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Licensed Unlicensed Requires Authentication Published by De Gruyter May 31, 2019

Total gestational weight gain and the risk of preeclampsia by pre-pregnancy body mass index categories: a population-based cohort study from 2013 to 2017

Tanja Premru-Srsen ORCID logo EMAIL logo , Zorana Kocic , Vesna Fabjan Vodusek , Ksenija Geršak and Ivan Verdenik



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.

Corresponding author: Tanja Premru-Srsen, MD, PhD, Department of Perinatology, Division of Obstetrics and Gynecology, University Medical Centre, Šlajmerjeva 3, 1000 Ljubljana, Slovenia; and Medical Faculty, University of Ljubljana, Vrazov trg 2, 1000 Ljubljana, Slovenia, Tel.: +386 1 522 60 24, Fax: +386 1 439 75 90, GSM: +386 41 521 331

  1. Author contributions: All the authors have accepted responsibility for the entire content of this submitted manuscript and approved submission.

  2. 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.

  3. Employment or leadership: None declared.

  4. Honorarium: None declared.

  5. Disclosure of interest: The authors report no conflict of interest.

  6. 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.


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Supplementary Material

The online version of this article offers supplementary material (

Received: 2019-01-07
Accepted: 2019-04-22
Published Online: 2019-05-31
Published in Print: 2019-08-27

©2019 Walter de Gruyter GmbH, Berlin/Boston

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