1. 2008 NAPHSIS Annual Meeting Celebrating 75 Years of Excellence Orlando, FL June 1 st – 5 th, 2008 BMI Body Mass Index and Pregnancy Outcome: James Rubertone Statistician, Bureau of Health Statistics and Research Pennsylvania Department of Health Sharon Kirmeyer, Ph.D. Statistician/Demographer, Division of Vital Statistics National Center for Health Statistics, Centers for Disease Control and Prevention Results from the revised birth certificate

2. 2008 NAPHSIS Annual Meeting Celebrating 75 Years of Excellence Orlando, FL June 1 st – 5 th, 2008 Introduction Presenting findings on Body Mass Index and pregnancy outcome, using new data from revised certificate Historically, concern with underweight mothers and pregnancy outcome Recently, concern also with overweight and obesity and pregnancy outcome

3. 2008 NAPHSIS Annual Meeting Celebrating 75 Years of Excellence Orlando, FL June 1 st – 5 th, 2008 Obesity trends Maps show why there is concern with obesity in U.S. Increase in adult obesity in 20 years: from being essentially non-existent to a prevalence of >25 % in half of states Example of obese woman= 5’4” and at least 30 pounds overweight

4. 2008 NAPHSIS Annual Meeting Celebrating 75 Years of Excellence Orlando, FL June 1 st – 5 th, 2008 Obesity Trends* Among U.S. Adults BRFSS, 1985 No Data <10% 10%–14%

5. 2008 NAPHSIS Annual Meeting Celebrating 75 Years of Excellence Orlando, FL June 1 st – 5 th, 2008 Obesity Trends* Among U.S. Adults BRFSS, 1986 No Data <10% 10%–14%

6. 2008 NAPHSIS Annual Meeting Celebrating 75 Years of Excellence Orlando, FL June 1 st – 5 th, 2008 Obesity Trends* Among U.S. Adults BRFSS, 1987 No Data <10% 10%–14%

7. 2008 NAPHSIS Annual Meeting Celebrating 75 Years of Excellence Orlando, FL June 1 st – 5 th, 2008 Obesity Trends* Among U.S. Adults BRFSS, 1988 No Data <10% 10%–14%

8. 2008 NAPHSIS Annual Meeting Celebrating 75 Years of Excellence Orlando, FL June 1 st – 5 th, 2008 Obesity Trends* Among U.S. Adults BRFSS, 1989 No Data <10% 10%–14%

9. 2008 NAPHSIS Annual Meeting Celebrating 75 Years of Excellence Orlando, FL June 1 st – 5 th, 2008 Obesity Trends* Among U.S. Adults BRFSS, 1990 No Data <10% 10%–14%

10. 2008 NAPHSIS Annual Meeting Celebrating 75 Years of Excellence Orlando, FL June 1 st – 5 th, 2008 No Data <10% 10%–14% 15%–19% Obesity Trends* Among U.S. Adults BRFSS, 1991

11. 2008 NAPHSIS Annual Meeting Celebrating 75 Years of Excellence Orlando, FL June 1 st – 5 th, 2008 Obesity Trends* Among U.S. Adults BRFSS, 1992 No Data <10% 10%–14% 15%–19%

12. 2008 NAPHSIS Annual Meeting Celebrating 75 Years of Excellence Orlando, FL June 1 st – 5 th, 2008 Obesity Trends* Among U.S. Adults BRFSS, 1993 No Data <10% 10%–14% 15%–19%

13. 2008 NAPHSIS Annual Meeting Celebrating 75 Years of Excellence Orlando, FL June 1 st – 5 th, 2008 Obesity Trends* Among U.S. Adults BRFSS, 1994 No Data <10% 10%–14% 15%–19%

14. 2008 NAPHSIS Annual Meeting Celebrating 75 Years of Excellence Orlando, FL June 1 st – 5 th, 2008 Obesity Trends* Among U.S. Adults BRFSS, 1995 No Data <10% 10%–14% 15%–19%

15. 2008 NAPHSIS Annual Meeting Celebrating 75 Years of Excellence Orlando, FL June 1 st – 5 th, 2008 Obesity Trends* Among U.S. Adults BRFSS, 1996 No Data <10% 10%–14% 15%–19%

16. 2008 NAPHSIS Annual Meeting Celebrating 75 Years of Excellence Orlando, FL June 1 st – 5 th, 2008 No Data <10% 10%–14% 15%–19% ≥20% Obesity Trends* Among U.S. Adults BRFSS, 1997

17. 2008 NAPHSIS Annual Meeting Celebrating 75 Years of Excellence Orlando, FL June 1 st – 5 th, 2008 Obesity Trends* Among U.S. Adults BRFSS, 1998 No Data <10% 10%–14% 15%–19% ≥20%

18. 2008 NAPHSIS Annual Meeting Celebrating 75 Years of Excellence Orlando, FL June 1 st – 5 th, 2008 Obesity Trends* Among U.S. Adults BRFSS, 1999 No Data <10% 10%–14% 15%–19% ≥20%

19. 2008 NAPHSIS Annual Meeting Celebrating 75 Years of Excellence Orlando, FL June 1 st – 5 th, 2008 Obesity Trends* Among U.S. Adults BRFSS, 2000 No Data <10% 10%–14% 15%–19% ≥20%

20. 2008 NAPHSIS Annual Meeting Celebrating 75 Years of Excellence Orlando, FL June 1 st – 5 th, 2008 No Data <10% 10%–14% 15%–19% 20%–24% ≥25% Obesity Trends* Among U.S. Adults BRFSS, 2001

21. 2008 NAPHSIS Annual Meeting Celebrating 75 Years of Excellence Orlando, FL June 1 st – 5 th, 2008 Obesity Trends* Among U.S. Adults BRFSS, 2002 No Data <10% 10%–14% 15%–19% 20%–24% ≥25%

22. 2008 NAPHSIS Annual Meeting Celebrating 75 Years of Excellence Orlando, FL June 1 st – 5 th, 2008 Obesity Trends* Among U.S. Adults BRFSS, 2003 No Data <10% 10%–14% 15%–19% 20%–24% ≥25%

23. 2008 NAPHSIS Annual Meeting Celebrating 75 Years of Excellence Orlando, FL June 1 st – 5 th, 2008 Obesity Trends* Among U.S. Adults BRFSS, 2004 No Data <10% 10%–14% 15%–19% 20%–24% ≥25%

24. 2008 NAPHSIS Annual Meeting Celebrating 75 Years of Excellence Orlando, FL June 1 st – 5 th, 2008 No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30% Obesity Trends* Among U.S. Adults BRFSS, 2005

25. 2008 NAPHSIS Annual Meeting Celebrating 75 Years of Excellence Orlando, FL June 1 st – 5 th, 2008 Obesity Trends* Among U.S. Adults BRFSS, 2006 No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%

26. 2008 NAPHSIS Annual Meeting Celebrating 75 Years of Excellence Orlando, FL June 1 st – 5 th, 2008 BMI What Is Body Mass Index? Based upon height and weight Formula: BMI = Weight (lb) / [height (in)] 2 x 703 Does not measure fat directly Used to identify possible weight problems

27. 2008 NAPHSIS Annual Meeting Celebrating 75 Years of Excellence Orlando, FL June 1 st – 5 th, 2008 Methods 18 states collected 2006 data using revised birth certificate with mother’s height and weight data Limited to singleton births (approx. 95% of all births) Excluded records which did not have mother’s height or weight Total 1.4 million births NOTE: All 2006 data considered preliminary

28. 2008 NAPHSIS Annual Meeting Celebrating 75 Years of Excellence Orlando, FL June 1 st – 5 th, 2008 Selected New Items on 2003 Certificate

29. 2008 NAPHSIS Annual Meeting Celebrating 75 Years of Excellence Orlando, FL June 1 st – 5 th, 2008 States Using Revised Birth Certificate in 2006 MT WY ID WA OR NV UT CA AZ ND SD NE CO NM TX OK KS AR LA MO IA MN WI IL IN KY TN MS AL GA FL SC NC VA WV OH MI NY PA MD DE NJ CT RI MA ME VT NH AK HI DC 2007 or later 2003 to 2006 Does not report height and weight NOTE: New York State, but not New York City

30. 2008 NAPHSIS Annual Meeting Celebrating 75 Years of Excellence Orlando, FL June 1 st – 5 th, 2008 BMI Category Definitions SOURCE: National Heart, Lung, and Blood Institute (1998).

31. 2008 NAPHSIS Annual Meeting Celebrating 75 Years of Excellence Orlando, FL June 1 st – 5 th, 2008 BMI distribution of Mothers 18 State Reporting Area - 2006 (preliminary) Average Underweight Overweight Obese

32. 2008 NAPHSIS Annual Meeting Celebrating 75 Years of Excellence Orlando, FL June 1 st – 5 th, 2008 Distribution of Mothers by BMI Category 18 State Reporting Area - 2006 (preliminary) -- Underweight -- Obese -- Average Overweight --

33. 2008 NAPHSIS Annual Meeting Celebrating 75 Years of Excellence Orlando, FL June 1 st – 5 th, 2008 BMI Distribution by Race of Mother 18 State Reporting Area - 2006 (preliminary)Obese Overweight Average Underweight NH=Non-Hispanic AI/AN=American Indian/Alaska Native A/PI=Asian/Pacific Islander

34. 2008 NAPHSIS Annual Meeting Celebrating 75 Years of Excellence Orlando, FL June 1 st – 5 th, 2008 Percent Preterm and Low Birthweight Infants by BMI Category 18 State Reporting Area - 2006 (preliminary) PretermLow Birthweight

35. 2008 NAPHSIS Annual Meeting Celebrating 75 Years of Excellence Orlando, FL June 1 st – 5 th, 2008 Percent Very Preterm and Very Birthweight by BMI Category 18 State Reporting Area – 2006 (preliminary) Very PretermVery Low Birthweight percent

36. 2008 NAPHSIS Annual Meeting Celebrating 75 Years of Excellence Orlando, FL June 1 st – 5 th, 2008 Percent of Women with 4000+ Gram Infants by BMI Category 18 State Reporting Area - 2006 (preliminary) % 4000+ Gram Infants percent 4000+ g. infant /No pre- pregnancy diabetes % 4000+ Gram Infants and Mother’s Pre-pregnancy Diabetes Status percent 4000+ g. infant / With pre- pregnancy diabetes

37. 2008 NAPHSIS Annual Meeting Celebrating 75 Years of Excellence Orlando, FL June 1 st – 5 th, 2008 Gestational Diabetes/Hypertension by BMI Category 18 State Reporting Area – 2006 (preliminary) Gestational HypertensionGestational Diabetes

38. 2008 NAPHSIS Annual Meeting Celebrating 75 Years of Excellence Orlando, FL June 1 st – 5 th, 2008 Breech Fetal Presentation by BMI Category 18 State Reporting Area – 2006 (preliminary) 0.0 //

39. 2008 NAPHSIS Annual Meeting Celebrating 75 Years of Excellence Orlando, FL June 1 st – 5 th, 2008 Cesarean Delivery by BMI Category 18 State Reporting Area – 2006 (preliminary)

40. 2008 NAPHSIS Annual Meeting Celebrating 75 Years of Excellence Orlando, FL June 1 st – 5 th, 2008 Unplanned Procedures by BMI Category 18 State Reporting Area – 2006 (preliminary) Unplanned Procedure Rates 0.0 //

41. 2008 NAPHSIS Annual Meeting Celebrating 75 Years of Excellence Orlando, FL June 1 st – 5 th, 2008 Average Pre-Pregnancy Weight Gain by BMI Category 18 State Reporting Area - 2006 (preliminary) Underweight Average Overweight Obese 0 //

42. 2008 NAPHSIS Annual Meeting Celebrating 75 Years of Excellence Orlando, FL June 1 st – 5 th, 2008 Average Pre-Pregnancy Weight Gain by BMI Category and Race/Ethnicity 18 State Reporting Area - 2006 (preliminary) Underweight Average Overweight Obese Non-Hispanic White Non-Hispanic Black Hispanic 0 //

43. 2008 NAPHSIS Annual Meeting Celebrating 75 Years of Excellence Orlando, FL June 1 st – 5 th, 2008 Summary  ½ women with singleton live births in 2006 reporting area were overweight or obese  Black and AI/AN women more likely to be obese  Risk of preterm and low birthweight elevated for infants of underweight mothers  Risk of giving birth to macrosomic (4000+ g.) infant elevated for obese women  Rates of many pregnancy risk factors, complications in delivery, and C-sections higher for obese women

44. 2008 NAPHSIS Annual Meeting Celebrating 75 Years of Excellence Orlando, FL June 1 st – 5 th, 2008 Conclusion  New BMI data are very useful to show associations with maternal-infant outcomes  Can translate findings into prepregnancy practice  Slides demonstrate power of states and federal DVS working together  We look forward to working together on a paper giving more detail on this topic

45. 2008 NAPHSIS Annual Meeting Celebrating 75 Years of Excellence Orlando, FL June 1 st – 5 th, 2008 Contacts and Links Contacts: Sharon Kirmeyer SKirmeyer@cdc.govSKirmeyer@cdc.gov James Rubertone JRubertone@state.pa.usJRubertone@state.pa.us Links: http://www.mayoclinic.com/health/bmi-calculator/NU00597 http://www.nytimes.com/ref/health/bmi.html http://www.cdc.gov/nccdphp/dnpa/bmi/ http://www.iom.edu/ http://www.cdc.gov/nccdphp/dnpa/obesity/trend/maps/ DATA SOURCE FOR PRESENTATION: National Vital Statistics System, NCHS, CDC