Maternal obesity and severe pre-eclampsia among immigrant women: a mediation analysis

Abstract

We investigated the extent to which pre-pregnancy obesity mediates the association between maternal place of birth and severe pre-eclampsia in the precARe cohort of pregnant women in paris (n = 9,579). Adjusted path analysis logistic regression models were used to assess the role of pre-pregnancy obesity as a mediator in the association between maternal place of birth and the development of severe pre-eclampsia. We calculated 1. adjusted odds ratios and 95% confidence intervals for the total exposure-outcome association and for the direct and indirect/obesity-mediated components 2. the indirect/obesity-mediated effect. Ninety-five (0.99%) women developed severe pre-eclampsia, 47.6% were non-European immigrants, 16.3% were born in Sub-Saharan Africa, and 12.6% were obese (BMI > = 30 kg/m 2 ). Women experiencing severe pre-eclampsia were more likely to be from Sub-Saharan Africa (p = 0.023) and be obese (p = 0.048). Mothers from Sub-Saharan Africa had an increased risk of severe pre-eclampsia compared to European-born mothers (aOR 2.53, 95% CI 1.39-4.58) and the obesity-mediated indirect effect was 18% of the total risk (aOR 1.18, 95%CI 1.03-1.35). In conclusion, Sub-Saharan African immigrant women have a two-fold higher risk of developing severe pre-eclampsia as compared to European-born women, one-fifth of which is mediated by pre-pregnancy obesity. Our results quantify the potential benefit of decreasing obesity among at-risk women.Pre-eclampsia, a disorder of pregnancy characterized by hypertension and proteinuria, affects 3-5% of pregnancies globally 1-3 and is one of the leading causes of maternal and neonatal mortality and morbidity in developed countries 2,4-7 . Severe pre-eclampsia is characterized by higher blood pressures and more profound organ dysfunction than mild pre-eclampsia 8 and constitutes the largest attributable fraction of severe morbidity due to hypertensive disorders in pregnancy 5 . Overall, the prevalence of pre-eclampsia has been declining in some European countries and Australia but continues to rise in the United States 5,9,10 . The increase in pre-eclampsia in the United States is driven specifically by higher rates of severe disease: while mild pre-eclampsia declined between 1980 and 2010, from 3.1% to 2.5%, severe pre-eclampsia increased from 0.3% to 1.4% 11 .There are known social and medical factors associated with a differential risk of developing pre-eclampsia. Maternal origin has been linked to disparities in rates of pre-eclampsia in various settings. In Europe, immigrant our understanding of the complex relationships between maternal origin, obesity, and severe pre-eclampsia, they also highlight the need to better understand other drivers of severe maternal outcomes among immigrant women. Future investigations should focus on better elucidating the role of other modifiable mediators, such as those pertaining to quality of care and the health care system factors in an effort to improve Data availabilityDue to ethical restrictions, data will be made available on request to A. S...

Prevalence and risk factors associated with severe pre-eclampsia among postpartum women in Zanzibar: a cross-sectional study

“…If we were to follow women through the entire postpartum period, we would anticipate the number to rise further as pre-eclampsia can develop within the postpartum period as well. This approach was demonstrated in a study done by Zenebe et al [ 9 ] in Ethiopia whereby the prevalence of severe pre-eclampsia was found to be 51.9%. This study was conducted in Ethiopia using a prospective cross-sectional design and was conducted for 1 year from April 2009 to March 2010.…”

“…A total sample size of 400 participants was achieved using the formula for quantitative studies [ 26 ], assuming 51% proportion of severe pre-eclampsia from a previous study in Ethopia at a 5% margin of error and 95% confidence interval [ 8 , 9 ].…”

“…Furthermore, risk factors for pre-eclampsia have been widely reported in sub-Saharan Africa, example is a retrospective study conducted at Kilimanjaro Christian Medical Center on prevalence and risk factors of pre-eclapsia and eclampsia, the factors including maternal age (≥35) years, ≥12 years of schooling, unmarried, overweight, obesity, hypertension and anaemia [ 8 ]. Moreover, obesity was reported as a risk factor for severe pre-eclampsia among sub-Sahan Africa women immigrated to Europe [ 9 ]. More literature have reported age 40 years or older, a pregnancy interval of more than 10 years, family history of pre-eclampsia, BMI of 35 kg/m2 or more, gestational age at presentation and pre-existing vascular disease (NICE, 2019).…”

Clinical Effects of Integrated Traditional Chinese and Western Medicine in Treating Severe Preeclampsia and Its Influence on Maternal and Infant Outcomes after Cesarean Section under Combined Lumbar and Epidural Anesthesia

“…e experimental group was 21-33 years old, with an average of 27.2 ± 3.4 years old; gestational age ranged from 24 to 33 weeks, mean 29.6 ± 2.7 weeks; and body mass index (BMI) was 21.4∼28.9 g/m 2 , with an average of 25.3 ± 2.7 g/m 2 . e control group was 23-32 years old, with an average of 27.6 ± 3.6 years old; gestational age ranged from 25 to 33 weeks, with an average of 29.3 ± 2.8 weeks; and BMI was 21.7-29.4 g/m 2 , mean 25.8 ± 2.9 g/m 2 .…”

“…Compared with mild-to-moderate preeclampsia, SPE patients often have significantly higher blood pressure and can even have significant symptoms such as persistent headache or upper abdominal pain [1]. SPE is a particular type of pregnancy-induced hypertension, with early onset, rapid progression, many complications, and poor perinatal prognosis, which can cause serious harm to maternal and infant health and even endanger their lives [2]. Numerous studies have shown that SPE can increase the long-term risk of cardiovascular and cerebrovascular diseases, kidney diseases, and diabetes for the mother and fetus [3].…”