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Review |

Maternal Overweight and Obesity and the Risk of Congenital Anomalies: A Systematic Review and Meta-analysis

Katherine J. Stothard, PhD; Peter W. G. Tennant, MSc; Ruth Bell, MD; Judith Rankin, PhD
JAMA. 2009;301(6):636-650. doi:10.1001/jama.2009.113.
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Published online

Context Evidence suggests an association between maternal obesity and some congenital anomalies.

Objective To assess current evidence of the association between maternal overweight, maternal obesity, and congenital anomaly.

Data Sources MEDLINE, EMBASE, CINAHL, and Scopus (January 1966 through May 2008) were searched for English-language studies using a list of keywords. Reference lists from relevant review articles were also searched.

Study Selection Observational studies with an estimate of prepregnancy or early pregnancy weight or body mass index (BMI) and data on congenital anomalies were considered. Of 1944 potential articles, 39 were included in the systematic review and 18 in the meta-analysis.

Data Extraction and Synthesis Information was extracted on study design, quality, participants, congenital anomaly groups and subtypes, and risk estimates. Pooled odds ratios (ORs) comparing risk among overweight, obese, and recommended-weight mothers (defined by BMI) were determined for congenital anomaly groups and subtypes for which at least 150 cases had been reported in the literature.

Results Pooled ORs for overweight and obesity were calculated for 16 and 15 anomaly groups or subtypes, respectively. Compared with mothers of recommended BMI, obese mothers were at increased odds of pregnancies affected by neural tube defects (OR, 1.87; 95% confidence interval [CI], 1.62-2.15), spina bifida (OR, 2.24; 95% CI, 1.86-2.69), cardiovascular anomalies (OR, 1.30; 95% CI, 1.12-1.51), septal anomalies (OR, 1.20; 95% CI, 1.09-1.31), cleft palate (OR, 1.23; 95% CI, 1.03-1.47), cleft lip and palate (OR, 1.20; 95% CI, 1.03-1.40), anorectal atresia (OR, 1.48; 95% CI, 1.12-1.97), hydrocephaly (OR, 1.68; 95% CI, 1.19-2.36), and limb reduction anomalies (OR, 1.34; 95% CI, 1.03-1.73). The risk of gastroschisis among obese mothers was significantly reduced (OR, 0.17; 95% CI, 0.10-0.30).

Conclusions Maternal obesity is associated with an increased risk of a range of structural anomalies, although the absolute increase is likely to be small. Further studies are needed to confirm whether maternal overweight is also implicated.

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Figures

Place holder to copy figure label and caption
Figure 1. Review and Selection of Articles
Graphic Jump Location

BMI indicates body mass index.

Place holder to copy figure label and caption
Figure 2. Forest Plot for Neural Tube Defects
Graphic Jump Location

Data markers within each subplot are proportional to the assigned study weight.
aTest for heterogeneity between studies.
bTest for heterogeneity between definitions of obese/overweight.

Place holder to copy figure label and caption
Figure 3. Forest Plot for Cardiovascular Anomalies
Graphic Jump Location

Data markers within each subplot are proportional to the assigned study weight.
aTest for heterogeneity between studies.
bTest for heterogeneity between definitions of obese/overweight.

Place holder to copy figure label and caption
Figure 4. Forest Plot for Orofacial Clefts
Graphic Jump Location

Data markers within each subplot are proportional to the assigned study weight.
aTest for heterogeneity between studies.
bTest for heterogeneity between definitions of obese/overweight.

Place holder to copy figure label and caption
Figure 5. Sensitivity Analysis
Graphic Jump Location

Dashed lines indicate the value of the odds ratio for the default model in each subcategory (reference). P values are for difference from reference odds ratio. Adjusted odds ratios were adjusted for maternal age, cigarette smoking status, and vitamin supplementation. BMI indicates body mass index; CI, confidence interval.

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