Pre-pregnancy BMI, gestational weight gain and risk of preeclampsia: a birth cohort study in Lanzhou, China

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Abstract

Background

To evaluate the independent and joint effects of maternal pre-pregnancy BMI and gestational weight gain (GWG) on the risk of preeclampsia and its subtypes.

Methods

A birth cohort study was conducted from 2010 to 2012 in Lanzhou, China. Three hundred fourty seven pregnant women with preeclampsia and 9516 normotensive women at Gansu Provincial Maternity and Child Care Hospital were included in the present study. Unconditional logistic regression models were used to evaluate the associations between pre-pregnancy BMI, GWG, and risk of preeclampsia and its subtypes.

Results

Compared to women with normal pre-pregnancy BMI, those who were overweight/obese had an increased risk of preeclampsia (OR = 1.81; 95%CI: 1.37–2.39). Women with excessive GWG had an increased risk of preeclampsia (OR = 2.28; 95%CI: 1.70–3.05) compared to women with adequate GWG. The observed increased risk was similar for mild-, severe- and late-onset preeclampsia. No association was found for early-onset preeclampsia. Overweight/obese women with excessive GWG had the highest risk of developing preeclampsia compared to normal weight women with no excessive weight gain (OR = 3.78; 95%CI: 2.65–5.41).

Conclusions

Our results suggested that pre-pregnancy BMI and GWG are independent risk factors for preeclampsia and that the risk might vary by preeclampsia subtypes. Our study also proposed a potential synergistic effect of pre-pregnancy BMI and GWG that warrants further investigation.

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Most cited references 55

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Epidemiology of pre-eclampsia and the other hypertensive disorders of pregnancy.

Jennifer A Hutcheon, Sarka Lisonkova, K.S. Joseph (2011)

Hypertensive disorders of pregnancy include chronic hypertension, gestational hypertension, pre-eclampsia and chronic hypertension with superimposed pre-eclampsia. Pre-eclampsia complicates about 3% of pregnancies, and all hypertensive disorders affect about five to 10% of pregnancies. Secular increases in chronic hypertension, gestational hypertension and pre-eclampsia have occurred as a result of changes in maternal characteristics (such as maternal age and pre-pregnancy weight), whereas declines in eclampsia have followed widespread antenatal care and use of prophylactic treatments (such as magnesium sulphate). Determinants of pre-eclampsia rates include a bewildering array of risk and protective factors, including familial factors, sperm exposure, maternal smoking, pre-existing medical conditions (such as hypertension, diabetes mellitus and anti-phospholipid syndrome), and miscellaneous ones such as plurality, older maternal age and obesity. Hypertensive disorders are associated with higher rates of maternal, fetal and infant mortality, and severe morbidity, especially in cases of severe pre-eclampsia, eclampsia and haemolysis, elevated liver enzymes and low platelets syndrome. Copyright © 2011 Elsevier Ltd. All rights reserved.

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Maternal body mass index and the risk of preeclampsia: a systematic overview.

Tara E O'Brien, Joel G. Ray, Wee-Shian Chan (2003)

Maternal obesity, both in itself and as part of the insulin resistance syndrome, is an important risk factor for the development of preeclampsia. Accurately quantifying the relation between prepregnancy maternal body mass index and the risk of preeclampsia may better identify those at highest risk. We performed a systematic overview of the literature to determine the association between prepregnancy body mass index and the risk of preeclampsia. Two reviewers independently retrieved all relevant English language cohort studies through a systematic search of Medline and Embase between 1980 and June 2002. Study data were abstracted in a similar fashion. For each study, the risk ratio of preeclampsia was calculated by comparing the risk of preeclampsia among women with the highest body mass index with those with the lowest. We identified thirteen cohort studies, comprising nearly 1.4 million women. The risk of preeclampsia typically doubled with each 5-7 kg/m2 increase in prepregnancy body mass index. This relation persisted in studies that excluded women with chronic hypertension, diabetes mellitus or multiple gestations, or after adjustment for other confounders. Most observational studies demonstrate a consistently strong positive association between maternal prepregnancy body mass index and the risk of preeclampsia. Increasing obesity in developed countries is likely to increase the occurrence of preeclampsia. Consideration should be given to the potential benefits of prepregnancy weight reduction programs.

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Pregnancy complications and outcomes among overweight and obese nulliparous women.

M Lambe, J Baeten, E Bukusi (2001)

This study examined the associations between prepregnancy weight and the risk of pregnancy complications and adverse outcomes among nulliparous women. We conducted a population-based cohort study with 96,801 Washington State birth certificates from 1992 to 1996. Women were categorized by body mass index. Multivariate logistic regression was performed. The rate of occurrence of most of the outcomes increased with increasing body mass index category. Compared with lean women, both overweight and obese women had a significantly increased risk for gestational diabetes, preeclampsia, eclampsia, cesarean delivery, and delivery of a macrosomic infant. Among nulliparous women, not only prepregnancy obesity but also overweight increases the risk of pregnancy complications and adverse pregnancy outcomes.

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Author and article information

Contributors

Yawen Shao: 316291706@qq.com

Jie Qiu: 1239243754@qq.com

Huang Huang: h.huang@yale.edu

Baohong Mao: 93689076@qq.com

Wei Dai: 283362560@qq.com

Xiaochun He: 155224178@qq.com

Hongmei Cui: 359678469@qq.com

Xiaojuan Lin: 420256299@qq.com

Ling Lv: gsfy0923@163.com

Dennis Wang: dennis.wang@yale.edu

Zhongfeng Tang: 1103155784@qq.com

Sijuan Xu: 603926550@qq.com

Nan Zhao: nan.zhao@yale.edu

Min Zhou: 1664714099@qq.com

Xiaoying Xu: 794983177@qq.com

Weitao Qiu: 30231598@qq.com

Qing Liu: 86-13893624908 , 2305470816@qq.com

Yawei Zhang: 203-785-6210 , yawei.zhang@yale.edu

Journal

Journal ID (nlm-ta): BMC Pregnancy Childbirth

Journal ID (iso-abbrev): BMC Pregnancy Childbirth

Title: BMC Pregnancy and Childbirth

Publisher: BioMed Central (London )

ISSN (Electronic): 1471-2393

Publication date (Electronic): 1 December 2017

Publication date PMC-release: 1 December 2017

Publication date Collection: 2017

Volume: 17

Electronic Location Identifier: 400

Affiliations

[1 ]Gansu Provincial Maternity and Child Care Hospital, 143 North Road, Qilihe District, Lanzhou, Gansu Province 730050 China

[2 ]ISNI 0000000419368710, GRID grid.47100.32, Yale University School of Public Health, ; 60 College Street, New Haven, CT 06520 USA

[3 ]ISNI 0000000419368710, GRID grid.47100.32, Yale School of Medicine, ; New Haven, CT USA

Article

Publisher ID: 1567

DOI: 10.1186/s12884-017-1567-2

PMC ID: 5709979

PubMed ID: 29191156

SO-VID: c36af8db-51e6-4e05-9ef0-772677a64a7d

License:

Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

History

Date received : 21 November 2016

Date accepted : 6 November 2017

Funding

Funded by: Gansu Provincial Maternity and Child Care Hospital, Gansu Provincial Science and Technology Department

Award ID: 1204WCGA021

Award Recipient : Qing Liu

Funded by: FundRef http://dx.doi.org/10.13039/100000002, National Institutes of Health;

Award ID: K02HD70324, R01ES016317, and R01ES019587

Award Recipient : Yawei Zhang

Custom metadata

ScienceOpen disciplines: Obstetrics & Gynecology

Keywords: pre-pregnancy bmi,gestational weight gain,preeclampsia,china,birth cohort

Data availability:

ScienceOpen disciplines: Obstetrics & Gynecology

Keywords: pre-pregnancy bmi, gestational weight gain, preeclampsia, china, birth cohort

Pre-pregnancy BMI, gestational weight gain and risk of preeclampsia: a birth cohort study in Lanzhou, China

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Abstract

Background

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Conclusions

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Chinese Journal of General Practice

Most cited references 55

Epidemiology of pre-eclampsia and the other hypertensive disorders of pregnancy.

Maternal body mass index and the risk of preeclampsia: a systematic overview.

Pregnancy complications and outcomes among overweight and obese nulliparous women.

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