Pre-Pregnancy Obesity, Excessive Gestational Weight Gain, and the Risk of Pregnancy-Induced Hypertension and Gestational Diabetes Mellitus
Open accessAbstract
Excessive pre-pregnancy weight is a known risk factor of pregnancy complications. The purpose of this analysis was to assess the relationship between several categories of maternal weight and the risk of developing hypertension and diabetes in pregnancy, and the relationship of these complications with the results of the newborn. It was carried out in a common cohort of pregnant women and taking into account the influence of disturbing factors. Our analysis was conducted in a prospective cohort of 912 Polish pregnant women, recruited during 2015–2016. We evaluated the women who subsequently developed diabetes with dietary modification (GDM-1) (n = 125) and with insulin therapy (GDM-2) (n = 21), as well as the women who developed gestational hypertension (GH) (n = 113) and preeclampsia (PE) (n = 24), compared to the healthy controls. Odds ratios of the complications (and confidence intervals (95%)) were calculated in the multivariate logistic regression. In the cohort, 10.8% of the women had pre-pregnancy obesity (body mass index (BMI) ≥ 30 kg/m2), and 36.8% had gestational weight gain (GWG) above the range of the Institute of Medicine recommendation. After correction for excessive GWG and other confounders, pre-pregnancy obesity (vs. normal BMI) was associated with a higher odds ratio of GH (AOR = 4.94; p < 0.001), PE (AOR = 8.61; p < 0.001), GDM-1 (AOR = 2.99; p < 0.001), and GDM-2 (AOR = 11.88; p <0.001). The threshold risk of development of GDM-2 occurred at lower BMI values (26.9 kg/m2), compared to GDM-1 (29.1 kg/m2). The threshold point for GH was 24.3 kg/m2, and for PE 23.1 kg/m2. For GWG above the range (vs. GWG in the range), the adjusted odds ratios of GH, PE, GDM-1, and GDM-2 were AOR = 1.71 (p = 0.045), AOR = 1.14 (p = 0.803), AOR = 0.74 (p = 0.245), and AOR = 0.76 (p = 0.672), respectively. The effect of maternal edema on all the results was negligible. In our cohort, hypertension and diabetes were associated with incorrect birth weight and gestational age at delivery. Conclusions: This study highlights the importance and influence of excessive pre-pregnancy maternal weight on the risk of pregnancy complications such as diabetes and hypertension which can impact fetal outcomes.
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Excessive gestational weight gain is a risk factor for gestational hypertension across all maternal BMI categories.
“Excessive GWG is also a risk factor for GHT across all maternal BMI categories. 61”
From Overweight, obesity and excessive weight gain in pregnancy as risk factors for adverse pregnancy outcomes: A narrative review (2022) · cites this paper as [61]
The Results report higher gestational-hypertension risk with excessive gestational weight gain, and the Discussion describes higher odds after adjustment for pre-pregnancy BMI. The Methods and Results do not establish that this association holds separately across all maternal BMI categories; the reported gestational-weight-gain subgroup analysis was limited to women with normal BMI. (LLM, conf=0.85)
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- Authors
- Lewandowska, M., Więckowska, B., & Sajdak, S.
- Affiliations
- Poznan University of Medical Sciences (PL)
- Corresponding author
- Lewandowska, Małgorzata
- Venue
- Journal of Clinical Medicine
- Publisher
- MDPI AG
- Published
- 2020-06-24
- Volume
- 9
- Issue
- 6
- Pages
- 1980
- ISSN
- 2077-0383 (ISSN-L)
- PMC
- PMC7355601
- OpenAlex
- W3037987870
- Cited by
- 153
- References
- 36
- Citations by year
- 2026: 19 · 2025: 26 · 2024: 32 · 2023: 28 · 2022: 23 · 2021: 16 · 2020: 9
- FWCI
- 11.62
- Type
- journal article
- Language
- en
- Open access
- gold
- dx.doi.org
- Licence
- Locations
- Journal of Clinical Medicine (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Topics
- Health Sciences › Medicine › Obstetrics and Gynecology › Gestational Diabetes Research and Management
- Health Sciences › Medicine › Obstetrics and Gynecology › Pregnancy and preeclampsia studies
- Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Birth, Development, and Health
- Keywords
- pre-pregnancy obesity, gestational weight gain, gestational hypertension, preeclampsia, gestational diabetes mellitus, maternal body mass index, insulin therapy, dietary change, neonatal outcomes, birth weight, preterm birth, low birth weight, IOM weight gain guidelines
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