Prepregnancy obesity as a risk factor for structural birth defects

Objective: To describe the relation between maternal obesity, overweight and underweight status, and 16 categories of structural birth defects. Design: An ongoing multisite, case- control study. Clinical geneticists reviewed all of the cases, excluding those that had or were strongly suspected to have a single- gene disorder or chromosomal abnormality. Mothers with preexisting-diabetes were also excluded. Body mass index was based on maternal report of height and weight prior to pregnancy. Setting: Eight participating states in the United States. Participants: Mothers enrolled in the National Birth Defects Prevention Study who had index pregnancies between October 1, 1997, and December 31, 2002. Main Exposure: Maternal obesity. Main Outcome Measures: Crude and adjusted odds ratios. Results: Mothers of offspring with spina bifida, heart defects, anorectal atresia, hypospadias, limb reduction defects, diaphragmatic hernia, and omphalocele were significantly more likely to be obese than mothers of controls, with odds ratios ranging between 1.33 and 2.10. Mothers of offspring with gastroschisis were significantly less likely to be obese than mothers of controls. Conclusions: To our knowledge, this is the first population-based study of its scale to examine prepregnancy obesity and a range of structural birth defects. These results suggest a weak to moderate positive association of maternal obesity with 7 of 16 categories of birth defects and a strong inverse association with gastroschisis. The mechanisms underlying these associations are not yet understood but may be related to undiagnosed diabetes.