239832 Obese mothers with advanced education: Are their pregnancies protected from fetal demise?

Tuesday, November 1, 2011

Hamisu Salihu, MD, PhD , Department of Epidemiology and Biostatistics, University of South Florida, College of Public Health, Tampa, FL
Euna August, MPH , Department of Community and Family Health, University of South Florida, College of Public Health, Tampa, FL
Hanna Weldeselasse , Department of Epidemiology and Biostatistics, University of South Florida, College of Public Health, Tampa, FL
Raymond De Cuba , Department of Epidemiology and Biostatistics, University of South Florida, College of Public Health, Tampa, FL
Alfred Mbah, PhD , Department of Epidemiology and Biostatistics, University of South Florida, College of Public Health, Tampa, FL
Background: Maternal obesity and educational level have been investigated separately for their influence on feto-infant health. Maternal obesity has been associated with increased risk for infant mortality and adverse fetal growth outcomes, whereas higher maternal educational levels result in declining risk. However, the confluence of these factors in relation to stillbirth remains poorly understood. Methods: We utilized data from the Missouri maternally linked cohort data files for 1989-2005 to examine the risk for stillbirth based on obesity status and educational level (less than high school degree vs. high school degree or more). We used odds ratios to approximate relative risks. Results: Women with higher educational levels were more likely to be white, of advanced age (> 35 years), to be obese, and less likely to smoke during pregnancy (p<0.01). They also had higher rates of pregnancy-related complications, including insulin-dependent diabetes, chronic hypertension, pre-eclampsia, and placenta previa (p<0.01). Obese women of advanced education (AOR=1.30; 95% CI 1.19-1.41) and those who did not complete high school (AOR=1.26; 95% CI 1.08-1.47) were equally at elevated risk for stillbirth, as compared to non-obese women with advanced education. Black women with advanced education were twice as likely to experience stillbirth (AOR=1.98; 95% CI 1.80-2018) compared to their white counterparts. Conclusions: Obese women experience higher risk for stillbirth regardless of educational status. Additionally, a black-white disparity was evident. The interplay of multiple demographic and socio-cultural factors should be considered in the determination of the appropriate interconception strategies for women and their families.

Learning Areas:
Assessment of individual and community needs for health education
Clinical medicine applied in public health
Epidemiology
Implementation of health education strategies, interventions and programs
Planning of health education strategies, interventions, and programs
Public health or related research

Learning Objectives:
1. Discuss the utility of risk and protective factors associated with feto-infant health outcomes within a population-based sample. 2. Evaluate of criteria to consider in tailoring preconception/interconception care for women and their families.

Keywords: Maternal and Child Health, Pregnancy Outcomes

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I worked with all aspects of this study.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.