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[Comment] Interpregnancy weight gain—a modifiable cause of stillbirth?

In The Lancet, Sven Cnattingius and Eduardo Villamor1 capitalise once more on the extraordinary resource of the Swedish Medical Birth Register to identify risk factors for stillbirth and infant death. In a population-based cohort study of 456 711 women with data on height and early gestational weight, the authors investigated the association between change in body-mass index (BMI) between first and second pregnancies and risks of stillbirth and infant mortality. The authors report an incremental increase in risk of stillbirth with BMI gain between first and second pregnancies (relative risk [RR] 1·38, 95% CI 1·16–1·63 if BMI gain is 2 to <4 kg/m2 vs −1 to <1 kg/m2; and RR 1·55, 95% CI 1·23–1·96, if BMI gain is ≥4 kg/m2 vs −1 to <1 kg/m2); and a novel finding in women of normal weight during their first pregnancy that even modest increases in BMI by their second pregnancy were associated with increased infant mortality (RR 1·27, 95% CI 1·01–1·59 if BMI gain was 2 to <4 kg/m2 vs −1 to <1 kg/m2).