Intersectional inequalities in body mass index among pregnant women in Sweden 2014-2017

Abstract Background In Sweden, the prevalence of overweight and obesity among pregnant women has increased and there are signs of growing social inequalities. Intersectionality-informed approaches have become common in epidemiology, as they provide a deeper understanding of the complexity of health inequalities by considering the combined impacts of multiple intersecting identities. Therefore, we investigated intersectional inequalities in body mass index (BMI) among Swedish pregnant women. Methods This study utilized data from the Swedish Medical Birth Register, focusing on pregnancies among women aged 18 years and older between 2014 and 2017. The final analytical sample comprised 218,783 women. BMI was measured during the first antenatal care visit. Five dimensions of social identity-age, education, income, place of birth, and cohabitation status-were used to construct 108 intersectional social strata. Intersectional MAIHDA analysis was conducted using multilevel linear regression models. Results Predicted BMI for each social stratum ranged from 19 kg/m² to 22.5 kg/m². Being over 35 years old and having lower educational levels were associated with higher BMI. However, women born outside Sweden had lower BMI than those born in Sweden. 4.5% of the variation in BMI was attributed to differences across social strata. Education accounted for 52% of the between-stratum variance, age for 15.1% and place of birth for 6.4%. The fully adjusted model reduced between-stratum variance by 81.5%. Thus 0.8% of the variance was attributable to intersectional interaction effects. Conclusions This study highlights the value of considering multiple intersecting social identities for a more nuanced understanding of BMI inequalities. However, considering the low degree of clustering, our findings suggest an emphasis on universal rather than targeted interventions to effectively reduce overweight and obesity among pregnant women. Key messages • An intersectional approach provides a detailed mapping of socioeconomic and demographic inequalities in BMI among pregnant women. • Universal interventions that account for intersecting social identities may be effective to reduce overweight and obesity among pregnant women.