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Connect the Dots-July 2020.

U.S. vital statistics with linked birth and infant death certificates from 2014 to 2017 were analyzed by Bicocca et al1 (see page 118) to study the association between the presence and degree of maternal obesity at delivery with the presence and timing of hypertensive disorders of pregnancy. The knowledge gap to be filled was whether obesity is related to early (less than 34 weeks of gestation) hypertension. The authors provide descriptive statistics of the more than 14 million births that met inclusion criteria. Fifty-four percent of the women were obese, with about 10% having class III obesity. Rates of hypertension were significantly and progressively associated with severity of obesity, with the effect being more pronounced for late-onset disease. As noted by Grimes,2 use of administrative databases for research carries both benefits and hazards. Vital statistics data may have very uneven data quality, with some fields being quite accurate, others less so. Bicocca et al followed Grimes’ recommendations that studies, “.using vital records should be limited to simple descriptive reports with caveats about data accuracy.”2 Even with these limits, the research reported supports an increasing burden of disease with increasing degrees of obesity. Given that more than one half of the women were obese at delivery, the public health implications are clear. Nancy C. Chescheir, MD University of North Carolina, Chapel Hill, Chapel Hill, North Carolina