Gestational weight gain and rate of late-onset preeclampsia: a retrospective analysis on 57 000 singleton pregnancies in Reunion Island

Abstract

ObjectivesTo investigate in singleton term pregnancies (≥37 weeks gestation) if applying optimal gestational weight gains (optGWG) on our population could have an effect on the incidence of late-onset preeclampsia (LOP).Design18.5-year-observational cohort study (2001–2019).SettingsCentre Hospitalier Universitaire Hospitalier Sud Reunion’s maternity (French overseas department, Indian Ocean), the only maternity providing services to take care of all preeclamptic cases in an area with approximately 360 000 inhabitants.Main outcomes and measuresSimulation rates of LOP between women achieving optimal versus inappropriate GWG (insufficient and excessive) in the non-overweight, overweight and class I–III obesity categories.ResultsAmong 66 373 singleton term pregnancies with a live birth, and 716 LOP (≥37 weeks, LOP37), the GWG could be determined in 87% of cases. In a logistic regression model validating the independent association of optGWG, maternal ages and body mass index (BMI), primiparity, smoking habit, chronic hypertension with term preeclampsia, optGWG reduced the risk of LOP37, aOR 0.74, p=0.004. Primiparity, higher maternal BMI, chronic hypertension and higher maternal age increased the risk of LOP37. The ‘protective’ effect of optGWG appeared stronger in patients with overweight and obesity in a linear manner: 0.57% versus 1.07% (OR 0.53, p=0.003), overweight; class I obese (30–34.9 kg/m²), 0.70% vs 1.56% (OR 0.44, p=0.01); severe obesity (≥35 kg/m²) 0.86% vs 2.55% (OR 0.33, p=0.06). All patients with overweight/obesity together, OR 0.42, p<0.0001.ConclusionsOverweight and obesity may not result in a higher risk of developing LOP at term when a optGWG is achieved. The results of this large retrospective population cohort study suggest that targeted and strictly monitored interventions on achieving an optGWG might represent an effective method to reduce the rate of LOP and would have the potential to halve its rate in women with overweight/obesity. These findings suggest a potentially achievable pathway to actively counterbalance the morbid effects of high BMIs, so we solicit adequately powered prospective trials.

Risk Factors for Early and Late Onset Preeclampsia in Reunion island: Multivariate Analysis of Singleton and Twin Pregnancies. A 20-year Population-Based Cohort of 2120 Preeclampsia Cases

“…Importantly, we have recently demonstrated that having a high BMI does not automatically translate in a high risk of term preeclampsia. Obese patients can significantly decrease their risks by fine tuning of their gestational weight gain (GWG) [24][25][26][27].…”

Adolphe Quetelet’s Premonition Two Centuries after: Besides Its Implications in Physiology (Obesity, Type 2 Diabetes), Its Paramount Importance in Human Pregnancy

“…First, in overweight/obese women, we may have much to win from reducing weight gain during pregnancy: significant health (and cost) benefits by lowering c-section rates, term preeclampsia, macrosomic/LGA babies, and probably gestational diabetes mellitus [ 19,20]. Second, and on the other hand, in lean women lower the rates of SGA and low-birthweights babies (< 2500g) [19].…”

Women and Pregnancies as an Immediate Target against the Obesity Epidemic

“…We have recently retrospectively tested the effect of achieving optGWG (± 2kg) in our reunionnese population by a mathematical simulation on a 18 -year (2001-2018) [15] and 19-year historical cohort. (2001-2019) [16] on 57,000, and then 59,000 term pregnancies.…”