Maternal and Child Health Journal

, Volume 20, Issue 7, pp 1497–1505 | Cite as

Impact of Missing Data for Body Mass Index in an Epidemiologic Study

  • Hilda Razzaghi
  • Sarah C. Tinker
  • Amy H. Herring
  • Penelope P. Howards
  • D. Kim Waller
  • Candice Y. Johnson
  • the National Birth Defects Prevention Study


Objective To assess the potential impact of missing data on body mass index (BMI) on the association between prepregnancy obesity and specific birth defects. Methods Data from the National Birth Defects Prevention Study (NBDPS) were analyzed. We assessed the factors associated with missing BMI data among mothers of infants without birth defects. Four analytic methods were then used to assess the impact of missing BMI data on the association between maternal prepregnancy obesity and three birth defects; spina bifida, gastroschisis, and cleft lip with/without cleft palate. The analytic methods were: (1) complete case analysis; (2) assignment of missing values to either obese or normal BMI; (3) multiple imputation; and (4) probabilistic sensitivity analysis. Logistic regression was used to estimate crude and adjusted odds ratios (aOR) and 95 % confidence intervals (CI). Results Of NBDPS control mothers 4.6 % were missing BMI data, and most of the missing values were attributable to missing height (~90 %). Missing BMI data was associated with birth outside of the US (aOR 8.6; 95 % CI 5.5, 13.4), interview in Spanish (aOR 2.4; 95 % CI 1.8, 3.2), Hispanic ethnicity (aOR 2.0; 95 % CI 1.2, 3.4), and <12 years education (aOR 2.3; 95 % CI 1.7, 3.1). Overall the results of the multiple imputation and probabilistic sensitivity analysis were similar to the complete case analysis. Conclusions Although in some scenarios missing BMI data can bias the magnitude of association, it does not appear likely to have impacted conclusions from a traditional complete case analysis of these data.


Missing BMI NBDPS BMI Missing data Birth defect 



This work was supported through cooperative agreements under PA 96043, PA 02081 and FOA DD09-001 from the Centers for Disease Control and Prevention to the Centers for Birth Defects Research and Prevention participating in the National Birth Defects Prevention Study.

Compliance with Ethical Standards

Conflicts of interest

The authors have no conflicts of interest to report. No financial disclosures were reported by the authors of this paper.

Supplementary material

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Supplementary material 1 (DOCX 21 kb)


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Copyright information

© Springer Science+Business Media New York (outside the USA) 2016

Authors and Affiliations

  • Hilda Razzaghi
    • 1
  • Sarah C. Tinker
    • 1
  • Amy H. Herring
    • 2
  • Penelope P. Howards
    • 3
  • D. Kim Waller
    • 4
  • Candice Y. Johnson
    • 1
    • 3
    • 5
  • the National Birth Defects Prevention Study
  1. 1.National Center for Chronic Disease Prevention and Health PormotionCenters for Disease Control and Prevention (CDC)AtlantaUSA
  2. 2.Gillings School of Global Public Health and Carolina Population CenterUniversity of North Carolina at Chapel HillChapel HillUSA
  3. 3.Rollins School of Public HealthEmory UniversityAtlantaUSA
  4. 4.UTHealth, School of Public HealthHoustonUSA
  5. 5.National Institute for Occupational Safety and HealthCenters for Disease Control and PreventionCincinnatiUSA

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