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Four BRI and BMI quantiles (Q1\u2010Q4) were defined, and rates of adverse pregnancy outcomes were compared using multivariable logistic regression.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Among 9671 individuals, greater BRI was associated with gestational diabetes (GDM), hypertensive disorders, preterm birth, cesarean delivery, and large\u2010for\u2010gestational age infants. Discordant BRI and BMI assignments affected GDM and cesarean odds. Those with Q2 BMI but Q3\u2013Q4 BRI had increased odds of GDM (aOR 2.28, 1.49\u20133.47) and cesarean (aOR 1.39, 1.15\u20131.68). Those with Q3 BMI and Q1\u2013Q2 BRI demonstrated reduced odds for GDM (aOR 0.31, 0.15\u20130.63) and cesarean (aOR 0.75, 0.60\u20130.94). Participants with Q4 BMI and Q1\u2013Q3 BRI experienced decreased odds for cesarean (aOR 0.55, 0.43\u20130.70) but similar GDM odds.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Greater first trimester BRI, a reflection of central adiposity, is associated with adverse pregnancy outcomes. Early pregnancy BRI may improve risk stratification for GDM and cesarean delivery beyond BMI.<\/jats:p>\n                    <jats:p>\n                      <jats:boxed-text content-type=\"graphic\" position=\"anchor\">\n                        <jats:graphic xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" mimetype=\"image\/png\" position=\"anchor\" specific-use=\"enlarged-web-image\" xlink:href=\"graphic\/oby70274-gra-0001-m.png\">\n                          <jats:alt-text>image<\/jats:alt-text>\n                        <\/jats:graphic>\n                      <\/jats:boxed-text>\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/oby.70274","type":"journal-article","created":{"date-parts":[[2026,8,6]],"date-time":"2026-08-06T06:01:11Z","timestamp":1785996071000},"page":"1818-1829","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Early Pregnancy Body Roundness Index and Development of Adverse Pregnancy Outcomes: A Secondary Analysis of the\n                    <scp>nuMoM2b<\/scp>\n                    Study"],"prefix":"10.1002","volume":"34","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9854-6786","authenticated-orcid":false,"given":"Kelsey J.","family":"Pape","sequence":"first","affiliation":[{"name":"Department of Obstetrics &amp; Gynecology, Division of Maternal\u2010Fetal Medicine Indiana University School of Medicine  Indianapolis Indiana USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Taylor M.","family":"Bynarowicz","sequence":"additional","affiliation":[{"name":"Department of Obstetrics &amp; Gynecology Indiana University School of Medicine  Indianapolis Indiana USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sruthi","family":"Bhamidipalli","sequence":"additional","affiliation":[{"name":"Department of Biostatistics Indiana University School of Medicine  Indianapolis Indiana USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yan","family":"Tong","sequence":"additional","affiliation":[{"name":"Department of Biostatistics Indiana University School of Medicine  Indianapolis Indiana USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maisa N.","family":"Feghali","sequence":"additional","affiliation":[{"name":"Department of Obstetrics &amp; Gynecology, Division of Maternal\u2010Fetal Medicine University of Pittsburgh Medical Center Magee\u2010Womens Hospital  Pittsburgh Pennsylvania USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8379-0743","authenticated-orcid":false,"given":"David M.","family":"Haas","sequence":"additional","affiliation":[{"name":"Department of Obstetrics &amp; Gynecology Indiana University School of Medicine  Indianapolis Indiana USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Uma M.","family":"Reddy","sequence":"additional","affiliation":[{"name":"Department of Obstetrics &amp; Gynecology, Division of Maternal\u2010Fetal Medicine Columbia University Vagelos College of Physicians and Surgeons  New York New York USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5794-3152","authenticated-orcid":false,"given":"Robert M.","family":"Silver","sequence":"additional","affiliation":[{"name":"Department of Obstetrics &amp; Gynecology, Division of Maternal\u2010Fetal Medicine University of Utah School of Medicine  Salt Lake City Utah USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6274-0544","authenticated-orcid":false,"given":"Lynn M.","family":"Yee","sequence":"additional","affiliation":[{"name":"Department of Obstetrics &amp; Gynecology, Division of Maternal\u2010Fetal Medicine Northwestern University Feinberg School of Medicine  Chicago Illinois USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2992-7187","authenticated-orcid":false,"given":"Christina M.","family":"Scifres","sequence":"additional","affiliation":[{"name":"Department of Obstetrics &amp; Gynecology, Division of Maternal\u2010Fetal Medicine Indiana University School of Medicine  Indianapolis Indiana USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,8,5]]},"reference":[{"key":"e_1_2_11_2_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMsa1909301"},{"key":"e_1_2_11_3_1","volume-title":"Prevalence of Obesity and Severe Obesity Among Adults: United States, 2017\u20132018","author":"Hales C. 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