{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,29]],"date-time":"2026-08-29T02:22:08Z","timestamp":1787970128178,"version":"build-2784847793"},"reference-count":37,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2014,1,7]],"date-time":"2014-01-07T00:00:00Z","timestamp":1389052800000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/www.springer.com\/tdm"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["BMC Pregnancy Childbirth"],"published-print":{"date-parts":[[2014,12]]},"abstract":"<jats:title>Abstract<\/jats:title>\n          <jats:sec>\n            <jats:title>Background<\/jats:title>\n            <jats:p>Obesity is highly related to negative reproductive health outcomes, but its relationship with spontaneous abortion and stillbirth remains to be understood, especially in transitioning economies. This study aimed to examine the relationship between obesity and spontaneous abortions and stillbirths in a representative sample of the Brazilian population.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Methods<\/jats:title>\n            <jats:p>Cross-sectional study using secondary data of Brazilian women of reproductive age (15\u201345\u00a0years old) from the National Demographic and Health Survey in 2006. Obesity was measured by body mass index (BMI), waist circumference (WC) and waist-to-height ratio (WHR). Logistic regression modeling of the survey data was used to evaluate the relationship between obesity and the study outcomes.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Results<\/jats:title>\n            <jats:p>The three obesity markers used were found to be strongly and positively associated with spontaneous abortion and stillbirth occurrence. In the adjusted models, there was strong evidence that for each unit increase in BMI (OR\u2009=\u20091.05; 95%CI: 1.02-1.08) and WHR (OR\u2009=\u20091.32; 95%CI: 1.03-1.69), the odds of having a spontaneous abortion was higher. In addition, compared to those of optimal weight, obese women were more likely to have negative outcomes. Maternal age, parity, skin color, educational level and household income were important covariates for adjustment. A sensitivity analysis among women who had only one pregnancy was also performed and showed similar results.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Conclusion<\/jats:title>\n            <jats:p>Obesity is potentially associated with an increased risk of spontaneous abortion and stillbirth in a representative sample of the Brazilian population. These findings are in accordance with previous studies and thus reinforce the need for obstetric care providers to counsel obese reproductive-age women regarding the risks, complications and importance of weight loss and weight control prior to pregnancy.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1186\/1471-2393-14-5","type":"journal-article","created":{"date-parts":[[2014,1,7]],"date-time":"2014-01-07T14:01:29Z","timestamp":1389103289000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":24,"title":["Maternal obesity and fetal deaths: results from the Brazilian cross-sectional demographic health survey, 2006"],"prefix":"10.1186","volume":"14","author":[{"given":"Mariana Santos","family":"Felisbino-Mendes","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fernanda Penido","family":"Matozinhos","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J Jaime","family":"Miranda","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eduardo","family":"Villamor","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gustavo","family":"Velasquez-Melendez","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2014,1,7]]},"reference":[{"key":"895_CR1","first-page":"1","volume":"894","author":"World Health Organization","year":"2000","unstructured":"World Health Organization: Obesity: preventing and managing the global epidemic. Report of a WHO consultation. World Health Organ Tech Rep Ser. 2000, 894: 1-253.","journal-title":"World Health Organ Tech Rep Ser"},{"key":"895_CR2","doi-asserted-by":"publisher","first-page":"299","DOI":"10.14310\/horm.2002.1280","volume":"9","author":"N Sirimi","year":"2010","unstructured":"Sirimi N, Goulis DG: Obesity in pregnancy. Hormones. 2010, 9: 299-306.","journal-title":"Hormones"},{"key":"895_CR3","doi-asserted-by":"crossref","first-page":"714","DOI":"10.1093\/ajcn\/81.3.714","volume":"81","author":"MA Mendez","year":"2005","unstructured":"Mendez MA, Monteiro CA, Popkin BM: Overweight exceeds underweight among women in most developing countries. Am J Clin Nutr. 2005, 81: 714-721.","journal-title":"Am J Clin Nutr"},{"key":"895_CR4","doi-asserted-by":"publisher","first-page":"2139","DOI":"10.3945\/jn.109.112029","volume":"139","author":"Y Balarajan","year":"2009","unstructured":"Balarajan Y, Villamor E: Nationally representative surveys show recent increases in the prevalence of overweight and obesity among women of reproductive age in Bangladesh, Nepal, and India. J Nutr. 2009, 139: 2139-2144. 10.3945\/jn.109.112029.","journal-title":"J Nutr"},{"key":"895_CR5","doi-asserted-by":"publisher","first-page":"703","DOI":"10.1089\/jwh.2010.2397","volume":"20","author":"MM Hillemeier","year":"2011","unstructured":"Hillemeier MM, Weisman CS, Chuang C, Downs DS, McCall-Hosenfeld J, Camacho F: Transition to overweight or obesity among women of reproductive age. J Womens Health (Larchmt). 2011, 20: 703-710. 10.1089\/jwh.2010.2397.","journal-title":"J Womens Health (Larchmt)"},{"key":"895_CR6","volume-title":"Pesquisa de or\u00e7amentos familiares 2008\u20132009: an\u00e1lise da disponibilidade domiciliar de alimentos e do estado nutricional no Brasil","author":"INSTITUTO BRASILEIRO DE GEOGRAFIA E ESTAT\u00cdSTICA\/IBGE","year":"2010","unstructured":"INSTITUTO BRASILEIRO DE GEOGRAFIA E ESTAT\u00cdSTICA\/IBGE: Pesquisa de or\u00e7amentos familiares 2008\u20132009: an\u00e1lise da disponibilidade domiciliar de alimentos e do estado nutricional no Brasil. 2010, Rio de Janeiro: IBGE"},{"key":"895_CR7","first-page":"1117","volume":"113","author":"CKH Yu","year":"2006","unstructured":"Yu CKH, Teoh TG, Robinson S: Obesity in pregnancy. RCOG. 2006, 113: 1117-1125.","journal-title":"RCOG"},{"key":"895_CR8","doi-asserted-by":"publisher","first-page":"515","DOI":"10.1111\/j.1467-789X.2007.00406.x","volume":"8","author":"M Metwally","year":"2007","unstructured":"Metwally M, Li TC, Ledger WL: The impact of obesity on female reproductive function. Obes Rev. 2007, 8: 515-523. 10.1111\/j.1467-789X.2007.00406.x.","journal-title":"Obes Rev"},{"key":"895_CR9","doi-asserted-by":"publisher","first-page":"140","DOI":"10.1111\/j.1467-789X.2007.00464.x","volume":"9","author":"I Guelincky","year":"2008","unstructured":"Guelincky I, Devlieger R, Beckers K, Vansant G: Maternal obesity: pregnancy complications, gestational weigh gain and nutrition. Obes Rev. 2008, 9: 140-150. 10.1111\/j.1467-789X.2007.00464.x.","journal-title":"Obes Rev"},{"key":"895_CR10","doi-asserted-by":"crossref","first-page":"4231","DOI":"10.1210\/jc.2002-020311","volume":"87","author":"JE Ramsay","year":"2002","unstructured":"Ramsay JE, Ferrell WR, Crawford L, Wallace AM, Greer IA, Sattar N: Maternal obesity is associated with dysregulation of metabolic, vascular, and inflammatory pathways. JCEM. 2002, 87: 4231-4237.","journal-title":"JCEM"},{"key":"895_CR11","doi-asserted-by":"publisher","first-page":"138","DOI":"10.1016\/j.physbeh.2012.04.014","volume":"107","author":"S Sen","year":"2012","unstructured":"Sen S, Carpenter AH, Hochstadt J, Huddleston JY, Kustanovich V, Reynolds A, Robert A: Nutrition, weight gain and eating behavior in pregnancy: a review of experimental evidence for long-term effects on the risk of obesity in offspring. Physiol Behav. 2012, 107: 138-145. 10.1016\/j.physbeh.2012.04.014.","journal-title":"Physiol Behav"},{"key":"895_CR12","doi-asserted-by":"publisher","first-page":"1691","DOI":"10.1001\/jama.2009.548","volume":"301","author":"SV Subramanian","year":"2009","unstructured":"Subramanian SV, Ackerson LK, Smith GD, John NA: Association of maternal height with child mortality, anthropometric failure, and anemia in India. JAM. 2009, 301: 1691-1701. 10.1001\/jama.2009.548.","journal-title":"JAM"},{"key":"895_CR13","doi-asserted-by":"publisher","first-page":"1507","DOI":"10.1001\/jama.2010.450","volume":"303","author":"E Ozaltin","year":"2010","unstructured":"Ozaltin E, Hill K, Subramanian SV: Association of maternal stature with offspring mortality, underweight, and stunting in low- to middle-income countries. JAMA. 2010, 303: 1507-1516. 10.1001\/jama.2010.450.","journal-title":"JAMA"},{"key":"895_CR14","doi-asserted-by":"publisher","first-page":"1325","DOI":"10.1016\/S0140-6736(12)60869-1","volume":"380","author":"JA Cresswell","year":"2012","unstructured":"Cresswell JA, Campbell OMR, De Silva MJ, Filippi V: Effect of maternal obesity on neonatal death in Sub-Saharan Africa: multivariable analysis of 27 national datasets. Lancet. 2012, 380: 1325-1330. 10.1016\/S0140-6736(12)60869-1.","journal-title":"Lancet"},{"key":"895_CR15","doi-asserted-by":"publisher","first-page":"46","DOI":"10.1590\/S0103-05822011000100008","volume":"29","author":"CC Beck","year":"2011","unstructured":"Beck CC, Lopes AS, Pitanga FJG: Anthropometric indexes of overweight and obesity as predictors of lipid changes in adolescents. Rev Paul Pediatr. 2011, 29: 46-53. 10.1590\/S0103-05822011000100008.","journal-title":"Rev Paul Pediatr"},{"key":"895_CR16","first-page":"358","volume-title":"Waist-to-height ratio is the best anthropometric index for screening the risk of obesity-related disorders","author":"SD Hsieh","year":"2011","unstructured":"Hsieh SD, Muto T: Asian Perspectives and Evidence on Health Promotion and Education. Waist-to-height ratio is the best anthropometric index for screening the risk of obesity-related disorders. 2011, Tokyo: Springer, 358-363."},{"key":"895_CR17","doi-asserted-by":"publisher","first-page":"969","DOI":"10.1016\/j.nut.2005.01.007","volume":"21","author":"A Misra","year":"2005","unstructured":"Misra A, Wasir JS, Vikram NK: Waist circumference criteria for the diagnosis of abdominal obesity are not applicable uniformly to all populations and ethnic groups. Nutrition. 2005, 21: 969-976. 10.1016\/j.nut.2005.01.007.","journal-title":"Nutrition"},{"key":"895_CR18","doi-asserted-by":"publisher","first-page":"28","DOI":"10.1186\/1758-5996-2-28","volume":"2","author":"DR Brenner","year":"2010","unstructured":"Brenner DR, Tepylo K, Eny KM, Cahill LE, El-Sohemy A: Comparison of body mass index and waist circumference as predictors of cardiometabolic health in a population of young Canadian adults. Diabetol Metab Syndr. 2010, 2: 28-10.1186\/1758-5996-2-28.","journal-title":"Diabetol Metab Syndr"},{"key":"895_CR19","first-page":"36","volume-title":"Physical status: the use and interpretation of anthropometry","author":"World Health Organization","year":"1995","unstructured":"World Health Organization: Physical status: the use and interpretation of anthropometry. 1995, Geneva: World Health Organization, 36-Technical Report Series, 854"},{"key":"895_CR20","doi-asserted-by":"publisher","first-page":"243","DOI":"10.1016\/S0140-6736(07)61690-0","volume":"371","author":"RE Black","year":"2008","unstructured":"Black RE, Allen LH, Bhutta ZA, Caulfield LE, de Onis M, Ezzati M, Mathers C, Rivera J: Maternal and child undernutrition: global and regional exposures and health consequences. Lancet. 2008, 371: 243-260. 10.1016\/S0140-6736(07)61690-0.","journal-title":"Lancet"},{"key":"895_CR21","doi-asserted-by":"publisher","first-page":"25","DOI":"10.2307\/2807954","volume":"10","author":"WH Mosley","year":"1984","unstructured":"Mosley WH, Chen LC: An analytical framework for the study of child survival in developing countries. Populat Dev Rev. 1984, 10: 25-45. Sup. Child Survival: Strategies for Research","journal-title":"Populat Dev Rev"},{"key":"895_CR22","doi-asserted-by":"crossref","first-page":"520","DOI":"10.1177\/1536867X0800800404","volume":"8","author":"BT West","year":"2008","unstructured":"West BT, Berglund P, Heeringa SG: A closer examination of subpopulation analysis of complex sample survey data. Stata J. 2008, 8: 520-531.","journal-title":"Stata J"},{"key":"895_CR23","volume-title":"Applied survey data analysis","author":"SG Heeringa","year":"2008","unstructured":"Heeringa SG, West BT, Berglund PA: Applied survey data analysis. 2008, Boca Raton: Chapman Hall\/CRC Press"},{"key":"895_CR24","doi-asserted-by":"publisher","first-page":"1164","DOI":"10.1016\/S0140-6736(06)69473-7","volume":"368","author":"E Villamor","year":"2006","unstructured":"Villamor E, Cnattingius S: Interpregnancy weight change and risk of adverse pregnancy outcomes: a population-based study. Lancet. 2006, 368: 1164-1170. 10.1016\/S0140-6736(06)69473-7.","journal-title":"Lancet"},{"key":"895_CR25","doi-asserted-by":"publisher","first-page":"1331","DOI":"10.1016\/S0140-6736(10)62233-7","volume":"377","author":"V Flenady","year":"2011","unstructured":"Flenady V, Koopmans L, Middleton P, Froen JF, Smith GC, Gibbons K, Coory M, Gordon A, Ellwood D, McIntyre HD, Fretts R, Ezzati M: Major risks for stillbirth in high-income countries: a systematic review and meta-analysis. Lancet. 2011, 377: 1331-1340. 10.1016\/S0140-6736(10)62233-7.","journal-title":"Lancet"},{"key":"895_CR26","doi-asserted-by":"publisher","first-page":"1292","DOI":"10.1016\/S0140-6736(12)61181-7","volume":"380","author":"EA Nohr","year":"2012","unstructured":"Nohr EA: Maternal obesity and neonatal mortality in an African setting. Lancet. 2012, 380: 1292-1293. 10.1016\/S0140-6736(12)61181-7.","journal-title":"Lancet"},{"key":"895_CR27","doi-asserted-by":"publisher","first-page":"1644","DOI":"10.1093\/humrep\/deh277","volume":"19","author":"H Lashen","year":"2004","unstructured":"Lashen H, Fear K, Sturdee DW: Obesity is associated with increased risk of first trimester and recurrent miscarriage: matched case control study. Hum Reprod. 2004, 19: 1644-1646. 10.1093\/humrep\/deh277.","journal-title":"Hum Reprod"},{"key":"895_CR28","doi-asserted-by":"publisher","first-page":"421","DOI":"10.1016\/j.rbmo.2011.06.018","volume":"23","author":"V Rittenberg","year":"2011","unstructured":"Rittenberg V, Seshadri S, Sunkara SK, Sobaleva S, Oteng-Ntim E, El-Thouky T: Effect of body mass index on IVF treatment outcome: an updated systematic review and meta-analysis. Reprod Biomed Online. 2011, 23: 421-439. 10.1016\/j.rbmo.2011.06.018.","journal-title":"Reprod Biomed Online"},{"key":"895_CR29","doi-asserted-by":"publisher","first-page":"507","DOI":"10.1055\/s-0031-1293204","volume":"29","author":"C Boots","year":"2011","unstructured":"Boots C, Stephenson MD: Does obesity increase the risk of miscarriage in spontaneous conception: a systematic review. Semin Reprod Med. 2011, 29: 507-513. 10.1055\/s-0031-1293204.","journal-title":"Semin Reprod Med"},{"key":"895_CR30","doi-asserted-by":"publisher","first-page":"147","DOI":"10.1056\/NEJM199801153380302","volume":"338","author":"S Cnattingius","year":"1998","unstructured":"Cnattingius S, Berstrom R, Lipworth L, Kramer MS: Prepregnancy weight and the risk of adverse pregnancy outcomes. N Engl J Med. 1998, 338: 147-152. 10.1056\/NEJM199801153380302.","journal-title":"N Engl J Med"},{"key":"895_CR31","doi-asserted-by":"publisher","first-page":"403","DOI":"10.1111\/j.1471-0528.2005.00437.x","volume":"112","author":"J Kristensen","year":"2005","unstructured":"Kristensen J, Vestergaard M, Wisborg K, Kesmodel U, Secher NJ: Pre-pregnancy weight and the risk of stillbirth and neonatal death. BJOG. 2005, 112: 403-408. 10.1111\/j.1471-0528.2005.00437.x.","journal-title":"BJOG"},{"key":"895_CR32","doi-asserted-by":"publisher","first-page":"e33370","DOI":"10.1371\/journal.pone.0033370","volume":"7","author":"EK Hayes","year":"2012","unstructured":"Hayes EK, Lechowicz A, Petrik JJ, Storozhuk Y, Paez-Parek S, Dai Q, Samjoo IA, Mansell M, Gruslin A, Holloway AC, Raha S: Adverse fetal and neonatal outcomes associated with a life-long high fat diet: role of altered development of the placental vasculature. PLoS One. 2012, 7: e33370-10.1371\/journal.pone.0033370.","journal-title":"PLoS One"},{"key":"895_CR33","doi-asserted-by":"publisher","first-page":"455","DOI":"10.1111\/j.1479-828X.2011.01343.x","volume":"51","author":"L Moran","year":"2011","unstructured":"Moran L, Tsagareli V, Norman R, Noakes M: Diet and IVF pilot study: short-term weight loss improves pregnancy rates in overweight\u2044obese women undertaking IVF. Aust N Z J Obstet Gynaecol. 2011, 51: 455-459. 10.1111\/j.1479-828X.2011.01343.x.","journal-title":"Aust N Z J Obstet Gynaecol"},{"key":"895_CR34","doi-asserted-by":"publisher","first-page":"41","DOI":"10.1016\/j.ijgo.2009.10.015","volume":"109","author":"Z Chen","year":"2010","unstructured":"Chen Z, Du J, Shao L, Zheng L, Wu M, Ai M, Zhang Y: Prepregnancy body mass index, gestational weight gain, and pregnancy outcomes in China. Int J Gynecol Obstet. 2010, 109: 41-44. 10.1016\/j.ijgo.2009.10.015.","journal-title":"Int J Gynecol Obstet"},{"key":"895_CR35","first-page":"357","volume":"83","author":"JL Stone","year":"1994","unstructured":"Stone JL, Lockwood CJ, Berkowitz GS, Alvarez M, Lapinski R, Berkowitz RL: Risk factors for severe preeclampsia. Obstet Gynecol. 1994, 83: 357-361.","journal-title":"Obstet Gynecol"},{"key":"895_CR36","doi-asserted-by":"publisher","first-page":"399","DOI":"10.1038\/nrcardio.2009.55","volume":"6","author":"VZ Rocha","year":"2009","unstructured":"Rocha VZ, Libby P: Obesity, inflammation, and atherosclerosis. Nat Rev Cardiol. 2009, 6: 399-409. 10.1038\/nrcardio.2009.55.","journal-title":"Nat Rev Cardiol"},{"key":"895_CR37","doi-asserted-by":"publisher","first-page":"1949","DOI":"10.1016\/S0140-6736(11)60135-9","volume":"377","author":"MI Schmidt","year":"2011","unstructured":"Schmidt MI, Duncan BB, Silva GA, Menezes AM, Monteiro CA, Barreto SM, Chor D, Menezes PR: Chronic non-communicable diseases in Brazil: burden and current challenges. Lancet. 2011, 377: 1949-1961. 10.1016\/S0140-6736(11)60135-9.","journal-title":"Lancet"}],"container-title":["BMC Pregnancy and Childbirth"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/link.springer.com\/content\/pdf\/10.1186\/1471-2393-14-5.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"http:\/\/link.springer.com\/article\/10.1186\/1471-2393-14-5\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"http:\/\/link.springer.com\/content\/pdf\/10.1186\/1471-2393-14-5","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/1471-2393-14-5.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,9,2]],"date-time":"2021-09-02T02:28:31Z","timestamp":1630549711000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmcpregnancychildbirth.biomedcentral.com\/articles\/10.1186\/1471-2393-14-5"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2014,1,7]]},"references-count":37,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2014,12]]}},"alternative-id":["895"],"URL":"https:\/\/doi.org\/10.1186\/1471-2393-14-5","relation":{},"ISSN":["1471-2393"],"issn-type":[{"value":"1471-2393","type":"electronic"}],"subject":[],"published":{"date-parts":[[2014,1,7]]},"assertion":[{"value":"17 March 2013","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"19 December 2013","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"7 January 2014","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}}],"article-number":"5"}}