Mortality in infants of obese mothers: is risk modified by mode of delivery?

OBJECTIVE To examine the association between maternal obesity and infant mortality, while including information about mode of delivery and interpregnancy weight change. DESIGN Register-based cohort study. SETTING AND POPULATION A total of 1 199 183 singletons, including 3481 infant deaths, from the Swedish Birth Register 1992-2006. METHODS Maternal body mass index (BMI) was obtained from self-reports in early pregnancy and categorized as underweight (<18.5 kg/m(2)), normal-weight (18.5-24.9 kg/m(2)), overweight (25-29.9 kg/m(2)), obese (30-34.9 kg/m(2)) and extremely obese (≥35 kg/m(2)). Cox regression was used to estimate hazard ratios (95% confidence intervals). Infants of normal-weight women were the referent. MAIN OUTCOME MEASURES Neonatal and infant mortality. RESULTS Infant mortality increased with increasing maternal fatness [adjusted hazard ratios 1.2 (1.1-1.3), 1.4 (1.2-1.6) and 2.1 (1.8-2.5) for overweight, obesity and extreme obesity, respectively]. When accounting for mode of delivery, neonatal mortality was increased in infants of obese and extremely obese mothers after spontaneous births [adjusted hazard ratios 1.8 (1.4-2.4) and 2.6 (1.8-4.0), respectively, after term births, and 1.4 (1.1-1.9) and 2.2 (1.5-3.3), respectively, after preterm births]. No excess risk was present for infants of obese mothers after induced term and preterm births (p-values for interaction <0.05). For post-neonatal mortality, no interaction between mode of delivery and maternal obesity was observed. In women with two subsequent pregnancies, high interpregnancy weight change >1 BMI unit (1 kg/m(2)) seemed to involve a modest increase in neonatal mortality in the second infant, but only after spontaneous births [adjusted odds ratio 1.3 (0.9-1.7)]. CONCLUSIONS Maternal obesity, especially at levels that may involve cardiometabolic morbidity, was associated with increased mortality in the offspring.