Validation of a Strict Obesity Definition Proposed for Asian to Predict Adverse Pregnancy Outcomes in Korean Pregnant Women

Seo Yeon Kim, Soo young Oh, Ji Hee Sung, Suk Joo Choi, Cheong Rae Roh, Seung Mi Lee, Jong Kwan Jun, Mi Young Lee, Joon Ho Lee, Soo Hyun Kim, Dong Hyun Cha, You Jung Han, Min Hyoung Kim, Geum Joon Cho, Han Sung Kwon, Byoung Jae Kim, Mi Hye Park, Hee Young Cho, Hyun Sun Ko, Jae Yoon ShimHyun Mee Ryu

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Background: People are considered overweight and obese if their body mass index (BMI) is above 25 kg/m2 and 30.0 kg/m2, respectively. The World Health Organization proposed stricter criteria for Asians (≥ 23 kg/m2: overweight, ≥ 25 kg/m2: obese). We aimed to verify whether this criteria could predict adverse pregnancy outcomes in Korean women. Methods: We included 7,547 Korean women from 12 institutions between June 2016 and October 2018. Women with no pre-pregnancy BMI data, not Korean, or lost to follow-up were excluded, leaving 6,331. The subjects were categorized into underweight, normal, overweight, class I obesity, and class II/III obesity based on a pre-pregnancy BMI of < 18.5,,,, and ≥ 30.0 kg/m2, respectively. Results: Overall, 13.4%, 63.0%, 11.8%, 9.1%, and 2.6% of women were underweight, normal, and overweight and had class I obesity and class II/III obesity, respectively. In the multivariable analysis adjusted for maternal age, a higher BMI significantly increased the risk of preeclampsia, gestational diabetes, preterm delivery caused by maternal-fetal indications, cesarean section, large for gestational age, and neonatal intensive care unit admission. Conclusion: Adverse pregnancy outcomes increased in those with a pre-pregnancy BMI ≥ 23.0 kg/m2 after adjusting for maternal age. The modified obesity criteria could help predict adverse pregnancy outcomes in Koreans.

Original languageEnglish
Article numbere281
JournalJournal of Korean Medical Science
Issue number44
StatePublished - Nov 2021

Bibliographical note

Funding Information:
Funding The original research of the Korean Perinatal Diagnosis Study was supported by a grant of the Korea Health Technology R&D Project at the Korea Health Industry Development Institute, funded by the Ministry of Health & Welfare, Republic of Korea (grant No. HC15C1336). We thank Dr. Dong Wook Shin (Department of Family Medicine/Supportive Care Center, Samsung Medical Center and Department of Clinical Research Design & Evaluation, Samsung Advanced Institute for Health Science & Technology, Sungkyunkwan University) and Kyunga Kim (1 Biomedical Statistics Center, Research Institute for Future Medicine, Samsung Medical Center, Seoul, Korea and Department of Digital Health, SAIHST, Sungkyunkwan University, Seoul, Korea) for providing statistical advice.

Funding Information:
Diagnosis Study was supportProvisionaled by a grant Moreover, it was also found that Asians tend to have a higher body fat mass than non-of the Korea Health Technology R&D Project Asians within the same BMI groups.8 Therefore, the WHO proposed stricter criteria of the at the Korea Health Industry Development classification of obesity for Asians,9 which was adopted by the Korean Obesity Association & Welfare, Republic of Korea (grant No.Institute, funded by the Ministry of Health and Korean Diabetes Association in 201810,11: underweight (< 18.5 kg/m2), normal (18.5–22.9

Publisher Copyright:
© 2021. The Korean Academy of Medical Sciences. This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (https:// which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. All Rights Reserved.


  • Asian
  • Maternal Obesity
  • Neonatal
  • Obesity
  • Pregnancy


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