In 2016, we explored pregnancy complications in obese women, because there is interest in whether obese, but metabolically healthy, subgroups exist. We found that women who were obese but without any pre-pregnancy chronic diseases were at significantly increased risk of a wide range of obstetric interventions and obstetric and neonatal complications compared with normal BMI women (Kim et al. Obstetrics & Gynecology 2016). Moreover, obese women who entered pregnancy without comorbidity, did not develop pregnancy complications such as gestational hypertensive disorders or gestational diabetes, and gained weight within recommended guidelines, still experienced elevated risk for obstetric and neonatal complications, indicating that optimizing maternal weight prior to pregnancy is important for all women. Additional work was conducted that addressed the ongoing debate for how to best define fetal growth abnormalities by assessing whether clinicians should be using a definition customized for maternal and fetal characteristics, such as maternal height and fetal sex. We completed rigorous investigations of the different customized definitions for defining abnormal birthweight including small-for-gestational age birthweight among obese women delivering at term (Hinkle et al. British Journal of Obstetrics and Gynaecology 2016). We found that customized definitions did not improve detection of neonates at risk for adverse perinatal outcomes. Importantly, small-for-gestational age neonates of obese women had a fivefold increased risk for mortality, highlighting the clinical importance of monitoring for SGA among obese women. In another analysis, we found that deliveries complicated by maternal psychiatric disorders, particularly when complicated by anxiety disorders, were associated with an increased risk of both spontaneous and indicated preterm delivery, even for earlier gestational ages less than 34 and 28 weeks gestation (Mannisto et al. Annals of Epidemiology 2016). These findings have important public health implications given that 7.3% of women in our study had a psychiatric diagnosis recorded in their medical record or discharge summary. Our work on social factors continued in 2016 where we found that state level income inequality was associated with preterm birth rates (Wallace et al. Maternal Child Health Journal 2016).Collectively, this body of research continues to provide data useful for the ongoing development of clinical guidance regarding the management of contemporary pregnant women. Another important undertaking was making this data publicly available via the NICHD DASH website, thereby, encouraging continued prolific publication from this cohort study.
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