Relationship Between Prepregnancy Overweight, Obesity, and Preterm Birth in Puerto Rico

  • Stephanie M. EickEmail author
  • Michael Welton
  • José F. Cordero


Objectives We examined the association between prepregnancy body mass index (PP-BMI) and preterm birth (PTB) among women in Puerto Rico (PR) as a potentially modifiable risk factor. Methods We conducted a retrospective study using the birth certificate data files from 2005 to 2012 developed by the PR Department of Health to examine the relationship between PP-BMI and PTB. Logistic regression was used to determine crude and adjusted odds ratios (OR) and 95% confidence intervals (CI) for the categories of PP-BMI of overweight (25–29.9 kg/m2), obesity (≥ 30 kg/m2), and overweight and obesity together (≥ 25 kg/m2) and PTB. Stratified analysis explored the associations between PP-BMI and PTB by region within PR and year. Results Following exclusions of birth records with missing data, 343,508 births were included in our analysis. The percentage of PTB decreased from 18.6 to 15.2 during our study period. Statistically significant differences were observed between preterm and full term births across all covariates. Overweight (OR 1.08, 95% CI 1.06, 1.11), obesity (OR 1.17, 95% CI 1.14, 1.20), and overweight and obesity together (OR 1.11, 95% CI 1.09, 1.14) were significantly associated with increased odds of PTB after adjusting for confounders. The associations between PP-BMI and PTB persisted across all regions and years. Conclusions for Practice PP-BMI is associated with increased odds of PTB among women in PR and the associations were consistent in exploratory analyses. Future research should examine the relationship between PP-BMI and PTB among other Hispanic subgroups and among Puerto Ricans in the mainland United States.


Preterm birth Body mass index Epidemiology Puerto Rico Health disparities Pre-pregnancy weight 


Compliance with Ethical Standards

Conflicts of interest

The authors declare that they have no conflicts of interest and did not receive any funding for this study.


  1. Albrecht, S. S., & Gordon-Larsen, P. (2013). Ethnic differences in body mass index trajectories from adolescence to adulthood: A focus on Hispanic and Asian subgroups in the United States. PLoS ONE, 8(9), e72983. Scholar
  2. American College of Obstetricians and Gynecologists. (2013). ACOG Committee opinion no. 548: Weight gain during pregnancy. Obstetrics & Gynecology. 121(1), 210–212. Scholar
  3. Ananth, C. V., Getahun, D., Peltier, M. R., Salihu, H. M., & Vintzileos, A. M. (2006). Recurrence of spontaneous versus medically indicated preterm birth. American Journal of Obstetrics and Gynecology, 195(3), 643–650. Scholar
  4. Aponte, J. (2009). Diabetes-related risk factors across Hispanic subgroups in the Hispanic health and nutritional examination survey (1982–1984). Public Health Nursing, 26(1), 23–38. Scholar
  5. Behrman, R. E., & Butler, A. S. (2007). Preterm birth: Causes, consequences, and preventionassuring healthy, outcomes. In R. E. Behrman & A. S. Butler (Eds.), Institute of Medicine (US) Committee on Understanding Premature Birth and Assuring Healthy Outcome. Washington (DC): National Academies Press (US) National Academy of Sciences.Google Scholar
  6. Blencowe, H., Cousens, S., Chou, D., Oestergaard, M., Say, L., Moller, A.-B., et al. (2013). Born Too Soon: The global epidemiology of 15 million preterm births. Reproductive Health, 10(Suppl 1), S2–S2. Scholar
  7. Centers for Disease Control and Prevention. (2003). Infant health among Puerto Ricans–Puerto Rico and U.S. mainland, 1989–2000. Morbidity and Mortality Weekly Report, 52(42), 1012–1016.Google Scholar
  8. Cnattingius, S., Villamor, E., Johansson, S., Edstedt Bonamy, A. K., Persson, M., Wikstrom, A. K., & Granath, F. (2013). Maternal obesity and risk of preterm delivery. Jama, 309(22), 2362–2370. Scholar
  9. Derraik, J. G., Lundgren, M., Cutfield, W. S., & Ahlsson, F. (2016). Maternal height and preterm birth: A study on 192,432 Swedish Women. PLoS ONE, 11(4), e0154304. Scholar
  10. Doherty, D. A., Magann, E. F., Francis, J., Morrison, J. C., & Newnham, J. P. (2006). Pre-pregnancy body mass index and pregnancy outcomes. International Journal of Gynecology & Obstetrics, 95(3), 242–247. Scholar
  11. Elías-Boneta, A. R., Toro, M. J., Garcia, O., Torres, R., & Palacios, C. (2015). High prevalence of overweight and obesity among a representative sample of Puerto Rican children. BMC Public Health, 15(1), 219. Scholar
  12. Guilloty, N. I., Soto, R., Anzalota, L., Rosario, Z., Cordero, J. F., & Palacios, C. (2015). Diet, pre-pregnancy BMI, and gestational weight gain in Puerto Rican women. Maternal and Child Health Journal, 19(11), 2453–2461. Scholar
  13. Hamilton, B. E., Martin, J. A., Osterman, M. J., Curtin, S. C., & Matthews, T. J. (2015). Births: Final data for 2014. National Vital Statistics Reports, 64(12), 1–64.Google Scholar
  14. Han, Z., Lutsiv, O., Mulla, S., & McDonald, S. D. (2012). Maternal height and the risk of preterm birth and low birth weight: A systematic review and meta-analyses. Journal of Obstetrics and Gynaecology Canada, 34(8), 721–746. Scholar
  15. Harland, K. K., Saftlas, A. F., Wallis, A. B., Yankowitz, J., Triche, E. W., & Zimmerman, M. B. (2012). Correction of systematic bias in ultrasound dating in studies of small-for-gestational-age birth: An example from the Iowa Health in Pregnancy Study. American Journal of Epidemiology, 176(5), 443–455. Scholar
  16. Heaman, M., Kingston, D., Chalmers, B., Sauve, R., Lee, L., & Young, D. (2013). Risk factors for preterm birth and small-for-gestational-age births among Canadian women. Paediatric and Perinatal Epidemiology, 27(1), 54–61. Scholar
  17. Kaufman, J. S., MacLehose, R. F., Torrone, E. A., & Savitz, D. A. (2011). A flexible Bayesian hierarchical model of preterm birth risk among US Hispanic subgroups in relation to maternal nativity and education. BMC Medical Research Methodology, 11(1), 51. Scholar
  18. Madan, J., Chen, M., Goodman, E., Davis, J., Allan, W., & Dammann, O. (2010). Maternal obesity, gestational hypertension, and preterm delivery. The Journal of Maternal-Fetal & Neonatal Medicine, 23(1), 82–88. Scholar
  19. March of Dimes. (2017). Born Too Soon. Retrieved from
  20. Martin, J. A., Hamilton, B. E., Osterman, M. J., Driscoll, A. K., & Mathews, T. J. (2017). Births: Final data for 2015. National Vital Statistics Reports, 66(1), 1.Google Scholar
  21. Martin, J. A., Hamilton, B. E., Sutton, P. D., Ventura, S. J., Menacker, F., Kirmeyer, S., et al. (2006). Births: Final data for 2006. National Vital Statistics Reports, 57(7), 1–102.Google Scholar
  22. Martin, J. A., Hamilton, B. E., Ventura, S. J., Osterman, M. J., Wilson, E. C., & Mathews, T. J. (2012). Births: Final data for 2010. National Vital Statistics Reports, 61(1), 1–72.Google Scholar
  23. McDonald, S. D., Han, Z., Mulla, S., & Beyene, J. (2010). Overweight and obesity in mothers and risk of preterm birth and low birth weight infants: Systematic review and meta-analyses. Bmj, 341, c3428. Scholar
  24. Shachar, B. Z., Mayo, J. A., Lee, H. C., Carmichael, S. L., Stevenson, D. K., Shaw, G. M., & Gould, J. B. (2015). Effects of race/ethnicity and BMI on the association between height and risk for spontaneous preterm birth. American Journal of Obstetrics and Gynecology, 213(5), 700.e701–700.e709. Scholar
  25. Talge, N. M., Mudd, L. M., Sikorskii, A., & Basso, O. (2014). United States birth weight reference corrected for implausible gestational age estimates. Pediatrics. Scholar
  26. Torloni, M. R., Betran, A. P., Daher, S., Widmer, M., Dolan, S. M., Menon, R., et al. (2009). Maternal BMI and preterm birth: A systematic review of the literature with meta-analysis. Journal of Maternal-Fetal and Neonatal Medicine, 22(11), 957–970. Scholar
  27. Van Lieshout, R. J., Taylor, V. H., & Boyle, M. H. (2011). Pre-pregnancy and pregnancy obesity and neurodevelopmental outcomes in offspring: A systematic review. Obesity Reviews, 12(5), e548–e559. Scholar
  28. Visscher, T. L., Viet, A. L., Kroesbergen, I. H., & Seidell, J. C. (2006). Underreporting of BMI in adults and its effect on obesity prevalence estimations in the period 1998 to 2001. Obesity (Silver Spring), 14(11), 2054–2063. Scholar
  29. Wang, Y., & Beydoun, M. A. (2007). The obesity epidemic in the United States—gender, age, socioeconomic, racial/ethnic, and geographic characteristics: A systematic review and meta-regression analysis. Epidemiology Reviews, 29, 6–28. Scholar
  30. World Health Organization. (2017). Preterm birth. Retrieved from

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of Epidemiology and Biostatistics, College of Public HealthUniversity of GeorgiaAthensUSA

Personalised recommendations