
| Obese Class II: 748 | Obese Class II |
| 0.73 (0.24–2.21) |
| Obese Class III: 576 | Obese Class III |
| 0.95 (0.45–1.97) |
|
| Gavard et al. (2014) [28] | United States | 2002–2008 | Population-based historical cohort study | 66 010 obese pregnant women in Missouri delivering liveborn, singleton | Data from the Missouri maternally linked birth and fetal death certificate registry | Total n of samples = 66010; 25976 (15075 gained within; 10901 gained below guidelines); total n of obese women = 66010 | Obese Class I: 36568 | Self-reported | Maternal age, race, socioeconomic status, smoking, parity, cardiac disease, renal disease, chronic hypertension, and preeclampsia | OR 1.12 (0.77–1.63) |
| Obese Class I |
| 1.38 (1.17–1.62) |
| Obese Class II: 17195 | Obese Class II |
| 1.36 (1.06–1.75) |
| Obese Class III: 12247 | Obese Class III |
| 1.52 (1.10–2.09) |
|
| Hannaford et al. (2017) [29] | United States | 12/2008–4/2012 | Prospective cohort study | Women with singleton gestations | Obstetrics and Gynecology, Washington University | Total n of samples = 1120; 90 (49 gained within; 41 gained below guidelines); total n of obese women = 258 | NR | Prepregnancy maternal BMI was calculated based on patient reported height and weight | smoking, chronichypertension, and macrosomia | OR 1.40 (1.23–1.58) |
|
| Harper et al. (2011) [30] | Missou-ri | 1989–2005 | Retrospective cohort study | Women who were primiparous, who had singleton gestations, who were 520 years old, and who delivered at 24–44 weeks’ gestation | Swedish Medical Birth Registry | Total n of samples = 76682; 1778 (1090 gained within; 688 gained below guidelines); total n of obese women = 6279 | NR | Self-reported | Maternal age; race; smoking/alcohol use during pregnancy; medicaid use; prepregnancy BMI; chronic hypertension; DM; renal disease | OR 1.28 (1.11–1.47) |
|
| Haugen et al. (2014) [17] | Norway | 1998–2008 | Prospective cohort study | Women who delivered a singleton liveborn child during gestational weeks 37–42 and recruited from all over Norway | Norwegian Mother and Child Cohort Study (MoBa), conducted from the Norwegian Institute of Public Health | Total n of samples = 56101; 1931 (1054 gained within; 877 gained below guidelines); total n of obese women = 4963 | Obese Class I: 3680 | Self-reported | Maternal age; maternal height; maternal education; gestational weight; smoking, diabetes; separate analysis for nulliparous and parous | OR 0.9 (0.78–1.03) |
| Obese Class II: 976 |
| Obese Class III: 307 |
|
| Hinkle et al. (2010) [31] | Six unspecified states, United State | 2004–2006 | Retrospective cohort study | Obese nonhispanic white, nonhispanic black, and hispanic women with available data from a prenatal and postpartum visit, singleton term births | Primarily the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) | Total n of samples = 122327; 51328 (26437 gained within; 24891 gained below guidelines) total n of obese women = 122327 | Obesity Class I: 64717 | Self-reported | Education; gestational age; infant sex; marital status; maternal height; race/ethnicity; smoking | OR 1.11 (0.82–1.50) |
| Obese Class I |
| 1.59 (1.23–2.05) |
| Obesity Class II: 33156 | Obese Class II |
| 1.38 (1.12–1.71) |
| Obesity Class III: 24454 | Obese Class III |
| 1.25 (1.06–1.48) |
|
| Hirooka-Nakama et al. (2018) [32] | Japanese | 1/2013–12/2013 | Retrospective cohort study | Women who delivered singleton term live births between | Approximately 280 secondary and tertiary hospitals participated in the JSOG successive pregnancy birth registry system | Total n of samples = 64027; 1387 (560 gained within; 827 gained below guidelines); total n of obese women = 1840 | NR | Calculated from the self-reported prepregnancy weight and height | Parity, maternal age, smoking, and gestational age, and generalized estimating equations (GEE) | OR 1.15 (0.74–1.81) |
|
| Komini-arek et al. (2013) [33] | United States | 2002–2008 | Retrospective cohort study | 20950 obese women with a singleton, term live birth from the consortium on safe labor | 12 institutions (19 hospitals) across nine ACOG districts in the United States | Total n of samples = 20950; 7823 (3613 gained within; 4210 gained below guidelines); total n of obese women = 20950 | Obese Class I: 11984 | Self-reported | Gestational age; insurance; marital status; maternal age; parity; race/ethnicity; smoking | |
| OR 1.41 (1.23–1.61) |
| Obese Class I |
| 1.22 (1.01–1.47) |
| Obese Class II: 5307 | Obese Class II |
| 1.69 (1.32–2.16) |
| Obese Class III: 3659 | Obese Class III |
| 1.53 (1.15–2.03) |
|
| Mission et al. (2020) [34] | United States | 10/2012–8/2014 | Retrospective cohort study | All women with obesity (defined as a prepregnancy BMI >30 kg/m2), singleton gesta tions, onset of prenatal care before 24 weeks, and no history of pre-GDM at UPMC Magee-Womens Hospital (University of Pittsburgh, Pittsburgh, PA) | Magee Obstetric Medical and Infant (MOMI) database, which includes variables for all births at UPMC Magee-Womens Hospital in Pittsburgh, PA | Total n of samples = 2698; 1211 (539 gained within; 672 gained below guidelines); total n of obese women = 2698 | Obese Class I: 1446 | Measured | NR | OR 1.22 (0.49–3.07) |
| Obese Class II: 701 |
| Obese Class III: 551 |
|
| Nowak et al. (2019) [35] | Poland | 11/2006–11/2007 | Retrospective cohort study | (1) Singleton pregnancy | In the Obstetrics and Perinatology Department at Jagiellonian University Hospital in Cracow, Poland | Total n of samples = 474; total n of obese women = 27 | NR | Calculated using maternal weight before pregnancy and height | NR | OR 2.13 (0.48–9.51) |
| (2) No maternal chronic diseases, |
| (3) No congenital fetal abnormalities |
|
| Oza-Frank et al. (2013) [36] | United States | 1959–1965 | Prospective cohort study | Obese women at their first prenatal visit, singleton | 12 urban U.S. sites | Total n of samples = 11203; 1899 (632 gained within; 1267 gained below guidelines); total n of obese women = 2789 | Obese Class I: 1968 | Self-reported | Maternal age, parity, pre-pregnancy BMI, race/ethnicity, socioeconomic status, smoking | OR 1.32 (0.85–2.06) |
| Obese Class II: 588 | Obese Class I |
| Obese Class III: 233 | 1.55 (0.74–3.23) |
|
| Park et al. (2011) [37] | Florida, United States | 2004–2007 | Retrospective cohort study | Women aged 18–40 years with a singleton full term (37–41 week s), live birth; available information for prepregnancy BMI, gestational weight change, and LGA, or SGA status | Florida live birth certificate | Total n of samples = 570672; 37090 (17350 gained within; 19740 gained below); total n of obese women = 101590 | NR | Prepregnancy BMI data from Florida birth certificates | Maternal age; race/ethnicity; education; marital status; smoking status during pregnancy; parity; WIC program participation; gestational age | OR 3.1 (0.66–14.68) |
| Obese Class I |
| 1.39 (1.15–1.69) |
| Obese Class II |
| 1.41 (1.07–1.86) |
| Obese Class III |
| 1.25 (1.03–1.51) |
|
| Robillard et al. (2021) [38] | Europe | 1/2001–12/2019 | Retrospective cohort study | All consecutive term (37–42 weeks gestation) singleton pregnancies (>21 weeks) live birth pregnancies delivered in the maternity | The hospital records of all women delivered at the maternity of the University South Reunion Island | Total n of samples = 61764; 3464 (1941 gained within; 1151 gained below; 372 weight loss); total n of obese women = 11097 | Obese Class I: 6644 | Measured | NR | OR 1.10 (0.78–1.56) |
| Obese Class I |
| 1.49 (1.17–1.89) |
| Obese Class II: 2938 | Obese Class II |
| 1.48 (1.06–2.05) |
| Obese Class III: 1515 | Obese Class III |
| 1.13 (0.72–1.75) |
|
| Roussel et al. (2019) [39] | France | 1/2006–12/2015 | Retrospective cohort study | Singleton pregnancy, term delivery (between 37 and 41 weeks of gestation), and a BMI comprised between 35 and 40 kg/m2 | Two hospitals providing level III (Rouen University Hospital) and II (Belvedere General Hospital) | Total n of samples = 1537; 996 (424 gained within; 370 gained below guidelines; 202 weight loss); total n of obese women = 1537 | Obese Class II: 1537 | Maternal height and weight before pregnancy and weight at delivery from the flemish study center for perinatal epidemiology (SPE) | Maternal age, parity, ethnicity, chronic hypertension, preexisting diabetes mellitus, and tobacco use | Obese Class II 1.24 (0.74–2.06) |
|
| Salmon et al. (2020) [40] | United States | 2014 | Retrospective cohort study | Women were included in the present study if they delivered a singleton liveborn infant at term (37–40 weeks) gestation, had a prepregnancy BMI ≥30 kg/m2, and had no missing data on maternal height, prepregnancy weight, and weight at deliver | Birth certificate data from the 2014 United States (US) Natality Files | Total n of samples = 3998076; 289206 (150189 gained within; 86928 gained below; 52089 weight loss); total n of obese women = 642096 | Obese Class I: 355923 | Measured | Maternal age, maternal education, marital status, parity, medical insurance, maternal race, prepregnancy diabetes, and gestational diabetes, and smoking | OR 1.41 (1.16–1.7) |
| Obese Class I |
| 1.25 (1.09–1.43) |
| Obese Class II: 169000 | Obese Class II |
| 1.26 (1.07–1.5) |
| Obese Class III: 117173 | Obese Class III |
| 1.19 (0.93–1.52) |
|
| Sellner et al. (2021) [8] | United States | 9/2013–8/2017 | Retrospective cohort study | 1428 women with prepregnancy BMI ≥30 kg/m2 who received prenatal care at a large Medicaid clinic | Electronic medical record in Department of Obstetrics and Gynecology, Baylor college of Medicine | Total n of samples = 890; 416 (176 gained within; 161 gained below; 79 weight loss); total n of obese women = 890 | Obese Class I: 484 | Measured | Age, race/ethnicity, nutritional education, participation in group prenatal care, and medical conditions | OR 1.35 (0.94–1.93) |
| Obese Class I |
| 2.53 (1.04–6.16) |
| Obese cClass II: 218 | Obese Class II |
| 1.28 (0.36–4.6) |
| Obese Class III: 188 | Obese Class III |
| 1.49 (0.26–8.45) |
| Shin et al. (2015) [41] | United States | 2004–2011 | Retrospective cohort study | Women from the PRAMS (an ongoing surveillance project of the Centers for Disease Control and Prevention (CDC) and state health departments of 40 U.S. states and New York City) | Pregnancy Risk Assessment Monitoring System (PRAMS) | Total n of samples = 219868; total n of obese women = 42963 | NR | NR | Maternal age; gestational age; smoking; maternal education; family income; marital status | OR 1.24 (1.13–1.37) |
|
| Simas et al. (2012) [42] | United States | 4/2006–3/2010 | Retrospective cohort study | Women who delivered singleton, live birth, and nonanomalous neonates | University of Massachusetts (UMass) Memorial Healthcare automated electronic labour and delivery data | Total n of samples = 11203; 882 (424 gained within; 458 gained below guidelines); total n of obese women = 2313 | NR | (1) Self-reported prepregnancy weight as recorded in the woman’s pre natal record, (2) weight self-reported by the women upon admission for delivery, (3) measured weight at first prenatal visit as recorded in her prenatal record | Diabetes; marital status; hypertension; parity; race/ethnicity and smoking | OR 1.07 (0.9–1.28) |
|
| Tucker et al. (2021) [43] | Florida, USA | 7/2013–12/2017 | Retrospective cohort study | Patients who delivered a singleton at term (>37 weeks and 0 days) with a BMI >40 kg/m2 | Electronic medical record in Duke University Hospital or Duke Regional Hospital | Total n of samples = 374; 230 (101 gained within; 129 gained below); total n of obese women = 374 | Obese Class III: 374 | Measured | After controlling for entry BMI and gestational age at delivery | Obese Class III |
| 0.66 (0.26–1.66) |
|
| Vesco et al. (2011) [44] | Oregon and Washington, United States | 1/2000–12/2005 | Retrospective cohort study | Women with singleton live births ≥37 weeks, who delivered with in Kaiser Permanente Northwest with measured maternal weight between 6 months before pregnancy and 12 weeks; measured weight within the 2 weeks before delivery; documented height | Electronic medical records in Kaiser Permanente Northwest | Total n of samples = 12076 887 (513 gained within; 374 gained below guidelines); total n of obese women = 2080 | NR | Measured | Parity; maternal age; gestational age at delivery; tobacco use during the last trimester of pregnancy; Medicaid enrollment | OR 2.87 (1.18–6.99) |
|
| Wilkins et al. (2022) [45] | United States | 2009–2012 | Retrospective cohort study | Singleton pregnancies >35 weeks with prepregnancy obesity | Kaiser Permanente Northern California | Total n of samples = 17563; total n of obese women = 17563 | Obese Class I: 2459 | NR | Age, race, parity, gestational weeks, start of prenatal care, pregestational diabetes, GDM, neonate, education, substance use, prepregnancy BMl, rior chronic hypertension, and hypertension in pregnancy | OR 1.94 (1.39–2.71) |
| Obese Class I |
| 1.7 (0.81–3.59) |
| Obese Class II: 3688 | Obese Class II |
| 1.`66 (1.13–2.46) |
| Obese Class III: 4742 | Obese Class III |
| 2.85 (1.59–5.09) |
|
