Using appropriate pre-pregnancy body mass index cut points for obesity in the Chinese population: a retrospective cohort study

BACKGROUND: Appropriate classification of obesity is vital for risk assessment and complication prevention during pregnancy. We aimed to explore which pre-pregnancy BMI cut-offs of obesity, either BMI ≥ 25 kg/m(2) as recommended by the WHO for Asians or BMI ≥ 28 kg/m(2) as suggested by the Working Group on Obesity in China (WGOC), best predicts the risk of adverse maternal and perinatal outcomes. METHODS: We retrospectively reviewed 11,494 medical records for live singleton deliveries in a tertiary center in Guangzhou, China, between January 2013 and December 2016. The primary outcomes included maternal obesity prevalence, adverse maternal and perinatal outcomes. Data were analyzed using the Chi-square test, logistic regression, and diagnostics tests. RESULTS: Among the study population, 824 (7.2%) were obese according to the WHO criteria for Asian populations, and this would be reduced to 198 (1.7%) based on the criteria of WGOC. Obesity-related adverse maternal and perinatal outcomes were gestational diabetes mellitus, preeclampsia, cesarean section, and large for gestational age (P < 0.05). Compared to the WGOC criterion, the WHO for Asians criterion had a higher Youden index in our assessment of its predictive value in identifying risk of obesity-related adverse outcomes for Chinese pregnant women. Women in the BMI range of 25 to 28 kg/m(2) are at high risks for adverse maternal and perinatal outcomes, which were similar to women with BMI ≥ 28 kg/m(2). CONCLUSIONS: A lower pre-pregnancy BMI cutoff at 25 kg/m(2) for defining obesity may be appropriate for pregnant women in South China. If WGOC standards are applied to pregnant Chinese populations, a significant proportion of at-risk patients may be missed.