Super‐obesity and risk for early and late pre‐eclampsia

Mbah, AK; Kornosky, JL; Kristensen, Sibylle; August, Euna M.; Alio, AP; Pj, Marty; Belogolovkin, Victoria; Bruder, Karen; Hm, Salihu

doi:10.1111/j.1471-0528.2010.02593.x

Cited by 118 publications

(128 citation statements)

References 34 publications

(39 reference statements)

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“…In the United Kingdom, for example, nulliparous, morbidly obese women with a BMI Ͼ 40 determined at 10 wk of gestation were found to have a 30% chance of developing PE (13). This strong positive correlation between obesity and the prevalence of PE has also been observed in Americans (110), New Zealanders (103), and Canadians (43).…”

Section: Epidemiological Evidence Supporting That Obesity Increases Tmentioning

confidence: 70%

“…Furthermore, another study reported that prepregnancy obesity confers a three-to fourfold elevated risk for PE in triple gestations (152). The significance of BMI status as a predictor for PE is emphasized by an almost linear-response effect of BMI on the incidence of PE: incidence has been shown to be 7% in those gravidas with class I obesity (BMI ϭ 30 -34.9), 9% with class II (BMI ϭ 35-39.9), 11% with class III obesity (BMI ϭ 40 -49.9), 13% in super-obese women (BMI ϭ 50), whereas normal weight gravidas (BMI ϭ 18.5-24.9) had a 3% chance of developing PE (110) (Fig. 1).…”

Section: Epidemiological Evidence Supporting That Obesity Increases Tmentioning

confidence: 99%

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Increased risk for the development of preeclampsia in obese pregnancies: weighing in on the mechanisms

Spradley

Palei

Granger

2015

American Journal of Physiology-Regulatory, Integrative and Comp

108

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) is a pregnancy-specific disorder typically presenting as new-onset hypertension and proteinuria. While numerous epidemiological studies have demonstrated that obesity increases the risk of PE, the mechanisms have yet to be fully elucidated. Growing evidence from animal and human studies implicate placental ischemia in the etiology of this maternal syndrome. It is thought that placental ischemia is brought about by dysfunctional cytotrophoblast migration and invasion into the uterus and subsequent lack of spiral arteriole widening and placental perfusion. Placental ischemia/ hypoxia stimulates the release of soluble placental factors into the maternal circulation where they cause endothelial dysfunction, particularly in the kidney, to elicit the clinical manifestations of PE. The most recognized of these factors are the anti-angiogenic sFlt-1 and pro-inflammatory TNF-␣ and AT1-AA, which promote endothelial dysfunction by reducing levels of the provasodilator nitric oxide and stimulating production of the potent vasoconstrictor endothelin-1 and reactive oxygen species. We hypothesize that obesity-related metabolic factors increase the risk for developing PE by impacting various stages in the pathogenesis of PE, namely, 1) cytotrophoblast migration and placental ischemia; 2) release of soluble placental factors into the maternal circulation; and 3) maternal endothelial and vascular dysfunction. This review will summarize the current experimental evidence supporting the concept that obesity and metabolic factors like lipids, insulin, glucose, and leptin affect placental function and increase the risk for developing hypertension in pregnancy by reducing placental perfusion; enhancing placental release of soluble factors; and by increasing the sensitivity of the maternal vasculature to placental ischemia-induced soluble factors. body mass index; inflammation; placental ischemia; pregnancy; RUPP; sFlt-1 PE IS A PREGNANCY-SPECIFIC DISORDER typically identified by new-onset hypertension in the second half of pregnancy. Although often accompanied by new-onset proteinuria, PE can be associated with many other signs and symptoms including headaches, visual disturbances, epigastric pain, and the development of edema (4,192). Globally, this disease affects over 8 million pregnancies per year and is estimated to account for 40 -60% of maternal deaths in developing countries (125). In the United States, there was a 25% increase in the rate of PE between the years 1987-2004 (189). This significant increase highlights the importance of understanding how risk factors like obesity play a role in the pathogenesis of this maternal syndrome. Obesity is defined as a body mass index (BMI) of greater than or equal to 30 kg/m 2 . Greater than one-half of pregnant women are overweight or obese (48), and more than two-thirds of reproductive-aged women in the United States are overweight or obese (49). Although mounting epidemiological evidence supports obesity as a major risk factor for PE, the mechanisms linking these two morbidities are...

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Section: Epidemiological Evidence Supporting That Obesity Increases Tmentioning

confidence: 70%

Section: Epidemiological Evidence Supporting That Obesity Increases Tmentioning

confidence: 99%

Increased risk for the development of preeclampsia in obese pregnancies: weighing in on the mechanisms

Spradley

Palei

Granger

2015

American Journal of Physiology-Regulatory, Integrative and Comp

108

View full text Add to dashboard Cite

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“…Our results support a dose-response relationship between worsening obesity and cesarean delivery, macrosomia, neonatal hypoglycemia, and preeclampsia. This study provides information regarding the increased risk of perinatal complications with increasing BMI within obesity classes that include superobese women and builds on the few published studies on superobesity in pregnancy that primarily examined single outcomes and limited comparisons to normal weight women 5,6 or combined obesity classes. 7 Superobese women are at significantly increased risk of delivery by cesarean delivery, compared with morbidly obese and obese women.…”

Section: Commentmentioning

confidence: 99%

“…4 Although several studies compare obese women to normal-weight women, to date there have been limited studies on superobesity in pregnancy. [5][6][7] As the number of superobese pregnant women continues to rise, it is important to determine whether there is a "dose-response" relationship between the severity of maternal obesity and perinatal complications.The objective of this study was to determine the effect of maternal superobesity on perinatal outcomes compared with maternal obesity (BMI, 30-39.9 kg/m 2 ) and morbid obesity (BMI,(40)(41)(42)(43)(44)(45)(46)(47)(48)(49).9 kg/m 2 ). We hypothesized that pregnancy in super-obese women, compared with obese and morbidly obese women, is associated with (1) increased risk of maternal complications of pregnancy, (2) greater risk of fetal growth abnormalities, and (3) greater risk of infant complications.…”

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confidence: 99%

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597: Maternal super-obesity and perinatal outcomes

Marshall

Guild

Cheng

et al. 2011

American Journal of Obstetrics and Gynecology

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OBJECTIVE-The purpose of this study was to determine the effect of maternal superobesity (body mass index [BMI], ≥50 kg/m 2 ) compared with morbid obesity (BMI,(40)(41)(42)(43)(44)(45)(46)(47)(48)(49).9 kg/m 2 ) or obesity (BMI, kg/m 2 ) on perinatal outcomes.STUDY DESIGN-We conducted a retrospective cohort study of birth records that were linked to hospital discharge data for all liveborn singleton term infants who were born to obese Missouri residents from 2000-2006. We excluded major congenital anomalies and women with diabetes mellitus or chronic hypertension.RESULTS-There were 64,272 births that met the study criteria, which included 1185 superobese mothers (1.8%). Superobese women were significantly more likely than obese women to have preeclampsia (adjusted relative risk [aRR], 1.7; 95% confidence interval [CI], 1.4 -2.1), macrosomia (aRR, 1.8; 95% CI, 1.3-2.5), and cesarean delivery (aRR, 1.8; 95% CI, 1.5-2.1). Almost one-half of all superobese women (49.1%) delivered by cesarean section, and 33.8% of superobese nulliparous women underwent scheduled primary cesarean delivery.CONCLUSION-Women with a BMI of ≥50 kg/m 2 are at significantly increased risk for perinatal complications compared with obese women with a lower BMI. Keywords pregnancy outcome; superobesityThe obesity epidemic remains unabated in the United States. In 2007-2008 of American women who were 20-39 years old met obesity criteria (body mass index [BMI] ≥30 kg/m 2 ) 1 ; obesity is now an increasingly common and harmful pregnancy complication. Superobesity, as coined in the gastric bypass literature to describe patients who weigh ≥225% of ideal body weight, 2 represents individuals with a BMI of ≥50 kg/m 2 . The number of superobese individuals is growing 5 times faster than other obesity categories, 3 which means that healthcare providers increasingly will be challenged to accommodate their healthcare needs. Presented as a poster at the 31st annual meeting of the Society for Maternal-Fetal Medicine, San Francisco, CA, Feb. 7-12, 2011. NIH Public Access Obese women are more likely than normal weight women to experience preeclampsia, diabetes mellitus, cesarean delivery, fetal growth abnormalities, and stillbirth. 4 Although several studies compare obese women to normal-weight women, to date there have been limited studies on superobesity in pregnancy. [5][6][7] As the number of superobese pregnant women continues to rise, it is important to determine whether there is a "dose-response" relationship between the severity of maternal obesity and perinatal complications.The objective of this study was to determine the effect of maternal superobesity on perinatal outcomes compared with maternal obesity (BMI, 30-39.9 kg/m 2 ) and morbid obesity (BMI,(40)(41)(42)(43)(44)(45)(46)(47)(48)(49).9 kg/m 2 ). We hypothesized that pregnancy in super-obese women, compared with obese and morbidly obese women, is associated with (1) increased risk of maternal complications of pregnancy, (2) greater risk of fetal growth abnormalities, and (3) grea...

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