{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T10:48:04Z","timestamp":1790765284910,"version":"4.1.0"},"reference-count":21,"publisher":"Wiley","issue":"10","license":[{"start":{"date-parts":[[2026,4,23]],"date-time":"2026-04-23T00:00:00Z","timestamp":1776902400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"},{"start":{"date-parts":[[2026,4,23]],"date-time":"2026-04-23T00:00:00Z","timestamp":1776902400000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/501100000165","name":"Sick Kids Foundation","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100000165","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["obgyn.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["BJOG"],"published-print":{"date-parts":[[2026,9]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To quantify and compare the gestational age (GA)\u2010specific risks of stillbirth across pre\u2010pregnancy body mass index (BMI) categories, stratified by pre\u2010pregnancy diabetes status:<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>Retrospective population\u2010based cohort study.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Setting<\/jats:title>\n                    <jats:p>United States from 2022 to 2023.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Population or Sample<\/jats:title>\n                    <jats:p>Singleton live and stillbirths between 20 and 43\u2009weeks' gestation.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Data were obtained from the live birth and fetal death certificates available from the National Center for Health Statistics. We used Piecewise Additive Mixed Models to assess the GA\u2010specific relationship between pre\u2010pregnancy BMI and stillbirth in women with and without pre\u2010pregnancy diabetes mellitus adjusted for confounders. Results were expressed as gestational age\u2010specific adjusted hazard ratios (aHR), and weekly risk estimates from 37 to 40\u2009weeks' gestation.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Main Outcome Measures<\/jats:title>\n                    <jats:p>Stillbirth.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      A total of 6\u2009923\u2009146 women were included of which 187\u2009734 (2.7%) were underweight, 2\u2009631\u2009390 (38.0%) had normal BMI, 1 915 636 (27.7%) were overweight, and 1\u2009169\u2009109 (16.9%), 591\u2009078 (8.5%), and 428\u2009199 (6.1%) had obesity class I, II and III, respectively. Overall, stillbirth rates increased with increasing BMI and were higher in women with pre\u2010pregnancy diabetes (16.6 per 1 000 total births) than those without these conditions (4.4 per 1 000 total births). The gestational age\u2010specific associations between elevated BMI and stillbirth differed depending on the presence of pre\u2010pregnancy diabetes across all gestational weeks. For example, at 31\u2009weeks' gestation, the aHR for women with a BMI of 40\u2009kg\/m\n                      <jats:sup>2<\/jats:sup>\n                      vs. 20\u2009kg\/m\n                      <jats:sup>2<\/jats:sup>\n                      and diabetes was 0.68 (95% CI\u2009=\u20090.54 to 0.85), while the same aHR for a non\u2010diabetic pregnancy was 1.22 (95% CI\u2009=\u20091.13, 1.33). Absolute risks were highest in diabetic women with class III obesity.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Among obese women, the optimal gestational age for delivery depends on the presence of other risk factors such as pre\u2010pregnancy diabetes.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/1471-0528.70247","type":"journal-article","created":{"date-parts":[[2026,4,23]],"date-time":"2026-04-23T10:16:37Z","timestamp":1776939397000},"page":"1916-1925","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Pre\u2010Pregnancy Body Mass Index, Diabetes Status, and Gestational Age\u2010Specific Stillbirth Risk: A Nationwide Retrospective Cohort Study"],"prefix":"10.1111","volume":"133","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7704-1677","authenticated-orcid":false,"given":"Jeffrey N.","family":"Bone","sequence":"first","affiliation":[{"name":"British Columbia Children's Hospital Research Institute  Vancouver British Columbia Canada"},{"name":"Department of Statistics University of British Columbia  Vancouver British Columbia Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2317-5607","authenticated-orcid":false,"given":"K. S.","family":"Joseph","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynaecology University of British Columbia and the Children's and Women's Hospital and Health Centre of British Columbia  Vancouver British Columbia Canada"},{"name":"School of Population and Public Health University of British Columbia  Vancouver British Columbia Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1355-610X","authenticated-orcid":false,"given":"Laura","family":"Magee","sequence":"additional","affiliation":[{"name":"Department of Women and Children's Health, School of Life Course Sciences, Faculty of Life Sciences and Medicine King's College London  London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chantal","family":"Mayer","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynaecology University of British Columbia and the Children's and Women's Hospital and Health Centre of British Columbia  Vancouver British Columbia Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sarka","family":"Lisonkova","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynaecology University of British Columbia and the Children's and Women's Hospital and Health Centre of British Columbia  Vancouver British Columbia Canada"},{"name":"School of Population and Public Health University of British Columbia  Vancouver British Columbia Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,4,23]]},"reference":[{"key":"e_1_2_11_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajog.2014.01.044"},{"key":"e_1_2_11_3_1","doi-asserted-by":"publisher","DOI":"10.1097\/01.AOG.0000172422.81496.57"},{"issue":"2","key":"e_1_2_11_4_1","article-title":"Prepregnancy Body Mass Index and Adverse Perinatal Outcomes in the Presence of Other Maternal Risk Factors","volume":"3","author":"Bone J. N.","year":"2023","journal-title":"American Journal of Obstetrics and Gynecology Global Reports"},{"key":"e_1_2_11_5_1","doi-asserted-by":"publisher","DOI":"10.1111\/1471-0528.15386"},{"key":"e_1_2_11_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajog.2010.10.002"},{"key":"e_1_2_11_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jogc.2019.03.026"},{"key":"e_1_2_11_8_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jogc.2016.04.002"},{"key":"e_1_2_11_9_1","doi-asserted-by":"publisher","DOI":"10.1177\/1471082X17748083"},{"key":"e_1_2_11_10_1","doi-asserted-by":"publisher","DOI":"10.1111\/ppe.12993"},{"key":"e_1_2_11_11_1","doi-asserted-by":"publisher","DOI":"10.1093\/aje\/kwq472"},{"key":"e_1_2_11_12_1","doi-asserted-by":"crossref","volume-title":"Regression Modeling Strategies: With Applications to Linear Models, Logistic and Ordinal Regression, and Survival Analysis","author":"Harrell F. E.","DOI":"10.61700\/2QPNSLOX87SNV2328"},{"key":"e_1_2_11_13_1","volume-title":"Pammtools: Piece\u2010Wise Exponential Additive Mixed Modeling Tools","author":"Bender A.","year":"2018"},{"issue":"12","key":"e_1_2_11_14_1","article-title":"Pregnancy Outcomes in Type 2 Versus Type 1 Diabetes: Systematic Review With Meta\u2010Analyses","volume":"13","author":"Drabl\u00f8s M.","year":"2024","journal-title":"Endocrine Connections"},{"key":"e_1_2_11_15_1","doi-asserted-by":"publisher","DOI":"10.1016\/S2213-8587(20)30406-X"},{"key":"e_1_2_11_16_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12884-024-06534-8"},{"key":"e_1_2_11_17_1","unstructured":"NHS England Digital \u201cNational Pregnancy in Diabetes Audit Dashboard 2024 (01 January 2022 to 31 December 2024) \u201d."},{"key":"e_1_2_11_18_1","unstructured":"National Center for Health Statistics (U.S.) \u201cTrends and Characteristics in Prepregnancy Diabetes \u201d."},{"key":"e_1_2_11_19_1","doi-asserted-by":"publisher","DOI":"10.1080\/14767058.2017.1381903"},{"issue":"24","key":"e_1_2_11_20_1","article-title":"Relationship Between Prepregnancy Body Mass Index and Gestational Age\u2010Specific Risk of Stillbirth and Perinatal Death in Women With Chronic Hypertension","volume":"0002","author":"Bone J. N.","year":"2024","journal-title":"American Journal of Obstetrics and Gynecology"},{"key":"e_1_2_11_21_1","doi-asserted-by":"publisher","DOI":"10.1111\/1471-0528.13807"},{"key":"e_1_2_11_22_1","doi-asserted-by":"publisher","DOI":"10.1097\/AOG.0b013e3182a6a4d0"}],"container-title":["BJOG: An International Journal of Obstetrics &amp; Gynaecology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/obgyn.onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/1471-0528.70247","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/obgyn.onlinelibrary.wiley.com\/doi\/full-xml\/10.1111\/1471-0528.70247","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/obgyn.onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/1471-0528.70247","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,19]],"date-time":"2026-08-19T00:18:36Z","timestamp":1787098716000},"score":1,"resource":{"primary":{"URL":"https:\/\/obgyn.onlinelibrary.wiley.com\/doi\/10.1111\/1471-0528.70247"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,4,23]]},"references-count":21,"journal-issue":{"issue":"10","published-print":{"date-parts":[[2026,9]]}},"alternative-id":["10.1111\/1471-0528.70247"],"URL":"https:\/\/doi.org\/10.1111\/1471-0528.70247","archive":["Portico"],"relation":{},"ISSN":["1470-0328","1471-0528"],"issn-type":[{"value":"1470-0328","type":"print"},{"value":"1471-0528","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,4,23]]},"assertion":[{"value":"2025-10-21","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-03-28","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-04-23","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}