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Cited by 53Pregnancy and preeclampsia studiesGestational Diabetes Research and ManagementNeurological Complications and Syndromes

Pre-Pregnancy Obesity vs. Other Risk Factors in Probability Models of Preeclampsia and Gestational Hypertension

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Lewandowska, Małgorzata, Więckowska, Barbara, Sajdak, Stefan, Lubiński, Jan·2020·Nutrients
DOI 10.3390/nu12092681PMC PMC7551880
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Abstract

In the face of the obesity epidemic around the world, attention should be focused on the role of maternal obesity in the development of pregnancy. The purpose of this analysis was to evaluate the prediction of preeclampsia (PE) and isolated gestational hypertension (GH) for a number of maternal factors, in order to investigate the importance of pre-pregnancy obesity (body mass index, BMI ≥ 30 kg/m2), compared to other risk factors (e.g., prior PE, pregnancy weight gain (GWG), infertility treatment, interpregnancy interval, family history, the lack of vitamin supplementation, urogenital infection, and socioeconomic factors). In total, 912 women without chronic diseases were examined in a Polish prospective cohort of women with a single pregnancy (recruited in 2015–2016). Separate analyses were performed for the women who developed GH (n = 113) vs. 775 women who remained normotensive, as well as for those who developed PE (n = 24) vs. 775 controls. The probability of each disease was assessed for the base prediction model (age + primiparity) and for the model extended by one (test) variable, using logistic regression. Three measures were used to assess the prediction: area under curve (AUC) of the base and extended model, integrated discrimination improvement (IDI) (the index shows the difference between the value of the mean change in the predicted probability between the group of sick and healthy women when a new factor is added to the model), and net reclassification improvement (NRI) (the index focuses on the reclassification table describing the number of women in whom an upward or downward shift in the disease probability value occurred after a new factor had been added, including results for healthy and sick women). In the GH prediction, AUC increased most strongly when we added BMI (kg/m2) as a continuous variable (AUC = 0.716, p < 0.001) to the base model. The highest IDI index was obtained for prior GH/PE (IDI = 0.068, p < 0.001). The addition of BMI as a continuous variable or BMI ≥ 25 kg/m2 improved the classification for healthy and sick women the most (NRI = 0.571, p < 0.001). In the PE prediction, AUC increased most strongly when we added BMI categories (AUC = 0.726, p < 0.001) to the base model. The highest IDI index was obtained for prior GH/PE (IDI = 0.050, p = 0.080). The addition of BMI categories improved the classification for healthy and sick women the most (NRI = 0.688; p = 0.001). After summing up the results of three indexes, the probability of hypertension in pregnancy was most strongly improved by BMI, including BMI ≥ 25 kg/m2 for the GH prediction, and BMI ≥ 30 kg/m2 for the PE prediction. Main conclusions: Pre-pregnancy BMI was the most likely factor to increase the probability of developing hypertension in pregnancy, compared to other risk factors. Hierarchies of PE and GH risk factors may suggest different (or common) mechanisms of their development.

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Authors
Lewandowska, M., Więckowska, B., Sajdak, S., & Lubiński, J.
Affiliations
  • Poznan University of Medical Sciences (PL)
  • International Hereditary Cancer Center (PL)
Corresponding author
Lewandowska, Małgorzata
ORCID
Venue
Nutrients
Publisher
MDPI AG
Published
2020-09-02
Volume
12
Issue
9
Pages
2681
ISSN
2072-6643 (ISSN-L)
DOI
10.3390/nu12092681
PMC
PMC7551880
OpenAlex
W3082725746
Cited by
49
References
52
Citations by year
2026: 4 · 2025: 7 · 2024: 13 · 2023: 8 · 2022: 9 · 2021: 6 · 2020: 2
FWCI
3.82
Type
journal article
Language
en
Open access
Licence
Locations
  • Nutrients (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 › Pregnancy and preeclampsia studies
  • Health Sciences › Medicine › Obstetrics and Gynecology › Gestational Diabetes Research and Management
  • Health Sciences › Medicine › Psychiatry and Mental health › Neurological Complications and Syndromes
Keywords
preeclampsia, gestational hypertension, pre-pregnancy obesity, body mass index, risk factors, prediction model, integrated discrimination improvement, net reclassification improvement, gestational weight gain, infertility treatment, interpregnancy interval, family history (medicine), vitamin supplementation, urogenital infections, socioeconomic factors, singleton pregnancy, primiparity
MeSH terms
Adolescent, Adult, Blood Pressure, Body Weight, Female, Humans, Obesity, Pre-Eclampsia, Pregnancy, Prospective Studies, Surveys and Questionnaires, Risk Factors, Socioeconomic Factors, Body Mass Index, Logistic Models, Hypertension, Pregnancy-Induced, Young Adult

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