Optimal gestational weight gain to reduce the risk of hypertension disorders of pregnancy among women with obesity: A single tertiary referral center study in Japan

Abstract

Aim: To examine the effect of weight gain during pregnancy on hypertension disorders of pregnancy among women with a prepregnancy body mass index ≥30.0 kg/m 2 . Methods: This retrospective cohort study included 257 Japanese women (116 primipara; 141 multipara) with singleton pregnancies with a prepregnancy body mass index ≥ 30.0 kg/m 2 , who gave birth during 2013 to 2020 at Ohta Nishinouchi Hospital. Multiple logistic regression analyses were performed to identify the effect of gestational weight gain on early-onset (<34 weeks), late-onset (≥34 weeks), and overall hypertension disorders of pregnancy. Results: The prevalence of hypertension disorders of pregnancy in primiparas and multiparas was 28.4% and 11.3%, respectively. By multiple logistic regression analysis, gestational weight gain during pregnancy increased the risk of early-onset (adjusted odds ratio: 1.20, 95% confidence interval: 1.03-1.39, p < 0.05) and overall hypertension disorders of pregnancy (adjusted odds ratio: 1.12, 95% confidence interval: 1.03-1.22, p < 0.05) among primiparas. Based on receiver operating characteristic curve analyses for early-onset (area under the curve 0.67, 95% confidence interval: 0.56-0.78; p < 0.05) and overall hypertension disorders of pregnancy (area under the curve 0.76, 95% confidence interval: 0.61-0.91; p < 0.05) among primiparas, we determined the cut-off weight gain during pregnancy for early-onset and overall hypertension disorders of pregnancy as 3.85 kg, with sensitivity/specificity of 0.76/0.59 and 0.91/0.53, respectively. Conclusion: We recommend that the optimal gestational weight gain for reducing HDP be under 3.85 kg. This information may facilitate personalized pre-conception counseling among women with obesity.

Predicting postpartum hemorrhage in women undergoing planned cesarean section: a multicenter retrospective cohort study in Japan

“…The prevention of PPH by minimizing its risk factors is a major clinical challenge. There has been increasing interest in the in uence of preconception care on obstetric outcomes, including lifestyle modi cations such as improving nutrition and smoking cessation [23,30,31]. Modi able factors such as high maternal BMI and smoking status are signi cant risk factors for PPH.…”

“…Birth weight was measured by a midwife immediately after delivery. Patients were categorized into four groups based on infant birth weight, as follows: < 2500 g; 2500-2999 g; 3000-3499 g, and > 3500 g. In this study, hypertensive disorders of pregnancy (HDP) were de ned as chronic maternal or new-onset hypertension after 20 weeks of gestation [23]. Estimated blood loss was also de ned based on the contents of the suction jar in the operating room and the weight of surgical pads.…”

Association between Gestational Weight Gain and Risk of Hypertensive Disorders of Pregnancy among Women with Obesity: A Multicenter Retrospective Cohort Study in Japan

“…Likewise, in Japan, the growing prevalence of BMI ≥ 25 kg/m 2 among women of reproductive age is raising concerns, echoing the trend seen in Western nations [10]. Given that a high body mass index (BMI) and substantial weight gain during gestation are significantly associated with an increased risk of developing hypertensive disorders during pregnancy [6,11,12], the management of pre-pregnancy BMI and careful control of weight gain during the course of pregnancy have emerged as crucial public health concerns. Addressing these issues could potentially serve as effective strategies to mitigate the incidence of hypertensive disorders during pregnancy, thereby improving the overall health outcomes for both mother and child [11,12].…”

“…Despite the high prevalence of obesity among women in the Fukushima Prefecture, Japan-the location of our research facility, where we find that 12.7% of women commence their pregnancies with a BMI of ≥25 kg/m 2 [1]-the relationship between weight gain during pregnancy and the occurrence of hypertensive disorders of pregnancy among these obese women, especially those who already have a pre-pregnancy BMI of ≥25 kg/m 2 , remains inadequately elucidated in Japan and requires further exploration. Thus, we recommend, based on data from a single tertiary referral center, a maximum weight gain of 3.85 kg during pregnancy for primiparous women with a pre-pregnancy BMI of over 30 kg/m 2 as a potentially preventive measure against hypertensive disorders of pregnancy [11]. However, our prior study had certain limitations, such as not categorizing hypertensive disorders of pregnancy into gestational hypertension and pre-eclampsia and only including women with a BMI over 30 kg/m 2 due to the relatively small sample size.…”

“…In this study, we investigated the relationship between gestational weight gain and the incidence of hypertensive disorders of pregnancy, gestational hypertension, and preeclampsia among women with a pre-pregnancy BMI of 25 to <30 kg/m 2 and ≥30 kg/m 2 at multiple tertiary referral centers in Fukushima, Japan. Considering that the occurrence of hypertensive disorders of pregnancy is influenced by parity [11,13], our analysis focused on overweight and obese primiparous women.…”