Due to the short-term and long-term implications of an unsuccessful induction in an obese primigravida, we recommend that induction of labor should only be undertaken for strict obstetric indications after careful consideration by an experienced clinician.
Background
Hypertension in pregnancy is an important cause of pregnancy complications for both mother and baby in about 8% of pregnancies. Epidemiological reviews have reported an association between pre-eclampsia and maternal obesity, based on a body mass index (BMI) > 29.9 kg/m2. However, BMI measurements were usually based on self-reporting of maternal weight and height which has been shown to be inaccurate, particularly in pregnancy and in obese women. The purpose of this prospective cross-sectional study was to compare the incidence of pre-eclampsia in the different WHO BMI categories in both primigravidas and multigravidas.
Methods
Women were recruited at their convenience in the first trimester. Height and weight were measured digitally and BMI calculated. Pre-eclampsia was defined as hypertension (a systolic blood pressure of ≥140 mm Hg and/or a diastolic blood pressure of ≥90 mm Hg) measured on at least two separate occasions at least 6 h apart with proteinuria (≥300 mg over 24 h) after 20 weeks.
Results
Of the 2230 women, the mean age was 28.2 years and mean parity was 1.0. The mean gestation at recruitment was 11.2 weeks and the mean BMI was 25.6 kg/m2. The incidence of obesity was 17.4%. The incidence of pre-eclampsia analysed by BMI category is show in table 1. In both primigravidas and multigravidas, there was no increase in pre-eclampsia with obesity (p=0.23, p=0.07).
Abstract PMM.82 Table 1Incidence of pre-eclampsia by Body Mass Index category.
Body Mass Index (kg/m2)
Primiparous
Multiparous
Total
Number with pre-eclampsia (Number in BMI category)
%
Number with pre-eclampsia (Number in BMI category)
%
Number with pre-eclampsia (Number in BMI category)
%
≤ 18.5
2 (36)
5.6
0 (14)
0
2 (50)
4.0
18.5– 24.9
27 (657)
4.1
5 (521)
1.0
32 (1178)
2.7
25.0– 29.9
13 (265)
4.9
12 (348)
3.5
25 (613)
4.1
30.0– 34.9
5 (106)
4.7
5 (125)
4
10 (231)
4.4
≥ 35.0
4 (59)
6.8
4 (100)
4
8 (159)
5.0
Total
51 (1123)
4.5
26 (1108)
2.3
77 (2231)
3.5
Conclusions
When maternal BMI is calculated accurately in early pregnancy, contrary to previous reports, there is no association between maternal obesity and pre-eclampsia.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.