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Title: [Associations between pre-pregnancy body mass index and occurrence and clinical features of preeclampsia].
Author: Wu LL, Chen YX, Guan XN, Tong JN, Wu XX, Niu JM.
Journal: Zhonghua Fu Chan Ke Za Zhi; 2021 Feb 25; 56(2):96-101. PubMed ID: 33631880.
Abstract:
Objective: To investigate the associations between pre-pregnancy body mass index (BMI) and occurrence and clinical features in pregnant women complicated by preeclampsia (PE). Methods: We recruited 42 427 pregnant women who were diagnosed with intrauterine pregnancy at Shenzhen Maternity and Child Healthcare Hospital from July 2017 to December 2019, with a gestational age of 6~8⁺⁶ weeks, excluding those with basic diseases and incomplete medical records. Among them, 659 were diagnosed with PE. According to the pre-pregnancy BMI, the pregnant women were divided into underweight group (42 cases), normal body weight group (422 cases), overweight group (138 cases) and obesity group (57 cases). Maternal outcomes (the occurrence of preeclampsia, cesarean delivery rate) and neonatal outcomes (birth weight, Apgar score and neonatal ICU admission) were recorded. The maternal outcomes, gestational age of delivery, delivery mode, newborn birth weight, Apgar score and admission to neonatal ICU were compared among the pregnant women in each group. Logistic regression model was established to analyze the influence of different pre-pregnancy BMI on the occurrence and clinical features of PE. Results: The incidence of PE was 1.55% (659/42 427), and the incidence of PE was 0.61% (42/6 941), 1.44% (422/29 297), 2.62% (138/5 273) and 6.22% (57/916) in the underweight group, the normal weight group, the overweight group and the obesity group, respectively. After adjustment for age, parity, educational level, history of preeclampsia, and in vitro fertilization and embryo transfer (IVF-ET), compared with normal group, the adjusted OR for developing early-onset PE were 0.57 (95%CI: 0.29-1.02) for underweight, 1.03 (95%CI: 0.65-1.56) for overweight and 2.15 (95%CI: 1.03-4.02) for obesity groups. The OR for developing late-onset PE were 0.50 (95%CI: 0.33-0.72) for underweight, 1.57 (95%CI: 1.23-1.99) for overweight and 4.25 (95%CI: 3.00-5.91) for obesity group. The OR for PE without severe features were 0.54 (95%CI: 0.30-0.89), 1.40 (95%CI: 0.97-1.99) and 5.11 (95%CI: 3.22-7.84) for underweight, overweight and obesity groups, respectively. The OR for severe PE were 0.51 (95%CI: 0.33-0.75), 1.42 (95%CI: 1.10-1.83) and 2.97 (95%CI: 1.95-4.38) for underweight, overweight and obesity groups, respectively. The median neonate birth weight in women with PE were 2 420 g (1 602-2 845 g), 2 435 g (1 692-3 030 g), 2 540 g (1 922-3 132 g), and 2 950 g (2 050-3 360 g) for underweight, normal, overweight and obesity groups, respectively. The neonatal birth weight in obesity group was heavier than that in normal group (P<0.05). The incidence rates of large for gestational age (LGA) in PE women were 0 (0/42), 3.3% (14/422), 7.3% (10/138) and 17.5% (10/57) for underweight, normal, overweight and obesity groups, respectively. The incidence rate of LGA in obesity group was higher than that in normal group (P<0.05). Conclusions: Pre-pregnancy obesity is an independent risk factor for PE. Obesity related PE is more likely associated with late-onset PE and LGA. It is recommended to control weight before pregnancy, limit weight gain during pregnancy and control blood pressure to reduce the incidence of PE and ensure the safety of mother and child. 目的： 探讨妊娠前体质指数（BMI）与子痫前期（PE）发生及临床特征的关系。 方法： 收集2017年7月1日至2019年12月31日于南方医科大学附属深圳妇幼保健院诊断为宫内妊娠，孕周为6~8周⁺⁶，排除有基础性疾病和病历资料不完整者，共计42 427例孕妇，其中诊断为PE者659例。依据孕前BMI分为低体重组（42例）、正常体重组（422例）、超重组（138例）和肥胖组（57例），对4组孕妇PE的发生率及发生风险、妊娠结局进行比较。建立logistic回归模型，分析不同妊娠前BMI对PE临床特征（包括PE的发生时间及严重程度）的影响。 结果： PE的发生率为1.55%（659/42 427）；其中，低体重组、正常体重组、超重组、肥胖组的PE发生率分别为0.61%（42/6 941）、1.44%（422/29 297）、2.62%（138/5 273）和6.22%（57/916）。校正产次、年龄、文化程度、PE病史、辅助生殖技术助孕史等混杂因素后，与正常体重组比较，低体重组晚发PE的发生风险显著降低（OR=0.50，95%CI为0.33~0.72，P<0.01）、超重组晚发PE的发生风险显著升高（OR=1.57，95%CI为1.23~1.99，P<0.01）、肥胖组早发和晚发PE的发生风险均显著增加（早发PE OR=2.15，95%CI为1.03~4.02，P=0.027；晚发PE OR=4.25，95%CI为3.00~5.91，P<0.01）；低体重组不伴严重表现的PE（OR=0.54，95%CI为0.30~0.89，P=0.024）和重度PE（OR=0.51，95%CI为0.33~0.75，P=0.001）的发生风险均显著降低、超重组重度PE的发生风险显著升高（OR=1.42，95%CI为1.10~1.83，P=0.007）、肥胖组不伴严重表现的PE（OR=5.11，95%CI为3.22~7.84，P<0.01）和重度PE（OR=2.97，95%CI为1.95~4.38，P<0.01）的发生风险均显著升高。659例PE孕妇中，低体重组、正常体重组、超重组和肥胖组的中位新生儿出生体重分别为2 420 g（1 602~2 845 g）、2 435 g（1 692~3 030 g）、2 540 g（1 922~3 132 g）和2 950 g（2 050~3 360 g）；与正常体重组比较，肥胖组的新生儿出生体重显著增加（P<0.05）。低体重组、正常体重组、超重组和肥胖组的大于胎龄儿（LGA）的发生率分别为0（0/42）、3.3%（14/422）、7.3%（10/138）和17.5%（10/57），与正常体重组比较，肥胖组LGA的发生率显著增加（P<0.05）。 结论： 妊娠前超重和肥胖是PE发生的危险因素，与晚发PE具有更密切的关联。妊娠前肥胖相关的晚发PE出现较多LGA新生儿。建议妊娠前控制体重、妊娠期限制体重增长及血压管理，以降低PE发病率，保障母婴安全。.

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