ABSTRACT The prevalence of obesity is currently rising in

developed countries, making pregravid overweight one of the

most common high-risk obstetric situations. Although the
designs and populations of published studies vary widely, most
authors agree that pregravid overweight increases maternal and
fetal morbidity. Even moderate overweight is a risk factor for
gestational diabetes and hypertensive disorders of pregnancy,
and the risk is higher in subjects with overt obesity. Compared
with normal weight, maternal overweight is related to a higher
risk of cesarean deliveries and a higher incidence of anesthetic
and postoperative complications in these deliveries. Low Apgar
scores, macrosomia, and neural tube defects are more frequent in
infants of obese mothers than in infants of normal-weight moth-
ers. The regional distribution of fat modulates the effects of
weight on carbohydrate tolerance, hemodynamic adaptation, and
fetal size. Maternal obesity increases perinatal mortality. Long-
term complications include worsening of maternal obesity and
development of obesity in the infant. The average cost of hospi-
tal prenatal and postnatal care is higher for overweight mothers
than for normal-weight mothers, and infants of overweight moth-
ers require admission to neonatal intensive care units more often
than do infants of normal-weight mothers. Preconception coun-
seling, careful prenatal management, tight monitoring of weight
gain, and long-term follow-up could minimize the social and
economic consequences of pregnancies in overweight women.
Am J Clin Nutr 2000;71(suppl):1242S8S.
KEY WORDS Obesity, waist-to-hip ratio, pregnancy,
gestational diabetes, hypertension, macrosomia, mortality, cost
FREQUENCY OF OVERWEIGHT AMONG PREGNANT
WOMEN
As the prevalence of obesity has risen in developed countries,
overweight among pregnant women has become increasingly
common. In the United States, the incidence of obesity among
pregnant women ranges from 18.5% to 38.3%, according to the
cohort studied and the cutoff point used to define overweight
(16). Pregravid overweight is therefore one of the most frequent
high-risk obstetric situations.
To determine the frequency of obesity during pregnancy in a
region where the incidence of obesity in the general population is
low, we undertook a study in Montpellier, France. Our series
included 435 pregnant women seen consecutively at the Obstetric
and Gynecology Department of Montpellier University Hospital
during the third trimester of their pregnancy. The women were
recruited between October 1993 and December 1994 and gave their
informed consent to participate in the study. Seventy-four women
(17.0 %) had a body mass index (BMI; in kg/m
2
) >25 and 54
women (12.6%) had a BMI >26 before becoming pregnant (Table 1).
Also shown in Table 1 is the frequency of obesity among pregnant
women or women of childbearing age in different cohorts in which
relative weight before pregnancy was reported (18).
OUTCOME OF PREGNANCY IN OVERWEIGHT
WOMEN: DIFFERENCES IN STUDY DESIGNS
Pregnancy outcome in overweight mothers was addressed as
early as 1945 (9). Since then, study designs have varied widely (1,
3, 1020). Differences in types of studies, thresholds used to dene
overweight, and denitions of control patients can result in major
discrepancies in the data provided. Shown in Table 2 are some dif-
ferences in denitions of overweight and choices of control groups
in studies addressing the outcome of pregnancy in overweight
women published since 1945. Other important differences include
the time and length of the study period, the choice of exclusion cri-
teria (eg, previous maternal pathology, multiple pregnancies, and
stillbirths), and the characteristics of the population studied (eg, age,
ethnic origin, and social background). Therefore, although most
authors agree that pregravid overweight increases maternal and fetal
morbidity, detailed comparisons between reports may be hazardous,
and for some complications, rates vary within a broad range.
MATERNAL MORBIDITY
Carbohydrate intolerance
Overweight is a risk factor for impairment of carbohydrate tol-
erance both in the nonpregnant state and during pregnancy. Fast-
ing and postabsorptive plasma insulin concentrations are higher
in obese pregnant women than in nonobese pregnant women (21).
However, insulin secretion is increased enough in many obese
women to maintain normoglycemia. Conversely, approximately
Am J Clin Nutr 2000;71(suppl):1242S8S. Printed in USA. 2000 American Society for Clinical Nutrition
Obesity and pregnancy: complications and cost
13
Florence Galtier-Dereure, Catherine Boegner, and Jacques Bringer
1242S
1
From the Service dEndocrinologie and the Service de Maladies
Mtaboliques, Hpital Lapeyronie, CHU Montpellier, France.
2
Presented at the symposium Maternal Nutrition: New Developments and
Implications, held in Paris, June 1112, 1998.
3
Address reprint requests to F Galtier-Dereure, Service dEndocrinologie,
Hpital Lapeyronie, 371 Avenue du Doyen Gaston Giraud, F-34295 Mont-
pellier Cedex 5, France. E-mail: ofdereure@wanadoo.fr.

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half of women diagnosed with gestational diabetes have no iden-
tifiable risk factor (22). Therefore, other factors must be sought to
explain the occurrence of gestational diabetes.
The regional distribution of fat was suggested to modulate
the response to an oral glucose load in obese women (23). In
this study, insulin areas under the curve after an oral glucose
tolerance test (OGTT) during the second and third trimester of
pregnancy and in the postpartum period were significantly
higher in pregnant women with upper-body obesity than in
pregnant women with lower-body obesity and in lean pregnant
women. The same study reported a positive correlation between
waist-to-hip ratio and glucose concentration and insulin areas
under the curve.
No epidemiologic investigation of the importance of regional
distribution of fat as a risk factor for gestational diabetes has
been undertaken so far, but weight excess clearly increases the
risk of overt impairment of carbohydrate tolerance in pregnant
women. Even in moderately overweight subjects (BMI 2530 or
weight 120150% of ideal body weight), the incidence of gesta-
tional diabetes is 1.8 to 6.5 times greater than that in normal-
weight subjects (1, 3, 14, 16). In obese women (BMI >30 or
weight >150% of ideal body weight), the incidence of gesta-
tional diabetes is 1.4- to 20-fold higher than that in normal-
weight subjects (1, 3, 1014, 1620).
Screening for gestational diabetes must be performed early to
allow for efficient management. In obese women, however, a
negative test result at the 24th-week screening does not rule out
the possibility that diabetes mellitus will develop later. There-
fore, we suggest performing repeated acceptable screening tests
(such as measuring fasting and postprandial glycemia) through-
out pregnancy in this high-risk group, rather than performing a
single OGTT between the 24th and 28th week of gestation.
If carbohydrate intolerance is diagnosed, tight metabolic con-
trol should be achieved through diet and, when indicated, insulin
therapy. The American Diabetes Association recommends an
average daily intake of 100 kJ/kg for obese mothers with gesta-
tional diabetes (24). Greater energy restrictions have been pro-
posed (25), but with the risk of excessive ketogenesis. Whether
ketone bodies impair fetal development and long-term child out-
come is still unclear. Thus, if control of glycemia is poor with
standard diet alone, insulin therapy should be initiated. Insulin
treatment of gestational diabetes is required more often in obese
women than in lean women (26) and reduces maternal and fetal
morbidity (27, 28). In obese mothers with gestational diabetes,
insulin treatment increases neither maternal weight gain during
pregnancy (27) nor long-term adiposity in the offspring (29).
Hypertensive disorders
Maternal hemodynamic changes in obese mothers include
higher arterial blood pressure, hemoconcentration, and altered
cardiac function (30). Hypertensive disorders are significantly
more prevalent in obese pregnant women than in their lean coun-
terparts. Even when overweight is moderate, the occurrence of
hypertension and preeclampsia is significantly higher by com-
parison with control patients (1, 3, 14, 16). In obese women, the
incidence of hypertension is 2.221.4 times higher than in con-
trol subjects, and preeclampsia occurs 1.229.7 times more often
(1, 3, 1014, 18, 19). In a case-control study of 66 women with
eclampsia who were matched with 264 control subjects, a ten-
dency toward an increased risk of eclampsia in the obese women,
although not statistically significant, was reported (odds ratio:
2.49; 95% CI: 0.78, 7.96) (31). Although hypertension in obese
women is associated with a reduction in subcutaneous fat of the
newborn (32), the incidence of small-for-gestational-age infants
is usually not higher in obese patients than in normal-weight
control subjects.
In nonpregnant subjects, hypertension is associated with
upper-body rather than with lower-body obesity. Similarly, the
regional distribution of fat may modulate the risk of cardiovascu-
lar disease in pregnant women. In a study involving 22 patients
with preeclampsia and 126 control subjects, the ratio of upper-
body to lower-body fat was more accurately associated with the
development of preeclampsia than was total body fat (33).
Miscellaneous
Obesity during pregnancy is also associated with a slightly
higher risk of urinary tract infections and thromboembolic disor-
ders (1). On the other hand, anemia appears to occur less often
in severely obese pregnant women than in normal-weight preg-
nant women (1, 14).
OBESITY AND PREGNANCY: COMPLICATIONS AND COST 1243S
TABLE 1
Prevalence of obesity in different studies of women of childbearing age
1
Setting
2
Population studied Denition of overweight Percentage overweight
%
United States, 1980 (1) Pregnant women (n = 9666) >120% of IBW 19.5
United States, 19801983 (2) Pregnant women (n = 2948)
3
BMI > 23 38.3
United States, 1959 (3) Pregnant women (n = 56857) BMI > 25 26.9
United States, 1988 (4) Pregnant women (n = 1771000) BMI > 26 18.5
United States, 19831986 (5) Pregnant women (n = 7170)
3,4
BMI > 26 27.9
United States, 19901991 (6) Pregnant women (n = 65809)
3,5
BMI > 26 30.0
Netherlands, 19861988 (7) Women in donor insemination program BMI > 25 17.0
(n = 489)
Sweden, 19921993 (8) Pregnant women (n = 167750)
5
BMI > 25 26.1
France, 1994 (unpublished) Pregnant women (n = 435) BMI > 25 17.0
France, 1994 (unpublished) Pregnant women (n = 435) BMI > 26 12.6
1
IBW, ideal body weight.
2
Years indicated are those of cohort recruitment and differ from the years of publication.
3
Pregnancies terminated by stillbirth were excluded.
4
Complicated pregnancies were excluded.
5
Only singleton pregnancies were considered.

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COMPLICATIONS OF DELIVERY
The association between maternal obesity and premature birth
is a matter of controversy. Compared with that in normal-weight
control subjects, the incidence of premature birth in overweight
women was shown to be lower (11, 13), higher (3), or similar (1,
10, 16, 17). A recent article based on a cohort study of 167750
women reported that obesity increases the frequency of very pre-
mature delivery (<32 wk) only in nulliparous women. In parous
women, obesity was not a significant risk factor for premature
delivery (8). However, obese women were not compared with the
lower-risk group (ie, normal-weight women), but with lean
women, in whom the risk of premature deliveries was also
increased. Thus, it seems that both excessive leanness and over-
weight lead to a higher frequency of preterm birth.
Most authors report a higher frequency of induction of labor
in obese women than in normal-weight women (11, 13, 17),
whereas the duration of labor (11, 17, 18) and the percentage of
instrumental deliveries (10, 11, 13, 17) are usually similar. The
rate of cesarean deliveries in obese women is consistently higher,
with a 1.15- to 3.0-fold increase over the rates in control groups
(1, 1020). Each 1-unit increase in pregravid BMI increases the
risk of cesarean delivery by 7% (34). Prepartum complications
of obesity largely account for this higher cesarean delivery rate,
and the percentage of cesarean deliveries in obese women with-
out obesity-related complications is similar to that in control
subjects (18). Reasons reported for surgery generally include
macrosomia-associated cephalopelvic dysproportion, fetal dis-
tress, and stagnation of induced labor. Anesthetic and postopera-
tive risks are also high in obese patients, and massive obesity
increases perioperative total operative time, blood loss, and
endometritis (35).
INFANTS OF OVERWEIGHT MOTHERS
Neonatal parameters
Low Apgar scores are slightly more frequent in infants of obese
mothers than in infants of normal-weight mothers (12, 15, 16).
Prepregnancy BMI is a strong predictor of birth weight, and obese
mothers deliver large-for-gestational-age infants 1.4 to 18 times
more frequently than do lean mothers (6, 1013, 1518). Neonatal
skinfold thickness is also higher in infants born to obese mothers,
suggesting that the excess weight in the newborn is due to a larger
fat mass (32). Macrosomia increases the risk for shoulder dystocia,
birth injury, depression of Apgar scores, and perinatal death (36).
Cesarean deliveries result in fewer birth injuries for macrosomic
infants, but the perinatal death rate remains unchanged (37).
High gestational weight gain enhances the risk of delivering
large-for-gestational-age infants in overweight women (6, 19).
Gestational diabetes also affects fetal growth (36). However, the
effect of gestational diabetes on birth weight can be counter-
acted by insulin treatment (28). In a multivariate analysis of
1000 mother-newborn pairs (209 with macrosomia), maternal
constitutional factors predicted macrosomia better than positive
OGTT results, and treated gestational diabetes was not a signifi-
cant predictive factor (37). In patients with gestational diabetes,
maternal weight is an independent risk factor that increases the
risk of both macrosomia and operative delivery (38).
Fetal growth is also influenced by the location of body fat
stores in the mother. The influence of regional distribution of fat
on newborn size was investigated prospectively in a sample of
702 women whose preconceptional nutritional characteristics
were recorded. Each 0.1-unit increase in pregravid waist-to-hip
ratio predicted a 120-g greater birth weight, a 0.51-cm greater
length, and a 0.3-cm greater head circumference (39).
Congenital abnormalities
Maternal obesity is also a risk factor for congenital abnormal-
ities. Data based on 56857 children in an analysis from the
National Institute of Neurological and Communicative Disorders
and Stroke showed an increase in the incidence of major con-
genital malformations of 35% when mothers were overweight
and of 37.5% when they were obese (3). This increase was later
found to be accounted for by a higher percentage of neural tube
defects; 4 independent studies reported an association between
neural tube defects and maternal obesity (4043). The odds
ratios for neural tube defects in the offspring ranged from 1.8 to
3 according to the degree of maternal overweight (Table 3). This
1244S GALTIER-DEREURE ET AL
TABLE 2
Differences in denitions of overweight and choices of control groups in studies addressing the outcome of pregnancy in overweight women
1
Setting Denition of overweight Choice of control group
United States, 1945 (9)
2
>91 kg during pregnancy No control group
United States, 1978 (10) >150% of pregravid IBW <150% of pregravid IBW
United States, 1980 (11) >90 kg during pregnancy <90 kg during pregnancy
Australia, 1981 (12) >90 kg during pregnancy Entire hospital population
United States, 1985 (1) >120% of pregravid IBW 80120% of pregravid IBW
United States, 1987 (13) >113.6 kg during pregnancy <113.6 kg during pregnancy
United States, 1988 (14) Pregravid BMI >25.6 Pregravid BMI 19.225.6
United States, 1990 (3) Pregravid BMI >25 Pregravid BMI 2024
Italy, 1991 (15) Pregravid BMI >30 Pregravid BMI 26.6
United States, 1992 (16) >136 kg during pregnancy <136 kg during pregnancy
France, 1992 (17) Pregravid BMI >30 Pregravid BMI <25
France, 1995 (18) Pregravid BMI >25 Pregravid BMI 1825
United States, 1996 (19) Pregravid BMI >29 Pregravid BMI 19.826
Sweden, 1998 (8) Pregravid BMI >25 Pregravid BMI 19.9
United States, 1998 (20) Pregravid BMI >35 Pregravid BMI 1927
1
IBW, ideal body weight.
2
Years indicated are those of publication.

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relation persisted after adjustment for confounding factors such
as maternal age, smoking, socioeconomic status, and folate
intake. Obesity is also a risk factor for cryptorchism in male
infants (adjusted odds ratio: 2.42; 95% CI: 1.11, 5.27) (44) and
raises the risk of fluctuating dental asymmetry in the offspring,
indicating developmental destabilization (45).
Mortality
Three cohort studies addressed the incidence of perinatal mor-
tality according to the amount of pregravid weight excess (1, 3,
8). Even in moderately overweight mothers (BMI 2530 or
120150% of ideal body weight), the incidence of perinatal
death in the infants was 1.15- to 2.5-fold higher than that in normal-
weight women (1, 3). In obese women (BMI >30 or >150% of
ideal body weight), the incidence of perinatal death in infants
exceeded that in normal-weight women by 2.5 (3) and 3.4 (1). A
more recent epidemiologic survey conducted in Sweden (8)
reported that only late fetal deaths are significantly higher in
overweight women (odds ratio: 1.7; 95% CI: 1.1, 2.4) and obese
women (odds ratio: 2.7; 95% CI: 1.8, 4.1), whereas the risk for
early neonatal death is not modified by maternal pregravid BMI
(8). The effect of obesity is higher in nulliparous than in parous
women (8). Maternal complications and preterm deliveries
largely contribute to this excessive mortality (3).
LONG-TERM COMPLICATIONS
After delivery, obese mothers are more likely than normal-
weight mothers to experience urinary symptoms such as stress
incontinence and urgency (46). Excessive weight gain during
pregnancy worsens maternal obesity. Weight gain during preg-
nancy is a strong predictor for sustained weight retention (47)
and weight gains >9 kg are correlated with the amount of weight
retained between 2 successive pregnancies (48).
Infants of obese mothers are at higher risk of being over-
weight at 12 mo of age than are infants of normal-weight moth-
ers (10). In particular, macrosomic infants are more likely to
become obese in later life (49). When diabetes complicates the
course of pregnancy, infants are predisposed to develop over-
weight and obesity during childhood, especially in the case of
high birth weight (50). Hypertension during pregnancy is also
responsible for increased morbidity during infancy. At 6 y of age,
mean diastolic blood pressure is higher in children of women who
developed preeclampsia during pregnancy than in of children of
control subjects (51).
However, a statistical association does not imply a causal rela-
tion. Genetic factors also play an important role in the develop-
ment of obesity in the offspring of overweight mothers, as shown
by Stunkard et al (52), who showed that the weight of adopted
children correlated better with their natural parents weight than
with that of their foster parents. A study from the Minnesota
Twin Registry reported that in monozygotic twins, intrapair dif-
ferences in birth weight correlate with intrapair differences in
adult height but not with intrapair differences in adult BMI.
Thus, intrauterine nongenetic factors (ie, environmental determi-
nants of birth weight) influence adult height but not adult rela-
tive weight (53). This suggests that genetic factors are involved
in the relation between maternal obesity and childhood obesity
in the offspring.
COST
Despite the great number of surveys focused on pregnancy
complications in overweight women, few data are available on
the extra cost induced by these high-risk pregnancies. Consider-
ing the high prevalence of obesity among women of childbearing
age, however, this is a major public health issue. In 1995 we
found in a retrospective study that the cost of prenatal care in
overweight women exceeded that in normal-weight control sub-
jects by 5.4- to 16.2-fold depending on the degree of obesity
(18). Because we wanted to control possible bias due to the ret-
rospective design of our study, we also assessed the cost of preg-
nancy follow-up in a prospective case-control study.
We studied 435 pregnant women seen consecutively at the
Obstetric and Gynecology Department of Montpellier Univer-
sity Hospital in Montpellier, France, during the third trimester
of their pregnancy and who gave their informed consent to par-
ticipate in the study. The total duration of nighttime and day-
time hospitalization in standard obstetric or surgical units dur-
ing pregnancy and in the postpartum period was recorded.
Fifty-four women (12.6%) had a BMI >26 before becoming
pregnant. Each was paired with a normal-weight control sub-
ject (BMI 1825) matched for age and parity. Exclusion crite-
ria were previous diabetes mellitus or severe disease, height
<145 cm, and age <18 y. Forty-two case-control pairs who
matched the inclusion criteria and whose anthropometric meas-
urements and hospitalization records were complete were
available for statistical analysis.
OBESITY AND PREGNANCY: COMPLICATIONS AND COST 1245S
TABLE 3
Adjusted odd ratios (ORs) for neural tube defects in offspring of
overweight mothers
Reference Mothers BMI OR (95% CI)
Watkins et al (42) >29 1.9 (1.1, 3.4)
Shaw et al (41) >29 1.9 (1.3, 2.9)
Waller et al (40) >31 1.8 (1.1, 3.0)
Werler at al (43) >32 2.8 (1.1, 6.7)
Shaw et al (41) 3137 1.5 (0.8, 2.7)
Waller et al (40) 3137 1.8 (1.0, 3.2)
Shaw et al (41) >38 2.6 (0.9, 7.7)
Waller et al (40) >38 3.0 (1.2, 7.7)
TABLE 4
Hospital cost of pregnancy follow-up and delivery in overweight mothers
1
Overweight women Control women
Age (y) 29.0 5.5 29.0 5.5
Parity 1.0 1.1 1.0 1.1
Pregravid BMI (kg/m
2
) 30.3 4.02 20.8 1.73
2
Daytime hospitalization (d) 2.33 2.60 0.60 1.43
3
Nighttime hospitalization (d) 2.55 5.10 0.41 1.22
4
Cost of prenatal care (d)
5
4.46 5.97 0.89 1.81
6
Total cost (d)
7
11.89 7.29 7.46 3.16
8
1
x

SD.
2
Signicantly different from overweight women, P = 0.001 (Students
t test).
3,4,6,8
Signicantly different from overweight women (Mann-Whitney-
Wilcoxon test):
3
P = 0.0001,
4
P = 0.0237,
6
P = 0.0002,
8
P = 0.0019.
5
Sum of duration of nighttime hospitalization and corrected daytime
hospitalization.
7
Sum of prenatal cost and corrected postpartum hospitalization.

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The cost of hospitalization was calculated as described previ-
ously (18). Briefly, the cost was expressed in days of hospital-
ization in a nighttime obstetric department. When women were
hospitalized in units where the daily price differed, a correcting
coefficient was applied: 0.766 for daytime hospitalization and
1.40 for nighttime hospitalization in a surgical department (in the
case of cesarean delivery). The cost of prenatal care was the sum
of the duration of nighttime hospitalization and corrected daytime
hospitalization. The total cost was the sum of prenatal cost and
corrected postpartum hospitalization. The hypothesis that no dif-
ference existed between means was evaluated with Students t test
or the Mann-Whitney-Wilcoxon test when appropriate. Results
were considered significant if the P value was <0.05.
As shown in Table 4, the average cost of hospital prenatal care
was 5 times higher in mothers who were overweight before preg-
nancy than in normal-weight control women. The duration of both
day and night hospitalization was also higher, by 3.9- and 6.2-fold,
respectively. When both pre- and postnatal care were considered,
women whose pregravid BMI was >29 stayed in the hospital an
average of 4.43 more days than did lean women. Thus, these
results emphasize that maternal weight excess has a high cost.
The percentage of infants requiring admission to a neonatal
intensive care unit is 3.5 times higher in cases of maternal obe-
sity (16, 18, 20) (Table 5). Obesity also leads to significantly
longer postpartum hospital stays as a result of more frequent
cesarean deliveries and endometritis (54). The long-term social
and economic effects of maternal obesityrelated birth trauma,
neural tube defects, and childhood obesity were not evaluated.
MANAGEMENT
Preconception counseling
Overweight women of childbearing age should be informed of
the risks associated with pregnancy and receive appropriate
dietary counseling. These women should be screened for hyper-
tension and carbohydrate intolerance and encouraged to perform
physical activity. Stable, massive pregravid weight loss in mor-
bidly obese women markedly reduces the occurrence of maternal
complications during pregnancy (55).
Optimal weight gain in obese pregnant women
How much weight obese women should gain during preg-
nancy is controversial. In this case, maternal and fetal interests
seem to be in conflict. The Institute of Medicine recommends a
minimum increase of 6.8 kg even for massively obese women to
improve fetal outcome (56). But gestational weight gain appears
to benefit maternal fat stores rather than birth weight in obese
women. Each kilogram of gestational weight gain increases birth
weight by 44.9 g for very underweight women, by 22.9 g for
normal-weight women, and by 11.9 g for overweight women
(57). Although an association between low weight gain and low
birth weight in obese women is sometimes reported (19), most
studies fail to show any association (2, 6, 20). In a recent study
involving 53541 live birth, the odds ratio for delivering low-
birth-weight infants when weight gains were <6.8 kg in over-
weight (BMI 2629) and very overweight (BMI > 29) mothers
were not statistically significant (6). On the other hand, high
weight gains in overweight and obese mothers lead to a higher
rate of macrosomic infants (6, 19, 20). Moreover, low weight
gains are associated with lower weight retention after birth and
fewer long-term complications of obesity (47, 48). To date, no
study has simultaneously considered fetal outcome and long-
term maternal complications associated with different categories
of weight gain in obese pregnancies.
Postpartum
Birth-control methods must be chosen according to maternal
relative weight and possible concomitant metabolic or vascular
disorders. Women in whom gestational diabetes is diagnosed
must be screened for type 2 diabetes 2 mo after delivery or after
the end of lactation. Prevention of future overt type 2 diabetes is
a major issue in these patients.
CONCLUSION
Even moderate overweight has a significant deleterious effect
on the outcome of pregnancy, and obesity leads to major mater-
nal and fetal complications. Given the major economic and med-
ical consequences of pregnancy in overweight women, all
attempts should be made to prevent obesity in women of child-
bearing age and to encourage weight loss before pregnancy. The
consequences of obesity on maternal and fetal morbidity and
mortality might be minimized through appropriate multidiscipli-
nary management.
We are grateful to Marie-Christine Picot, who performed the statistical
analysis.
REFERENCES
1. Garbaciak JA, Richter MD, Miller S, Barton JJ. Maternal weight and
pregnancy complications. Am J Obstet Gynecol 1985;152:23845.
2. Abrams BF, Laros RK Jr. Prepregnancy weight, weight gain, and
birth weight. Am J Obstet Gynecol 1986;154:5039.
3. Naeye RL. Maternal body weight and pregnancy outcome. Am J
Clin Nutr 1990;52:2739.
4. Taffel SM, Keppel KG, Jones GK. Medical advice on maternal weight
gain and actual weight gain. Results from the 1988 National Maternal
and Infant Health Survey. Ann N Y Acad Sci 1993;678:293305.
1246S GALTIER-DEREURE ET AL
TABLE 5
Admission of infants of normal-weight or overweight mothers to neonatal intensive care
Denitions Admission to neonatal intensive care
Reference Normal weight Overweight Normal weight Overweight
%
Perlow et al (16) Weight <136 kg Weight >136 kg 4.5 15.6
1
Galtier-Dereure et al (18) 18 < BMI <25 BMI >30 9.3 33.3
2
Bianco et al (20) 19 < BMI <27 BMI >35 8.7 13.1
3
13
Signicantly different from normal weight:
1
P < 0.01,
2
P < 0.001,
3
P < 0.01.

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