Identifying the risk factors for preeclampsia (PE) is essential for the implementation of preventive actions. In the present study, we aimed at exploring the association between total gestational weight gain (GWG) and PE.
We performed a population-based cohort survey of 98,820 women with singleton pregnancies who delivered in Slovenia from 2013 to 2017. Aggregated data were obtained from the National Perinatal Information System (NPIS). The main outcome measure was the incidence of PE. The main exposure variable was total GWG standardized for the gestational duration by calculating the z-scores. The associations between total GWG and PE stratified by pre-pregnancy body mass index (BMI) categories adjusted for a variety of covariates were determined using multivariable logistic regression. We calculated the crude odds ratio (OR) and adjusted odds ratio (aOR) with a 95% confidence interval using a two-way test.
Excessive GWG was associated with increased odds of PE in all pre-pregnancy BMI categories. The increase in the odds of PE by 445% was the highest in underweight women and by 122% was the lowest in obese women. Low GWG was associated with decreased odds of PE in all pre-pregnancy BMI categories except in normal-weight women with a GWG below −2 standard deviation (SD) and underweight women. The decrease in the odds of PE by 67% was the highest in obese women and by 41% was the lowest in normal-weight women.
Excessive GWG is a significant risk factor for PE, especially in underweight women, while low GWG is an important protective factor against PE, especially in obese women.
Author contributions: All the authors have accepted responsibility for the entire content of this submitted manuscript and approved submission.
Research funding: We received no financial support and used no services from commercial organizations. The authors entirely did the study within the Division of Obstetrics and Gynecology, University Medical Centre, Ljubljana.
Employment or leadership: None declared.
Honorarium: None declared.
Disclosure of interest: The authors report no conflict of interest.
Competing interests: The funding organization(s) played no role in the study design; in the collection, analysis, and interpretation of data; in the writing of the report; or in the decision to submit the report for publication.
1. Say L, Chou D, Gemmill A, Tunçalp Ö, Moller AB, Daniels J, et al. Global causes of maternal death: a WHO systematic analysis. Lancet Glob Heal 2014;2:323–33.10.1016/S2214-109X(14)70227-XSearch in Google Scholar
2. Blencowe H, Cousens S, Jassir FB, Say L, Chou D, Mathers C, et al. National, regional, and worldwide estimates of stillbirth rates in 2015, with trends from 2000: a systematic analysis. Lancet Glob Heal [Internet]. 2016;4:e98–108.10.1016/S2214-109X(15)00275-2Search in Google Scholar
3. Catalano PM, Shankar K. Obesity and pregnancy: mechanisms of short term and long term adverse consequences for mother and child. Br Med J 2017;356:j1.10.1136/bmj.j1Search in Google Scholar PubMed PubMed Central
4. WHO. Global Health Observatory Data. 2017. Available from: http://www.who.int/en/news-room/fact-sheets/detail/obesity-and-overweight, Cited 12 Nov 2018.Search in Google Scholar
6. Institute of Medicine and National Research Council. Weight Gain during Pregnancy: Reexamining the Guidelines. Washington, DC: The National Academies Press. 2009 Available from: https://doi.org/10.17226/12584 [cited 2018 Nov 12].10.17226/12584Search in Google Scholar PubMed
7. Mannan M, Doi SA, Mamun AA. Association between weight gain during pregnancy and postpartum weight retention and obesity: a bias-adjusted meta-analysis. Nutr Rev 2013;71: 343–52.10.1111/nure.12034Search in Google Scholar PubMed
8. Thangaratinam S, Rogozińska E, Jolly K, Glinkowski S, Roseboom T, Tomlinson JW, et al. Effects of interventions in pregnancy on maternal weight and obstetric outcomes: meta-analysis of randomised evidence. Br Med J 2012;344:1–15.10.1097/OGX.0b013e31826f78d9Search in Google Scholar
9. Ren M, Li H, Cai W, Niu X, Ji W, Zhang Z, et al. Excessive gestational weight gain in accordance with the IOM criteria and the risk of hypertensive disorders of pregnancy: a meta-analysis. BMC Pregnancy Childbirth 2018;18:281.10.1186/s12884-018-1922-ySearch in Google Scholar PubMed PubMed Central
10. Hutcheon JA, Bodnar M. Good practices for observational studies of maternal weight and weight gain in pregnancy. Paediatr Perinat Epidemiol 2018;32:152–60.10.1111/ppe.12439Search in Google Scholar PubMed PubMed Central
11. Johansson K, Hutcheon J, Stephansson O, Cnattingius S. Pregnancy weight gain by gestational age and BMI in Sweden: a population-based cohort study. Am J Clin Nutr 2016;103:1278–84.10.3945/ajcn.115.110197Search in Google Scholar PubMed
12. Leonard SA, Hutcheon JA, Bodnar LM, Petito LC, Abrams B. Gestational weight gain-for-gestational age Z-score charts applied across U.S. populations. Paediatr Perinat Epidemiol 2018;32:161–71.10.1111/ppe.12435Search in Google Scholar PubMed PubMed Central
13. Babnik J, Blejec T, Cetin-Lovšin I, Lovšin B, Lučovnik M, Kavšek G, et al. Perinatal information system (PIS): definitions and methodology guidelines for receiving data via e-transfer. 2013 Available from: http://www.nijz.si/sites/www.nijz.si/files/uploaded/mg_pis_mn_ver_1_5.pdf [cited 2018 Jul 27].Search in Google Scholar
14. Roberts JM, Druzin M, August PA, Gaiser RR, Bakris G, Granger JP, et al. ACOG guidelines: hypertension in pregnancy. Am Coll Obstet Gynecol 2012. 1–100p. Available from: https://www.acog.org/∼/media/Task Force and Work Group Reports/public/HypertensioninPregnancy.pdf [cited 2018 Jul 27].Search in Google Scholar
15. Howards PP, Schisterman EF, Poole C, Kaufman JS, Weinberg R. Practice of epidemiology “Toward a Clearer Definition of Confounding” Revisited with Directed Acyclic Graphs. Am J Epidemiol 2012;176:506–11.10.1093/aje/kws127Search in Google Scholar PubMed PubMed Central
16. Personal Data Protection Act. Off J Repub Slov 2007;94:12707.Search in Google Scholar
17. Macdonald-Wallis C, Tilling K, Fraser A, Nelson SM, Lawlor DA. Gestational weight gain as a risk factor for hypertensive disorders of pregnancy. Am J Obstet Gynecol 2013;209:327.e1–17.10.1016/j.ajog.2013.05.042Search in Google Scholar PubMed PubMed Central
18. Chasan-Taber L, Silveira M, Waring ME, Pekow P, Braun B, Manson JE, et al. Gestational weight gain, body mass index, and risk of hypertensive disorders of pregnancy in a predominantly Puerto Rican population. Matern Child Heal J 2016;20:1804–13.10.1007/s10995-016-1983-3Search in Google Scholar PubMed PubMed Central
19. Shao Y, Qiu J, Huang H, Mao B, Dai W, He X, et al. Pre-pregnancy BMI, gestational weight gain and risk of preeclampsia: a birth cohort study in Lanzhou, China. BMC Pregnancy Childbirth 2017;17:2–9.10.1186/s12884-017-1567-2Search in Google Scholar PubMed PubMed Central
20. Fortner RT, Pekow P, Solomon CG, Markenson G, Chasan-Taber L. Prepregnancy body mass index, gestational weight gain, and risk of hypertensive pregnancy among Latina women. Am J Obstet Gynecol 2018;200:167.e1–7.10.1016/j.ajog.2008.08.021Search in Google Scholar PubMed
21. Khanolkar AR, Hanley GE, Koupil I, Janssen PA. 2009 IOM guidelines for gestational weight gain: how well do they predict outcomes across ethnic groups? Ethn Heal 2017;1–16 [Epub ahead of print]. Available from: https://doi.org/10.1080/13557858.2017.1398312 [cited 2018 Jul 27].10.1080/13557858.2017.1398312Search in Google Scholar PubMed
22. Hutcheon JA, Stephansson O, Cnattingius S, Bodnar LM, Wikström A-K, Johansson K. Pregnancy weight gain before diagnosis and risk of preeclampsia novelty and significance. Hypertension 2018;72:433–41.10.1161/HYPERTENSIONAHA.118.10999Search in Google Scholar PubMed PubMed Central
23. Covassin N, Sert-Kuniyoshi FH, Singh P, Romero-Corral A, Davison DE, Lopez-Jimenez F, et al. Experimental weight gain increases ambulatory blood pressure in healthy subjects: implications of visceral fat accumulation. Mayo Clin Proc 2018;93:618–26.10.1016/j.mayocp.2017.12.012Search in Google Scholar PubMed PubMed Central
24. Romero-Corral A, Sert-Kuniyoshi F, Sierra-Johnson J, Orban M, Gami A, Davison D, et al. Modest visceral fat gain causes endothelial dysfunction in healthy humans. J Am Coll Cardiol 2010;56:662–6.10.1016/j.jacc.2010.03.063Search in Google Scholar PubMed PubMed Central
25. Truong YN, Yee LM, Caughey AB, Cheng YW. Weight gain in pregnancy: does the Institute of Medicine have it right? Am J Obstet Gynecol 2015;212:362.e1–8.10.1016/j.ajog.2015.01.027Search in Google Scholar PubMed
26. Cheikh Ismail L, Bishop DC, Pang R, Ohuma EO, Kac G, Abrams B, et al. Gestational weight gain standards based on women enrolled in the Fetal Growth Longitudinal Study of the INTERGROWTH-21st Project: a prospective longitudinal cohort study. BMJ 2016;352:i555.10.1136/bmj.i555Search in Google Scholar PubMed PubMed Central
27. Gardosi J, Francis A, Turner S, Williams M. Customized growth charts: rationale, validation and clinical benefits. Am J Obstet Gynecol 2018;218:S609–18.10.1016/j.ajog.2017.12.011Search in Google Scholar PubMed
28. Johnson J, Clifton RG, Roberts JM, Myatt L, Hauth JC, Spong CY, et al. Pregnancy outcomes with weight gain above or below the 2009 Institute of medicine guidelines. Obstet Gynecol 2013;121:969–75.10.1097/AOG.0b013e31828aea03Search in Google Scholar PubMed PubMed Central
The online version of this article offers supplementary material (https://doi.org/10.1515/jpm-2019-0008).
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