Effects of Maternal Pre-Pregnancy BMI and Gestational Weight Gain on the Development of Preeclampsia and Its Phenotypes: A Prospective Cohort Study in China

Maternal adiposity measures and hypertensive disorders of pregnancy: a meta-analysis

BACKGROUND

Hypertensive disorders of pregnancy (HDP) are a prevalent complication during pregnancy with significant implications for maternal and perinatal health globally. Maternal obesity is a known risk factor for HDP. This review sought to identify adiposity indicators in early pregnancy that are linked to the development of HDP.

METHODS

We conducted a systematic search of the PubMed, Science Citation Index (Web of Science), and Embase databases. Screening and quality evaluation of studies was conducted independently by two reviewers. Both random effects meta-analysis and narrative synthesis were performed.

RESULTS

Thirty-one studies were included with a pooled sample of 81,311 women. The meta-analysis showed that the odds of HDP were significantly increased by higher pregnancy measures of adiposity (pre-pregnancy body mass index (OR = 2.14, 95%CI: 1.67-2.75), visceral adipose tissue (OR = 1.79, 95%CI: 1.01-3.16), subcutaneous adiposity thickness (OR = 1.67, 95%CI: 1.36-2.05), waist circumference (OR = 2.20, 95%CI: 1.37-3.54), waist to-hip ratio (OR = 3.08, 95% CI: 1.38-6.87), weight gain (OR = 1.69, 95%CI: 1.42-2.02) and percentage body fat (OR = 1.71, 95%CI: 1.16-2.53)). Epicardial fat thickness was significantly associated with HDP, although limited data were available.

CONCLUSIONS

The results of our study highlight the importance of investigating the predictive value of adiposity measures in identifying the risk of HDP to tailor care towards women at the highest risk.

Causal pathways in preeclampsia: a Mendelian randomization study in European populations

Purpose

Our study utilizes Mendelian Randomization (MR) to explore the causal relationships between a range of risk factors and preeclampsia, a major contributor to maternal and perinatal morbidity and mortality.

Methods

Employing the Inverse Variance Weighting (IVW) approach, we conducted a comprehensive multi-exposure MR study analyzing genetic variants linked to 25 risk factors including metabolic disorders, circulating lipid levels, immune and inflammatory responses, lifestyle choices, and bone metabolism. We applied rigorous statistical techniques such as sensitivity analyses, Cochran's Q test, MR Egger regression, funnel plots, and leave-one-out sensitivity analysis to address potential biases like pleiotropy and population stratification.

Results

Our analysis included 267,242 individuals, focusing on European ancestries and involving 2,355 patients with preeclampsia. We identified strong genetic associations linking increased preeclampsia risk with factors such as hyperthyroidism, BMI, type 2 diabetes, and elevated serum uric acid levels. Conversely, no significant causal links were found with gestational diabetes, total cholesterol, sleep duration, and bone mineral density, suggesting areas for further investigation. A notable finding was the causal relationship between systemic lupus erythematosus and increased preeclampsia risk, highlighting the significant role of immune and inflammatory responses.

Conclusion

This extensive MR study sheds light on the complex etiology of preeclampsia, underscoring the causal impact of specific metabolic, lipid, immune, lifestyle, and bone metabolism factors. Our findings advocate for a multidimensional approach to better understand and manage preeclampsia, paving the way for future research to develop targeted preventive and therapeutic strategies.

Combined impact of Hepatitis B virus and gestational diabetes mellitus on ultrasound-measured fetal growth and adverse perinatal outcomes: A seven-year retrospective study

AIMS

To investigate the impact of pregnancy with combined hepatitis B virus (HBV) infection and Gestational diabetes mellitus (GDM) on fetal growth and adverse perinatal outcomes.

METHODS

All the pregnant women with HBV infection and/or GDM who delivered at Women's Hospital, Zhejiang University between January 2015, and September 2022 were included. A total of 1633 pregnant women were recruited in the final analysis, including 409 women with HBV infection and GDM, 396 with HBV infection only, 430 with GDM only, and 398 without HBV infection and GDM. Linear and logistic regression models were used to study the impact of pregnancy with combined HBV infection and GDM on fetal growth and adverse perinatal outcomes.

RESULTS

Pregnancy with combined HBV infection and GDM was associated with increased Z-scores on primary fetal ultrasound parameters and significantly increased the risk of fetal femur length overgrowth (OR: 2.88, 95 % CI: 1.13 ∼ 7.35), placental abruption (OR: 3.64, 95 % CI: 1.18 ∼ 11.22), and macrosomia (OR: 4.19, 95 % CI: 1.66 ∼ 10.56) compared to pregnancy without HBV infection and GDM.

CONCLUSIONS

Both maternal HBV infection and GDM are independently associated with adverse perinatal outcomes. Their combination further increases the risk of adverse perinatal outcomes.

Gestational weight gain of multiparas and risk of primary preeclampsia: a retrospective cohort study in Shanghai

BACKGROUND

In all studies conducted so far, there was no report about the correlation between excessive gestational weight gain (GWG) and the risk of preeclampsia (PE) in multiparas, especially considering that multiparity is a protective factor for both excessive GWG and PE. Thus, the aim of this retrospective cohort study was to determine whether GWG of multiparas is associated with the increased risk of PE.

METHODS

This was a study with 15,541 multiparous women who delivered in a maternity hospital in Shanghai from 2017 to 2021, stratified by early-pregnancy body mass index (BMI) category. Early-pregnancy body weight, height, week-specific and total gestational weight gain as well as records of antenatal care were extracted using electronic medical records, and antenatal weight gain measurements were standardized into gestational age-specific z scores.

RESULTS

Among these 15,541 multiparous women, 534 (3.44%) developed preeclampsia. The odds of preeclampsia increased by 26% with every 1 z score increase in pregnancy weight gain among normal weight women and by 41% among overweight or obese women. For normal weight women, pregnant women with preeclampsia gained more weight than pregnant women without preeclampsia beginning at 25 weeks of gestation, while accelerated weight gain was more obvious in overweight or obese women after 25 weeks of gestation.

CONCLUSIONS

In conclusion, excessive GWG in normal weight and overweight or obese multiparas was strongly associated with the increased risk of preeclampsia. In parallel, the appropriate management and control of weight gain, especially in the second and third trimesters, may lower the risk of developing preeclampsia.