Pre-Pregnancy BMI, Gestational Weight Gain, and the Risk of Hypertensive Disorders of Pregnancy: A Cohort Study in Wuhan, China

Abstract

BackgroundHypertensive disorders of pregnancy (HDP) are major causes of maternal death worldwide and the risk factors are not fully understood. Few studies have investigated the risk factors for HDP among Chinese women. A cohort study involving 84,656 women was conducted to investigate pre-pregnancy BMI, total gestational weight gain (GWG), and GWG during early pregnancy as risk factors for HDP among Chinese women.MethodsThe study was conducted between 2011–2013 in Wuhan, China, utilizing data from the Maternal and Children Healthcare Information Tracking System of Wuhan. A total of 84,656 women with a live singleton pregnancy were included. Multiple unconditional logistic regression was conducted to evaluate associations between putative risk factors and HDP.ResultsWomen who were overweight or obese before pregnancy had an elevated risk of developing HDP (overweight: OR = 2.66, 95% CI = 2.32–3.05; obese: OR = 5.53, 95% CI = 4.28–7.13) compared to their normal weight counterparts. Women with total GWG above the Institute of Medicine (IOM) recommendation had an adjusted OR of 1.72 (95% CI = 1.54–1.93) for HDP compared to women who had GWG within the IOM recommendation. Women with gestational BMI gain >10 kg/m2 during pregnancy had an adjusted OR of 3.35 (95% CI = 2.89–3.89) for HDP, compared to women with a gestational BMI gain <5 kg/m2. The increased risk of HDP was also observed among women with higher early pregnancy (up to 18 weeks of pregnancy) GWG (>600g/wk: adjusted OR = 1.48, 95% CI = 1.19–1.84).ConclusionThe results from this study show that maternal pre-pregnancy BMI, early GWG, and total GWG are positively associated with the risk of HDP. Weight control efforts before and during pregnancy may help to reduce the risk of HDP.

Association between vomiting in the first trimester and preterm birth: a retrospective birth cohort study in Wuhan, China

“…The WMCHMIS was introduced in our previous study. 21 Enrolled women included every pregnant woman who had a live, singleton newborn from 1 January 2010 to 23 May 2016. The study has been approved by the Wuhan Children’s Hospital (Wuhan Maternal and Child Healthcare Hospital).…”

Care of Women with Obesity in Pregnancy

“…Maternal size can make the assessment of fetal size, presentation and external monitoring of fetal heart tracing more challenging during pregnancy. Initiation and maintenance of breastfeeding are also more difficult in the women with obesity . High prepregnancy BMI is associated with a small but statistically significant increase in severe maternal morbidity or mortality, with the adjusted rate difference per 10 000 women compared with normal BMI being 24.9 (95% CI 15.7–34.6) for women with class I obesity, 35.8 (95% CI 23.1–49.5) for women with class II obesity and 61.1 (95% CI 44.8–78.9) for women with class III obesity .…”

“…Initiation and maintenance of breastfeeding are also more difficult in the women with obesity. 1,[5][6][7][8][9][10][11][12][13][14][15][16][17] High prepregnancy BMI is associated with a small but statistically significant increase in severe maternal morbidity or mortality, with the adjusted rate difference per 10 000 women compared with normal BMI being 24.9 (95% CI 15.7-34.6) for women with class I obesity, 35.8 (95% CI 23.1-49.5) for women with class II obesity and 61.1 (95% CI 44.8-78.9) for women with class III obesity. 18 These US data are supported by the 2015 MBRRACE-UK (Mothers and Babies: Reducing Risk through Audits and Confidential Enquiries across the UK) review into maternal deaths, which reported that 30% of women who died were obese and 22% were overweight.…”

Night work and hypertensive disorders of pregnancy: a national register-based cohort study

“…It is suggested that the incidence of HDP has increased over time probably due to advanced maternal age and increased occurrence of obesity and diabetes in mothers (13,14). The pathophysiology of HDP is not fully elucidated but seems to involve maternal, fetal and placental factors (14)(15)(16)(17)(18)(19).…”