Author ORCID Identifier

Date of Award

Fall 11-30-2023

Degree Type


Degree Name

Master of Public Health (MPH)


Public Health

First Advisor

Suhasini Ramisetty-Mikler

Second Advisor

Alexander Kirpich

Third Advisor

Chetan Tiwari


Introduction: Georgia has one of the highest rates of maternal mortality in the nation with 30.2 pregnancy-related deaths per 100,000 live births between 2018-2020. Pregnancy-associated conditions (PACs) are associated with maternal mortality and negative birth outcomes. Evidence supports that pre-pregnancy overweight, and obesity are associated with weight gain, increased body mass index (BMI) during pregnancy, gestational hypertension (GHT), and gestational diabetes mellitus (GDM) which in turn are associated with adverse birth outcomes. The primary objective of the study is to investigate the risk of pre-pregnancy BMI associated with adverse maternal conditions and birth outcomes among Georgia mothers after controlling for demographics and other covariates.

Methods: The study used secondary data from Georgia’s Department of Public Health (DPH) birth certificate and natality data for the year 2022 (N=129,723). Descriptive analyses were conducted to examine pre-pregnancy BMI, maternal characteristics, the incidence of BMI during pregnancy, hypertension, gestational diabetes, and birth outcomes (birth weight, premature birth, and cesarian method of delivery). Logistic regression modeling was utilized to assess the association between pre-pregnancy BMI and PACs and to estimate the adjusted odds ratio (AOR) while controlling for maternal demographics and covariates.

Results: Based on pre-pregnancy BMI, mothers were grouped into normal (36%), overweight (27%), and obese (34%). The incidence of GHT is 9.3%, and GDM is 6.7%, while more than one-quarter of the mothers are overweight (29%), and two-thirds are obese (62%), during pregnancy. Mothers who are obese before pregnancy are nearly 3 times more likely to have GHT (AOR= 2.81, 95%CI= 2.68, 2.95), 3 times more likely to experience GDM (AOR=2.89, 95%CI= 2.73, 3.05), and over 300 times likely to stay obese during pregnancy (AOR=360, 95% CI= 281, 463). Regarding the mother's age, we found a consistent increase in the odds of becoming overweight/obese and having GDM during pregnancy. Women of Hispanic descent (AOR=1.22, 95%CI=1.15, 1.30) have a 1.2 times likelihood of being obese during pregnancy, whereas other groups such as Hawaiian/Pacific islander (AOR=1.21, 95% CI=0.64, 2.31), and non-Hispanic Black/African American (AOR=1.10, 95%CI=1.05, 1.15) also had a higher chance of being obese. Non-Hispanic Black/ African American (AOR=1.02, 95% CI=0.97, 1.06) descent was found to have the highest odds of developing GHT than mothers of a different racial/ethnic identity. The highest chance of a mother developing gestational diabetes was in Asian mothers (AOR=2.27, 95% CI=2.09, 2.46) have nearly 2.3 times higher odds for GDM compared to white mothers. Birth outcomes such as birth weight and delivery through the cesarian method had a strong significant relationship across all PACs. Mothers with GHT (AOR=2.82, 95%CI= 2.28, 2.95) and mothers with GDM (AOR=1.46 95%CI= 1.38, 1.55) have higher odds of having a premature birth (gestation). Mothers who are overweight/obese have higher odds of giving birth to a macrosomia baby (AOR=3.13, 95%CI= 2.73, 3.59).

Conclusion: These findings are consistent with data on maternal health and birth outcomes. Pre-pregnancy BMI ≥30 among women enhances the risk that leads to a myriad of pregnancy-associated conditions and negative birth outcomes. Maintaining a healthy weight through a balanced diet and regular physical activity before becoming pregnant can help reduce these risks. Our study highlights the importance of physical health and good prenatal care before pregnancy. Although making healthier individual choices is key these choices could be hindered by social, economic, and environmental factors such as stress, low income, food insecurity, vehicle dependence, and more that can keep mothers from a healthier lifestyle.


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