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Preeclampsia Risk Increases With Prenatal Weight Gain in Study of Urban Women


 

VIENNA — Obesity and excess prenatal weight gain increase the risk of preeclampsia among women from a diverse urban population, Terry J. Rosenberg, Ph.D., reported.

The findings suggest that the focus should shift from the treatment of preeclampsia to its prevention, said Dr. Rosenberg, who is the deputy director of research and evaluation, Medical Health and Research Association of New York City Inc. The association is an independent, nonprofit organization that works with the New York City Department of Health and Mental Hygiene in studying medically underserved populations.

Since many low-income women do not have regular health care providers, “There's a window of opportunity during pregnancy for ob.gyns. to provide the kind of advice that these women aren't likely to get from another physician. … Providing encouragement for a healthy diet and exercise during the perinatal period will carry over to better health throughout the lifetime of these women,” she said during the 14th World Congress of the International Society for the Study of Hypertension in Pregnancy.

Among 330,216 singleton births during 1999-2001 from New York City's birth certificate database, 6% (20,702) of the mothers had a prepregnancy weight of more than 199 pounds. This weight was used as the definition of obesity, since height data were not included in the database.

Excess prenatal weight gain, which was defined as more than 40 pounds, was recorded for 18% (60,695) of the women in the study.

Preeclampsia, which was diagnosed by the physician, was recorded for 2% of the study population (7,011).

One-third of the mothers (33%) were Hispanic, 29% were white, 26% were black, and 12% were Asian.

One-third were foreign-born.

Obesity rates were highest among the black women (12.7%), followed by the Hispanic women (5.2%), and the whites (4.8%), with Asians far lower (0.8%), she said.

Excess weight gain was recorded for 21% of the Hispanic women, 20% of the black women, 17% of the whites, and 11% of the Asians.

Preeclampsia was diagnosed in 2.9% of the black women and 2.6% of the Hispanic women, at least double the rates among white (1.3%) and Asian (1.2%) women, Dr. Rosenberg reported during her presentation at the meeting.

After adjustment for significant predictors of preeclampsia—which included age older than 35, black or Hispanic ethnicity, low socioeconomic status, and chronic diabetes and/or hypertension—the risk for preeclampsia was 1.8 times greater for women who weighed 200-299 pounds, compared with those women weighing 100-149 pounds, the investigators found.

The risk was elevated 2.6-fold among women weighing at least 300 pounds.

Moreover, preeclampsia was 1.5 times as common among the women who gained more than 40 pounds during pregnancy, compared with those who gained less weight.

Those elevated risks did not differ significantly after 4,036 women with chronic diabetes and/or hypertension were removed from the analysis, Dr. Rosenberg noted.

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