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pregnancy body mass index (BMI) categories: non-obese (BMI < 30 kg/m2); class I (BMI 30e34.9 kg/m2), class II (BMI 35e39.9 kg/m2) and class III (BMI >40 kg/m2). SMM was defined by published algorithms as delivery associated with a life-threatening complication or performance of a lifesaving procedure. Multivariable logistic regression was used to evaluate the association between obesity classes, and non-Hispanic White, non-Hispanic Black, Hispanic and Asian racial/ethnic groups and SMM, adjusting for maternal sociodemographics and medical comorbidities. RESULTS: In total 560,705 women were included. Of these women: 468,419 (83.5%) were non-obese, 58,162 (10.3%) were Class I; 21,775 (3.9%) Class 2; and 12,349 (2.2%) were class III obese. Compared to non-obese women, women with Class III obesity had higher odds of SMM after adjusting for race/ ethnicity (aOR 1.23, 95%CI 1.11-1.35). Across all weight categories non-Hispanic Black, Hispanic and Asian women had a higher rate of SMM per 1000 than non-Hispanic White women. SMM was highest in normal weight non-Hispanic Black women (aOR 2.68 95%CI 2.50-2.87) and non-Hispanic Black women with Class III obesity (aOR 2.55 95%CI 1.69-3.75). The rate of SMM was highest for non-Hispanic Black women with Class III obesity at 46.5 per 1000 women. CONCLUSION: The risk of SMM increased with higher classes of obesity; however racial/ethnic disparities persist in SMM irrespective of obesity class. The factors driving these disparities are important to understand to address increasing SMM rates in the United States.

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The effect of pregnancy on hepatitis B (HBV) viral loads has not been studied. For the past 5 years, our health care organization has recommended testing for HBV DNA levels at early gestational age (GA) and at 24-32 weeks GA. We assessed changes in HBV viral load during pregnancy. STUDY DESIGN: A retrospective cohort study of pregnant women with HBV between 2014 and 2019 was performed from database extraction and chart review. Women with non-continuous coverage, concurrent anti-viral therapy, immunosuppressive treatment or unknown viral loads at either early (14 weeks) or late (24-32 weeks) GA were excluded. We compared the proportion of women with high HBV viral load (200,000 IU/mL) at early versus late GA using McNemar's test and evaluated the association between hepatitis B e-antigen (HBeAg) status (within 18 months prior to delivery) and high viral load at late GA using univariate logistic regression. RESULTS: 328 women met inclusion criteria, 88% maintained low viral load throughout pregnancy. 9% (30/328) had high viral load at early GA and 11% (36/328) at late GA (p¼0.11). 52 women had undetectable viral load (<20 IU/mL) throughout pregnancy. Ten women (3%) progressed from low viral load at early GA to high viral load. Among these 10 women, median HBV viral load at early gestation was 24,850 (IQR 1,701-42,764) IU/mL, none had undetectable viral load at early gestation, and only one woman was positive for HBeAg. Within our study cohort, the odds of having high viral load at late GA was significantly higher among women who were positive for HBeAg (unadjusted OR [95% CI]: 30.5 [13.1, 71.2], p<0.0001). CONCLUSION: Most women with HBV will maintain low viral load throughout pregnancy; however, a small percentage may progress to high viral load. Clinically, the optimal time to assess viral load is at 24-32 weeks in order to identify women who will benefit from treatment to prevent vertical transmission.