American Journal of Epidemiology Advance Access originally published online on January 4, 2006
American Journal of Epidemiology 2006 163(5):459-466; doi:10.1093/aje/kwj053
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Original Contribution |
Prepregnancy Body Mass Index, Vaginal Inflammation, and the Racial Disparity in Preterm Birth
1 Department of Obstetrics, Gynecology, and Reproductive Sciences, University of Pittsburgh School of Medicine, Pittsburgh, PA
2 Department of Epidemiology, University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA
Correspondence to Dr. Hyagriv N. Simhan, 300 Halket Street, Pittsburgh, PA 15213 (e-mail: hsimhan{at}mail.magee.edu).
The authors sought to quantify the overall and race/ethnic-specific relations between prepregnancy body mass index and both preterm birth and vaginal inflammation. Data from a cohort of 11,392 women who enrolled in the multicenter Vaginal Infections and Prematurity Study (19841989) at 2326 weeks' gestation were used. Compared with a prepregnancy body mass index of 22, a body mass index of 16 increased the risk of preterm birth by 90% (odds ratio = 1.9, 95% confidence interval (CI): 1.5, 2.6), and a body mass index of 18 increased the risk by 40% (odds ratio = 1.4, 95% CI: 1.2, 1.7). Ethnicity substantially modified the magnitude of the body mass index effect and the shape of the preterm birth risk curve, with underweight having a greater impact on preterm birth among Blacks and Hispanics than among Whites. Low body mass index increased the risk of a high level of neutrophils (>5 per oil immersion field) and a high vaginal pH measurement (
5.0) among Black women; for a body mass index of 16 versus 22, the odds ratio = 1.7 (95% CI: 1.1, 2.6). Compared with Black women with a body mass index of 22, Blacks with a body mass index of 16 had a 1.7-fold increased risk for a high level of neutrophils and a high vaginal pH measurement, while those with a body mass index of 18 had a 1.3-fold increased risk.
African continental ancestry group; body mass index; European continental ancestry group; Hispanic Americans; inflammation; pregnancy; premature birth; vagina
Abbreviations: CI, confidence interval
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