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PubMed1992

Coffee consumption and cause-specific mortality. Association with age at death and compression of mortality.

The relationship between reported coffee consumption and specific causes of death was examined in 9484 males enrolled in the Adventist Mortality Study in 1960 and followed through 1985. Coffee consumption was divided into three levels: less than 1 cup per day, 1-2 cups per day, and greater than or equal to 3 cups per day. Approximately one third of the subjects did not drink coffee. Cause-specific mortality rates were compared using survival analysis including Cox's proportional hazard model, and controlling for potential confounders such as body mass index, heart disease and hypertension at baseline, race, physical activity, marital status, educational level, smoking history, and dietary pattern. Inclusion of interaction terms between coffee consumption and attained age as time-dependent covariates allowed the hazard ratio to vary with age. Univariate analyses showed a statistically significant association (p less than 0.05) for coffee consumption and mortality for most endpoints. Multivariate analyses showed a small but statistically significant association between coffee consumption and mortality from ischemic heart disease, other cardiovascular diseases, all cardiovascular diseases, and all causes of death. For the major causes of death, the hazard ratios decreased from about 2.5 at 30 years of age to 1.0 around 95 years of age. These results indicate that abstinence from coffee leads to compression of mortality rather than an increase in lifespan.

Adult↗

PubMed1992

An evaluation of structural and functional prefrontal deficits in schizophrenia: MRI and neuropsychological measures.

Magnetic resonance imaging was used to assess prefrontal brain structure in 17 schizophrenic, 18 psychiatric control, and 19 normal control subjects of comparable age, social background, and educational status, while three neuropsychological measures were used to assess prefrontal functioning. Schizophrenic patients had significantly smaller prefrontal areas than both psychiatric control and normal control subjects in all three planes. When posterior brain area and temporal lobe were entered into statistical analysis as covariates, they did not explain the prefrontal deficits. Schizophrenic patients made more perseveration errors on the Wisconsin Card Sorting Task and had fewer correct responses on the Spatial Delayed Response Task than normal control subjects. Schizophrenic patients performed more poorly than psychiatric control subjects on the Block Design Test. No group differences were found on three other nonfrontal tasks. These data lend some support to the role of prefrontal deficits in the development of schizophrenia.

Adult↗

PubMed2005

Overview of current state of research on pregnancy outcomes in minority populations.

Pregnancy outcomes improved significantly over the 20th century in the United States but currently vary widely between women of different ethnic and racial backgrounds. The current health disparities that exist are based, in part, only on differences in socioeconomic status or education. There is wide variability in pregnancy outcomes within specific subgroups of women. Disparities may be due to underlying differences in health before pregnancy, differences in community norms, and individual lifestyle choices and to differences in health care delivery systems. Areas for needed research and promising new models of care are reviewed.

Delivery of Health Care↗

PubMed2005

The role of body weight in oral contraceptive failure: results from the 1995 national survey of family growth.

PURPOSE: Many unintended pregnancies occur in women who use contraception. We conducted this study to determine if increasing body weight is associated with oral contraceptive (OC) failure. METHODS: This retrospective cohort study consists of the 1916 women who reported using OCs in January 1993 and provided complete covariate information on the 1993 National Health Interview Survey and 1995 National Survey of Family Growth. Body weight and body mass index (BMI) were self-reported in 1993. The outcome was defined to be any conception occurring in women reporting OC use during the month of conception. Cox proportional hazards models were used to model the body weight/BMI-OC failure association. RESULTS: Women with a BMI >/= 30 had a statistically significant increased risk of having an OC failure as compared to women with BMIs of 20 to 24.9 (HR=1.80, 95% CI, 1.01, 3.20). However, after adjustment for age, marital status, education, poverty, race/ethnicity, parity, and dual method use, this increased risk was attenuated and no longer statistically significant (HR=1.51, 95% CI, 0.81, 2.82). Increasing body weight was not associated with an increased risk of OC failure in the unadjusted or adjusted models. CONCLUSIONS: We did not find a strong or statistically significant association between increasing body weight/BMI and OC failure among this population of women. Prospective studies specifically designed to examine this association are needed to determine if heavier women should be advised to use a contraceptive method other than OCs to prevent pregnancy.

Adult↗

PubMedDate not supplied

Consanguineous marriages in the province of Antalya, Turkey.

To assess the trends in the frequency and the medical effects of consanguinity in the south coast of Turkish population using local and national data in the last 11 years. This cross-sectional study was carried out in Manavgat province, which is a major tourism center on the Mediterranean coast of Turkey. The authors studied consanguineous marriages in rural and urban population in the Mediterranean coast, Manavgat province, Turkey, via a 1500 random survey sample of married couples. There has been a significant increase in the incidence of consanguineous marriages in rural areas (40.7%) since 1989 in the southern population of Turkey. The results showed that the most frequent type of marriage was between the first cousins. It is found that there is no statistically significant difference between the consanguineous and non-consanguineous marriages in the different age groups. The results were discussed on the basis of educational status, reasons for having consanguineous marriages and the general medical effects as well as with the relation of congenital malformations. The custom of consanguineous unions in the Mediterranean population of Turkey is still extremely high, and preventive measures should be done to decrease its frequency and associated complications.

Consanguinity↗

PubMed2006

Evaluation of the oral health status of the people aged 65 years and over living in near rural district of Middle Anatolia, Turkey.

The aim of this study was to assess the oral health status of aged 65 years and over, and evaluate the level of edentulousness and study the factors that could have an influence on edentulism. The participants of this study were 215 patients; 94 males (47.3%) and 121 females (56.3%), aged 65 years and over. Each subject underwent a comprehensive dental and radiographic examination by one examiner. Periodontal attachment loss observed in the panoramic radiographs was divided into three diagnostic categories: infrabony defects, horizontal bone loss, and furcation lesions. The number of teeth with apical periodontitis lesions, the number of carious teeth, and restorations, type of dentures and wear duration, intrabony root remains, impacted teeth, smoking status, educational level and self-reported medical history of the participants were recorded. Extent of tooth loss was significantly higher in females than males and increased with increasing age (p<0.05). Tooth loss was significantly associated with educational levels; lower literacy level was found to be associated with a higher number of missing teeth (p<0.01). Also, as the educational levels of the participants increased, the number of infrabony defects, furcation lesions and number of carious teeth decreased (p<0.05). Low literacy level and female gender are found to be high-risk groups for tooth loss. Community-based oral disease prevention programs should be implemented to reduce the risk for tooth loss in this population.

Age Distribution↗

PubMed2004

Epidemiologic characteristics of death by burn injury from 1991 to 2001 in Korea.

This study was designed to investigate the epidemiologic characteristics of death from burn injury in Korea. We recoded the death certificate database from 1991 to 2001 inclusive based on the short version of the International Classification of External Causes of Injuries (ICECI). Using variables such as sex, marital status, educational level, location of residence (metropolitan versus provincial), injury mechanism, and year, we calculated and compared the mortality rates and percentiles because of burn injury, and determined the adjusted odds ratio (OR) to assess the effect of socioeconomic factors on suicide deaths. The total number of deaths because of injury was 346,656, and the number of deaths because of burn injury was 9109 (2.6%), making burn injury the sixth leading cause of death from injury during the study period. The mortality rate due to burn injury was 1.8 per 100,000 person-years in 2001, without long-term change from 1991. Major mechanisms of death included surface burns (80.7%), smoke inhalation (14.4%), respiratory burns (1.5%), and associated trauma (3.5%). The number of the suicide deaths was 466 from 1993 to 2001 inclusive, and the adjusted OR for suicide burns compared to accidental burns was significantly larger in the more highly educated, metropolitan, and married and divorced groups than it was in the never-attended-school, provincial, and never-married groups, respectively.

Accidents↗

PubMed2006

Perceived neighborhood social disorder and residents' attitudes toward reporting child physical abuse.

OBJECTIVE: This study aimed to explore the relationship between perceived neighborhood social disorder and attitudes toward reporting child physical abuse. METHOD: Data from a national probabilistic sample (N=9,759) were used. Responses about the perception of neighborhood social disorder, perceived frequency of child physical abuse in Spanish families, and willingness to report a case of child physical abuse to the police were collected through face-to-face interviews in respondents' homes. RESULTS: Multivariate logistic regression analysis showed that perceived neighborhood social disorder was negatively related to residents' attitudes toward reporting child physical abuse. These results take into account the potential confounding effects of gender, age, socio-economic status, educational level, size of city, and perceived frequency of child physical abuse on reporting attitudes. CONCLUSION: Results illustrate the important role that community characteristics may play in processes relevant to the prevention of child maltreatment such as residents' attitudes towards reporting child physical abuse, and suggest that especially disadvantaged communities characterized by high levels of social disorder need to be specifically targeted if the aim is to increase the capacity to prevent child maltreatment in the community.

Adolescent↗

PubMed2005

Smoking as a risk factor for erectile dysfunction: data from the Andrology Prevention Weeks 2001-2002 a study of the Italian Society of Andrology (s.I.a.).

OBJECTIVE: To analyse the relationship between smoking and erectile dysfunction (ED). METHODS: To provide further data on this issue, we analysed information gathered from men attending a free andrologic consultation in 234 Italian medical centres, in the setting of a project focused on andrologic prevention. Men were asked about "their ability to achieve and maintain an erection sufficient for satisfactory sexual performance". If they were dissatisfied, they were defined as having ED. RESULTS: Out of 16724 subjects, ED was diagnosed in 4081 men (24.4%). After adjustment for age, marital status, education, alcohol consumption, physical activity and concomitant pathologies, in comparison with never smokers, men who currently smoked more than 10 cigarettes/day and former smokers showed significantly higher odds ratio (ORs 1.4 and 1.3, respectively) for ED. These results were confirmed performing analysis in strata of diabetes, hypertension, cardiovascular disease and hypercolesterolemia. COMMENTS: This transversal observational study shows that the risk of ED is influenced by smoking. A dose- and duration-response effect is present; changes in smoking habits do not seem to significantly affect the risk to develop ED.

Adult↗

PubMed2004

Factors associated with inadequate prenatal care in Ecuadorian women.

BACKGROUND: Although inadequate prenatal care has been associated with adverse perinatal outcomes, reports on the factors associated with poor prenatal care in developing Latin American countries are scarce. OBJECTIVE: To determine factors associated with inadequate prenatal care among women from low socioeconomic circumstances. METHOD: Women delivered after a pregnancy duration of more than 20 weeks at the Enrique C. Sotomayor Obstetrics and Gynecology Hospital, Guayaquil, Ecuador, were surveyed. The questionnaire collected sociodemographic data and reasons for having inadequate prenatal care. Adequacy of prenatal care was measured with the Kessner index and correlated to the sociodemographic data. RESULTS: During the study period, 1016 pregnant women were surveyed. Among them, there were adolescents (23.7%), primigravidas (30.8%), and women with a high-risk pregnancy (29.3%). According to the Kessner index, prenatal care was considered adequate or inadequate in 24.5% and 75.5% of cases, respectively. Knowledge regarding the importance of adequate prenatal care and the effects of poor prenatal care was lower among women who had received inadequate prenatal care. The women that were considered to have had adequate prenatal care had at least one visit, and they were more often cared for by a specialist than women who considered having inadequate prenatal care. The three most important reasons associated to inadequate prenatal care in this series (n=767), were economic difficulties having to care for a small child, and transportation difficulties. Logistic regression analysis determined that women with undesired pregnancies who resided in rural areas and were para 5 or higher had an increased risk of inadequate prenatal care. On the other hand, an adverse outcome to a prior pregnancy (abortion, intrauterine fetal demise, or ectopic pregnancy) decreased this risk. Marital status and educational level were confounding factors. CONCLUSIONS: Although prenatal care at our institution is free, adequacy was thought to be low. The main factors associated with poor prenatal care were mostly conditions related to poverty.

Confounding Factors, Epidemiologic↗

PubMed2024

Association of urinary levels of trace metals with type 2 diabetes and obesity in postmenopausal women in Korea: A community-based cohort study.

Several toxic metals have been associated with metabolic diseases like obesity and diabetes mellitus (DM) in humans. However, knowledge regarding the influence of many trace elements, especially in combination with essential elements is limited. This study aims to address this research gap by investigating the associations of both non-essential and essential inorganic trace elements in urine with DM and obesity, employing a group of postmenopausal women (n = 851) from the Korean Genome and Epidemiology Study (KoGES) cohort. Urine samples were collected during 2017-2018, and were analyzed for 19 trace elements using inductively coupled plasma-mass spectrometry and an automatic mercury analyzer. Outcomes of interest were metabolic diseases (DM and obesity) and DM-related traits (insulin resistance and β-cell function). After adjustment of covariates, such as age, alcohol consumption, smoking status, educational level, and daily energy intake, urinary Zn, Ni, Tl, and U levels were associated with the prevalence of DM and homeostatic model assessment (HOMA) for insulin resistance (IR) in the postmenopausal women. In the whole mixture model, however, no significant association was observed for the prevalence of DM. Urinary levels of Zn were negatively associated with HOMA of β-cell function (HOMA-β), positively correlated with HbA1c levels, HOMA-IR, and prevalent DM. In addition, urinary Zn, Co, Tl, and Cs were positively associated with obesity (body mass index ≥25 kg/m2). The present observation shows that several individual elements and their mixtures may be associated with the prevalence of DM, IR, or obesity.

Humans↗

PubMed2005

Borderline personality disorder characteristics in young adults with recurrent mood disorders: a comparison of bipolar and unipolar depression.

BACKGROUND: In young adults it can be difficult to differentiate between an early bipolar illness and borderline personality disorder. There are considerable areas of clinical overlap between cyclothymic temperament, bipolar-spectrum disorders and borderline characteristics. The aim of this study was to measure borderline characteristics in young adults during an index depressive episode and to compare three diagnostic groups: DSM-IV bipolar affective disorder (BPAD); bipolar spectrum disorder (BSD); and DSM-IV recurrent major depressive disorder (MDD). METHODS: Eighty-seven young adults with a current episode of major depression and at least one previous episode of depression were recruited from consecutive referrals to a psychiatric clinic. Diagnoses were based on the Structured Clinical Interview for DSM-IV (SCID-1) and recently proposed structured diagnostic criteria for BSD. All patients also completed the borderline questions from the screening questionnaire of the International Personality Disorders Examination (IPDE). RESULTS: Diagnostically, the cohort of 87 patients divided into three groups: 14 with BPAD; 27 with BSD; and 46 with MDD. None of the subjects fulfilled DSM-IV or ICD-10 diagnostic criteria for personality disorder and all three groups were well matched in terms of age, gender distribution, ethnicity, socioeconomic and educational status, age at onset of illness, and severity of index depressive episode. Both of the bipolar-depressed groups reported significantly higher median levels of borderline characteristics than the MDD group (p<0.0001). Three of the borderline characteristics emerged as potentially useful in differentiating bipolar depression from unipolar depression: 'I've never threatened suicide or injured myself on purpose' (sensitivity=0.93; positive predictive value [PPV]=56.7); 'I have tantrums or angry outbursts' (sensitivity 0.66; PPV=65.6%); and 'Giving in to some of my urges gets me into trouble' (sensitivity=0.76; PPV=59.6%). LIMITATIONS: All of the subjects were recruited from a university health service clinic and as such are unlikely to be representative of patients from more diverse socio-economic backgrounds. No structured diagnostic assessment of personality disorder was administered. The diagnostic criteria for BSD are not yet fully validated. CONCLUSIONS: Young adults with bipolar depression exhibit significantly higher levels of borderline personality pathology than those with unipolar depression. Those borderline screening questions that reflect cyclothymic characteristics or depressive mixed states may be of practical use to clinicians in helping to differentiate between bipolar depression and unipolar depression in young adults.

Adult↗

PubMed2006

Comparison of cognitive functions between first- and multi-episode bipolar affective disorders.

BACKGROUND: Cognitive impairment has been commonly found in euthymic patients with bipolar affective disorder (BPAD). Information about onset and course of cognitive deficits is, however, scarce. This study examined the cognitive profile of patients following their first episode of BPAD to determine whether cognitive problems are present at such an early stage. METHODS: Executive functions, memory, IQ, attention-concentration and perceptuomotor function were assessed in 16 euthymic patients with BPAD following their first episodes, and compared with a group of 30 euthymic patients with multiple episodes of BPAD and 20 normal controls. Comparisons were controlled for educational status, current IQ and residual symptoms. RESULTS: First-episode patients were significantly impaired, compared to normal controls, on tests of executive function, sustained attention, perceptuomotor function and IQ. Additionally, their performance was significantly worse than patients with multi-episode BPAD on tests of executive functions, sustained attention and perceptuomotor function. Multi-episode patients had impaired memory, compared to normal controls, and performed poorly on a subtest of executive functions compared to first-episode patients. LIMITATIONS: Sample sizes were small, assessments cross-sectional; all confounds could not be controlled for. CONCLUSIONS: Widespread cognitive disturbances following the first episode of BPAD were found in this study. Whether these disturbances progress following repeated episodes was not entirely clear. Since cognitive impairment can have several adverse consequences for patients of BPAD in terms of disability, quality of life, outcome etc., this must remain a priority area for future research.

Adult↗

PubMed2006

Risk factors for unintended versus intended rapid repeat pregnancies among adolescents.

PURPOSE: Whereas previous research has elucidated a number of risk factors for rapid repeat pregnancies among adolescents, we sought to assess both established and hypothetical risk factors in the context of the intendedness of the repeat pregnancy. METHODS: The study population, drawn from the 2002 National Survey of Family Growth (NSFG), consisting of women who experienced at least one pregnancy as an adolescent, were interviewed at least 24 months since that pregnancy's resolution and were aged 30 years and younger at the time of the NSFG interview. To evaluate the effect of various predictor variables on the intendedness of a rapid repeat pregnancy, we constructed a polytomous multiple logistic regression model. Outcomes are reported as ratios of odds ratios (ROR) and were calculated using women experiencing an adolescent pregnancy, but not a rapid repeat pregnancy, as the reference group. RESULTS: In the 2002 NSFG, 34% of the adolescents experiencing a rapid repeat pregnancy reported such pregnancies to be intended. Although young age (< or = 15 years) at first conception was associated with a decreased likelihood of an unintended rapid repeat pregnancy, racial/ethnic characteristics as well as characteristics of the teen's mother (educational status and young age of the teen's mother at first birth) were not associated with either intended or unintended rapid repeat pregnancies. Factors found to be associated with an increased likelihood of having an intended repeat pregnancy included an intended first pregnancy, prior poor obstetrical outcome, and having the repeat pregnancy intended by the teen's partner. Being married at the time of second conception was associated with a decreased likelihood of an unintended rapid repeat pregnancy. CONCLUSIONS: Consideration of the intendedness of repeat pregnancies among teenagers could help create more appropriate and effective family planning interventions.

Adolescent↗

PubMed2005

Cross-cultural adaptation and validation of multiple sclerosis quality of life questionnaire (MSQOL-54) in a Turkish multiple sclerosis sample.

OBJECTIVE: Multiple sclerosis (MS) is a chronic progressive disease with multiple neurological impairments. The disease can also dramatically affect the health-related quality of life of patients. The objective of this study was to investigate the validation of the translated and cross-culturally adapted MSQOL-54 in 183 Turkish MS patients. METHODS: 183 adults classified as having definite MS patients were enrolled into the study. Patients were classified into four severity groups according to the expanded disability status scale (EDSS); group I (EDSS 0-4), group II (EDSS 4.5-5.5), group III (EDSS 6-6.5) and group IV (EDSS 7-8). MSQOL-54 questionnaire were translated and culturally adapted into Turkish. Associations between age, gender, disease duration, EDSS score, marital status, education and health insurance and the MSQOL-54 physical and mental health composite scores were determined. RESULTS: The mean age of the 183 patients (138 female and 45 male) was 39+/-10 years. The questionnaire was well accepted but small cultural adaptations were required. EDSS scores showed significant associations with the MSQOL-54 physical and mental health composite scores. From the different EDSS groups only, the group I (EDSS 0-4) score was significantly associated with the physical health composite as well as the disease duration showed significant correlation with the physical and mental composite scores. None of the other EDSS groups and the other parameters showed correlation with physical health composite or mental health composite. CONCLUSION: Assessment of quality of life of MS patients in addition to disease severity and disability level is important, because it provides unique information that is important to patients and to clinicians. A translation of an existing MS-targeted HRQOL measure from US English into Turkish was easily administered and well accepted in a Turkish MS sample.

Adolescent↗

PubMed2006

Effects of acute tryptophan depletion on cognition, memory and motor performance in Parkinson's disease.

BACKGROUND: Parkinson's disease (PD) is a neuropsychiatric disease, which is not only characterized by motor symptoms, but also by cognitive and psychiatric symptoms. It is hypothesized that some of the non-motor symptoms are related to the serotonergic deficiency that is present in PD. AIM: To study the influence of serotonin on cognition, memory and motor performance in PD. METHODS: In a double blind, randomized, placebo-controlled, cross-over design, the effect of acute tryptophan depletion (ATD) on the Visual Verbal Learning Task (VVLT), the Concept Shifting Task (CST), Simple Reaction Time Task (SRT), Finger Precuing Task (FPT) and the motor section of the Unified Parkinson's Disease Rating Scale (UPDRS, Section 3) was investigated in 15 PD patients in early stages of their disease and 15 healthy volunteers, matched for age, sex and educational status. RESULTS: With the exception of the absence of a differential effect for PD patients with the long interval of the SRT, ATD produced similar effects in PD patients and control subjects on all tasks. These included impairment of delayed recall and delayed recognition on the VVLT, and improved SRT and FPT for 'short intervals'. The UPDRS in patients remained unaffected after ATD. CONCLUSION: Serotonin does not appear to play a disease-specific role in cognition and reaction time in early stage PD patients, nor does acute reduction of cerebral serotonin levels affect motor symptoms in a clinically relevant way.

Aged↗

PubMed2006

Prevalence of peripheral arterial disease and its association with smoking in a population-based study in Beijing, China.

OBJECTIVE: Although the prevalence of peripheral arterial disease (PAD) and its association with smoking in Western populations has been extensively studied, little information is available in China. The objective of this study was to determine the age-standardized prevalence of PAD and examine the relationship between smoking, quitting, and PAD in elderly Chinese. METHODS: We conducted a population-based cross-sectional study in an urban Beijing sample of 2334 subjects aged > or =60 years (943 men and 1391 women) in 2001 to 2002. PAD was assessed by symptoms of intermittent claudication (IC) as measured by the WHO/Rose questionnaire and an ankle-arm systolic blood pressure index (AAI) of <0.90. RESULTS: The prevalence of PAD defined by IC was 11.3% (men, 8.0%; women, 13.6%); 15.3% (men, 11.7%; women, 17.7%) by AAI, and 19.8% (men, 14.7%; women, 23.2%) by both criteria. After adjusting for age, gender, marital status, education, alcohol drinking, exercise, body mass index, and histories of hypertension and diabetes mellitus, the odds ratios and 95% confidence intervals of PAD for current smokers vs never smokers were 1.54 (1.12 to 2.11) and 1.28 (0.91 to 1.79) for former smokers (stopped smoking for at least 2 years). There was a dose-response relation between the number of cigarettes smoked and increasing risk of PAD. Quitting for > or =10 years nearly eliminated excess risk associated with smoking. CONCLUSIONS: PAD is common in elderly Chinese and the prevalence is higher in women than in men. About 40% of PAD patients were asymptomatic and unaware of their condition. Cigarette smoking is a major risk factor for PAD, and smoking cessation substantially reduces the risk.

Age Factors↗

PubMed2003

Prepregnancy weight and adverse perinatal outcomes in an ethnically diverse population.

OBJECTIVE: To examine the association between excessive prepregnancy weight and adverse outcomes, with a focus on women weighing over 200 lbs (91 kg) before pregnancy. METHODS: Data were from the 1998-1999 New York City births file for 213,208 singletons with information on prepregnancy weight. Five categories of prepregnancy weight were constructed and used to predict gestational diabetes, preeclampsia, cesarean delivery, very low birthweight, macrosomia, and treatment in the neonatal intensive care unit (NICU). Statistical adjustments were made for mother's age, race or ethnicity, marital status, education, parity, social risk (eg, smoking), initiation of prenatal care, health insurance, and infant's sex. RESULTS: Maternal prepregnancy weight was associated with several adverse outcomes. Women in the heaviest group (> 300 lbs or > 136 kg) had the highest adjusted odds ratios (OR) for gestational diabetes (OR 5.2), preeclampsia (OR 5.0), and cesarean delivery (OR 2.7) compared with women weighing 100-149 lbs (45-67 kg). Compared with the reference group, the heaviest women were more likely to have a macrosomic infant and an infant treated in the NICU (OR 4.2 and 1.9, respectively). Even among a subsample of women who did not have any diabetic or hypertensive diseases, excess weight significantly increased the likelihood of macrosomia and NICU treatment. Blacks were disproportionately represented in the two heaviest groups (49.8% of those weighing 200-299 lbs and 63.9% of those weighing over 300 lbs). CONCLUSION: In this population-based study of pregnant women, the adverse outcomes associated with excessive weight underline the urgency of weight loss interventions before pregnancy. The analysis also suggests that research is needed on rapidly growing racial or ethnic subgroups most at risk for obesity.

Adolescent↗