Meta-Analysis The Effect of Maternal Obesity on the Risk of Premature Birth and Neonatal Death

Fitria Wulandari, Uki Retno Budihastuti, Eti Poncorini Pamungkasari


Background: The prevalence of obesity in women of reproductive age worldwide is increasing by an estimated 20-36%. Increased prevalence of obesity also occurs in pregnant women. Obesity increases the risk of poor pregnancy outcome. This study aims to investigate the effect of maternal obesity on preterm birth and neonatal mortality.

Subjects and Method: This was a systematic review and meta-analysis. The articles used were obtained from several databases, including: Google Scholar, Science Direct, Springer Link, Proquest, and Scopus published from 2010 to 2021. The population in this study was pregnant women with an intervention in the form of obesity, comparison in the form of normal BMI, and outcome such as premature birth and neonatal death. The keywords used to search for articles were: (“maternal obesity” OR “maternal BMI”) AND (“premature birth” OR “preterm birth” OR “preterm delivery” OR “preterm labor”) AND (“neonatal mortality” OR “ neonatal death”) AND “adjusted Odds Ratio”, and “maternal obesity” AND (“premature birth” OR “preterm birth” OR “preterm delivery”) AND (“neonatal mortality” OR “neonatal death”) AND “adjusted Odds Ratio ". The article is a full text article with a cross-sectional and cohort study design. Articles were collected using PRISMA flow diagrams and analyzed using the Review Manager 5.3 . application.

Results:  There were 19 articles reviewed in the study. A meta-analysis of 13 cohort studies showed that obese pregnant women were 1.02 times more likely to have a premature birth when compared to normal BMI pregnant women, but this result was not statistically significant (aOR=1.02; 95% CI=0.93 to 1.13; p=0.630). A meta-analysis of 4 cohort studies showed that maternal obesity increased the risk of neonatal death and was statistically significant (aOR=1.52; 95% CI=1.17 to 1.99; p=0.002). A meta-analysis of 4 cross-sectional studies showed that maternal obesity increased the risk of neonatal death and was statistically significant (aOR=1.44; 95% CI=1.26 to 1.64; p<0.001).

Conclusion:  Maternal obesity increases the risk of neonatal death which is statistically significant and the risk of preterm birth which is not statistically significant.

Keywords: maternal obesity, premature birth, neonatal death.

Correspondence: Fitria Wulandari. Masters Program in Public Health, Universitas Sebelas Maret, Jl. Ir. Sutami 36A, Surakarta 57126, Central Java. Email: Mobile: 082169­215248.

Journal of Maternal and Child Health (2021), 06(06): 719-732



Full Text:



Alves P, Malheiro MF, Gomes JC, Ferraz T, Montenegro N (2020). Risks of mat-ernal obesity in pregnancy: A case-control study in a Portuguese obst-etrical population. Rev. Bras. Ginecol. e Obs. 41(12): 682–687. doi: 10.1055/S-0039-3400455.

Aly H, Hammad T, Nada A, Mohamed M, Bathgate S, El-Mohandes A (2010). Maternal obesity, associated comp-lications and risk of prematurity. J. Perinatol. 30(7): 447–451. doi: 10.1038/JP.2009.117.

Anderson KG, Spicer P, Peercy MT (2016). Obesity, diabetes, and birth outcomes among American Indians and Alaska natives. Matern. Child Health J. 20-(12): 2548–2556. doi: 10.1007/S109-95-016-2080-3.

Arredondo A, Torres C, Orozco E, Pacheco S, Huang F, Zambrano E, Bolaños-Jiménez F (2019). Socio-economic indicators, dietary patterns, and phy-sical activity as determinants of maternal obesity in middle-income countries: Evidences from a cohort study in Mexico. Int. J. Health Plann. Manage. 34(1): e713–e725. doi: 10.1002/HPM.2684.

Berger KE, Masterson J, Mascardo J, Grapa J, Appanaitis I, Temengil E, Watson BM, Cash HL (2016). The effects of chewing betel nut with tobacco and pre-pregnancy obesity on adverse birth outcomes among Palauan women. Matern. Child Health J. 20(8): 1696–1703. doi: 10.1007/S10995-016-1972-6.

Bonsaffoh A, Gyamfi B, Oppong SA, Seffah JD (2019). Determinants and outco-mes of preterm births at a tertiary hospital in Ghana. Placenta, 79: 62–67. doi:10.1016/J.PLACENTA.2019.0-1.007

Bukowski R, Carpenter M, Conway D, Coustan D, Dudley DJ, Goldenberg RL, Rowland Hogue CJ, et al. (2011). Causes of death among stillbirths. JAMA. 306(22): 2459–2468.doi: 10.10-01/JAMA.2011.1823.

Carvajal JA, Oporto JI (2020). The myometrium in pregnant women with obesity. Curr. Vasc. Pharmacol. 19(2): 193–200. doi: 10.2174/157016111866-6200525133530.

CEBM (2014). Critical appraisal of a cross-sectional study (survey) appraisal questions, 1. Tersedia pada:

Chen A, Feresu SA, Fernandez C, Rogan WJ (2009). Maternal obesity and the risk of infant death in the United States. Epidemiology. 20(1): 74–81. doi: 10-.1097/EDE.0b013e3181878645.

Cnattingius S, Villamor E, Johansson S, Bonamy AKE, Persson M, Wikström A-K, Granath F (2013). Maternal obesity and risk of preterm delivery. JAMA, 309(22): 2362–2370. doi: 10-.1001/JAMA.2013.6295.

Cresswell JA, Campbell OMR, De Silva MJ, Filippi V (2012). Effect of maternal obesity on neonatal death in sub-Saharan Africa: Multivariable analysis of 27 national datasets. Lancet, 380-(9850): 1325–1330. doi: 10.1016/S0-140-6736(12)60869-1.

Doi L, Williams AJ, Marryat L, Frank J (2020). Cohort study of high maternal body mass index and the risk of adverse pregnancy and delivery outcomes in Scotland. BMJ Open, 10(2). doi: 10.1136/BMJOPEN-2018-026168.

Emmanuel AO, Zhao Y, Lamichhane R (20-16). Socioeconomic, biodemographic and health/behavioral determinants of neonatal mortality in Nigeria: a multilevel analysis of 2013 demo-graphic and health survey. Int. J. Contemp. Pediatr. 3(2): 311–323. doi: 10.18203/2349-3291.ijcp20160499.

Gaillard R, Durmuş B, Hofman A, MacKenbach JP, Steegers EAP, Jaddoe VWV (2013). Risk factors and outcomes of maternal obesity and excessive weight gain during pregnancy. Obesity, 21(5): 1046–1055. doi: 10.1-002/oby.20088.

Galliano D, Bellver J (2013). Female obesity: short and long-term consequences on the offspring., 29(7): 626–631. doi: 10.3109/0951-3590.2013.777420.

Hanson M, Barker M, Dodd JM, Kumanyika S, Norris S, Steegers E, Stephenson J, et al (2017). Interventions to prevent maternal obesity before conception, during pregnancy, and post partum. Lancet Diabetes Endocrinol. 5(1): 65–76. doi: 10.1016/S2213-8587(16)301085.

Hung TH, Tsung (2016). Pregestational body mass index, gestational weight gain, and risks for adverse pregnancy outcomes among Taiwanese women: A retrospective cohort study. Taiwan. J. Obstet. Gynecol. 55(4): 575–581. doi: 10.1016/J.TJOG.2016.06.016.

Indarti J, Susilo SA, Hyawicaksono P, Berguna JSN, Tyagitha GA, Ikhsan M (2021). Maternal and perinatal outcome of maternal obesity at RSCM in 2014-2019. Obstet. Gynecol. Int. 2021. doi: 10.1155/2021/6039565.

Jeffrey SF, Eleftheria M (2013). Biology of obesity. in. Philadelphia: Harrisons Endocrinology. Tersedia pada:§ionid=79752768.

Korkmaz L, Baştuğ O, Kurtoğlu S (2016). Maternal obesity and its short and long-term maternal and infantile effects. J. Clin. Res. Pediatr. Endocrinol. 8(2): 114. doi: 10.4274/JCR-PE.2127.

Kutchi I, Chellammal P, Akila A (2020). Maternal obesity and pregnancy outcome: in perspective of new Asian Indian guidelines. J. Obstet. Gynecol. India. doi:

Liang CC, Chao M, Chang SD, Chiu SYH (2020). Impact of prepregnancy body mass index on pregnancy outcomes, incidence of urinary incontinence and quality of life during pregnancy - An observational cohort study. Biomed. J. doi: 10.1016/J.BJ.2019.11.001.

Marchi J, Berg M, Dencker A, Olander EK, Begley C (2015). Risks associated with obesity in pregnancy, for the mother and baby: a systematic review of reviews. Obes. Rev. 16(8): 621–638. doi: 10.1111/OBR.12288.

Melchor I, Burgos J, Del Campo A, Aiartzaguena A, Gutiérrez J, Melchor JC (2019). Effect of maternal obesity on pregnancy outcomes in women delivering singleton babies: A historical cohort study. J. Perinat. Med. 47(6): 625–630. doi: 10.1515/JPM-2019-0103.

National Center For Health Statistics (2021). National vital statistics system. CDC. doi: 10.5860/choice.49-1503.

Ng M, Fleming T, Robinson M, Thomson B, Graetz N, Margono C, Mullany EC, et al (2014). Global, regional, and national prevalence of overweight and obesity in children and adults during 19-80–2013: a systematic analysis for the Global Burden of Disease Study 2013. Lancet. 384(9945): 766–781. doi: 10.1016/S01406736(14)60460-8.

Nohr EA, Wolff S, Kirkegaard H, Wu C, Andersen AMN, Olsen J, Bech BH (2021). Cause-specific stillbirth and neonatal death according to prepregnancy obesity and early gestational weight gain: A study in the Danish national birth cohort. Nutrients, 13(1676). doi: 10.3390/nu13051676.

Onubi OJ, Marais D, Aucott L, Okonofua F, Poobalan AS (2016). Maternal obesity in Africa: A systematic review and meta-analysis. J. Public Heal. (United Kingdom). 38(3): e218–e231. doi: 10.1093/pubmed/fdv138.

Ovesen P, Rasmussen S, Kesmodel U (2011). Effect of prepregnancy maternal overweight and obesity on pregnancy outcome. Obstet. Gynecol. 118(2 Pt 1): 305–312. doi: 10.1097/AOG.0B013E3182245D49.

Ozodiegwu ID, Mamudu HM, Wang L, Wa-llace R, Quinn M, Liu Y, Doctor HV. (2019). Country-level analysis of the association between maternal obesity and neonatal mortality in 34 Sub-Saharan African Countries. Ann. Glob. Heal. 85(1): 1–13. doi: 10.5334/AOGH.2510.

Pakniat H, Mohammadi F, Ranjkesh F (20-15). The impact of body mass index on pregnancy outcome. J. Midwifery Reprod. Heal. 3(2): 361–367. doi: 10.22038/JMRH.2015.4049.

Polnaszek BE, Raghuraman N, Lopez JD, Frolova AL, Wesevich V, Tuuli MG, Cahill AG (2018). Neonatal morbidity in the offspring of obese women without hypertension or diabetes. Obstet. Gynecol. 132(4): 835–841. doi: 10.10-97/AOG.0000000000002775.

Rodie VA, Freeman DJ, Sattar N, Greer IA (2004). Pre-eclampsia and cardiovascular disease: metabolic syndrome of pregnancy? Atherosclerosis. 175(2): 189–202. doi: 10.1016/J.ATHEROSC-LEROSIS.2004.01.038.

Sauvegrain P, Carayol M, Piedvache A, Guéry E, Bréart G, Bucourt M, Zeitlin J, et al (2020). Understanding high rates of stillbirth and neonatal death in a disadvantaged, high-migrant district in France: A perinatal audit. Acta Obstet. Gynecol. Scand. 99(9): 1163–1173. doi: 10.1111/AOGS.13838.

Sharashova EE, Anda EE, Grjibovski AM (2014). Early pregnancy body mass index and spontaneous preterm birth in Northwest Russia: A registry-based study. BMC Pregnancy Childbirth, 14-(303).

Smith GCS, Shah I, Pell JP, Crossley JA, Dobbie R (2011). Maternal obesity in early pregnancy and risk of spontane-ous and elective preterm deliveries: A retrospective cohort study., 97(1): 157–162. doi: 10.2105/AJPH.2-005.074294.

Snowden JM, Mission JF, Marshall NE, Quigley B, Main E, Gilbert WM, Chung JH, et al (2016). The impact of maternal obesity and race/ethnicity on perinatal outcomes: independent and joint effects. Obesity (Silver Spring). 24(7): 1590. doi: 10.1002/O-BY.21532.

Stubert J, Reister F, Hartmann S, Janni W (2018). The risks associated with obesity in pregnancy. Dtsch. Arztebl. Int. 115(16): 276. doi: 10.3238/ARZ-TEBL.2018.0276.

Tabet M, Flick LH, Tuuli MG, Macones GA, Chang JJ (2015). Prepregnancy body mass index in a first uncomplicated pregnancy and outcomes of a second pregnancy. Am. J. Obstet. Gynecol. 213(4): 548.e1-548.e7. doi: 10.1016/J.AJOG.2015.06.031.

Tenenbaum K, Hod M (2013). Impact of maternal obesity on fetal health. Fetal Diagn. Ther. 34(1): 1–7. doi: 10.1159/000350170.

Tennant PWG, Rankin J, Bell R (2011). Maternal body mass index and the risk of fetal and infant death: A cohort study from the North of England. Hum. Reprod. 26(6): 1501–1511. doi: 10.1093/HUMREP/DER052.

Tuck M, Mockler JC, Stewart L, Knight M, Wallace EM (2016). Obesity and pregnancy outcomes: Do the relationships differ by maternal region of birth? A retrospective cohort study. BMC Pregnancy Childbirth. 16(1). doi: 10.1186/S12884-016-1087-5.

WHO (2018). Preterm birth. Tersedia pada:

WHO (2020). Newborns: improving survival and well-being. Rettrieved from:

WHO (2021). Obesitas and overweight. Tersedia pada:

Wu H, Liu F, Zhao M, Liang Y, Xi B (2020). Maternal body mass index and risks of neonatal mortality and offspring overweight and obesity: Findings from 0.5 million samples in 61 low-and middle-income countries. Pediatr. Obes. 15(11): e12665. doi: 10.1111/IJPO.12665.


  • There are currently no refbacks.