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Review Article
Special Issue on
Prediction of Preeclampsia
*Corresponding authors
Hiroaki Itoh, Department of Obstetrics and Gynecology,
Hamamatsu University School of Medicine, 1-20-1
Handayama, Higashi-ku, Hamamatsu 341-3192, Japan,
Phone: +81-53-435-2309; FAX: +81-53-435-2308; E-mail:
Abstract
The incidence of obesity in women of childbearing age has consistently increased
in the last half-century. Maternal obesity is a strong risk factor that a deteriorates the
perinatal outcome of both mothers and neonates, and this has raised specific issues
related to the management of pregnancy in obese women. Maternal obesity is a
well-known risk factor for the development of preeclampsia. Several large population
studies have shown that obese women are two to three times more likely to develop
preeclampsia than their leaner counterparts. This association between maternal obesity
and an increased incidence of preeclampsia is an important factor that deteriorates
perinatal mortality and morbidity in obese mothers. In this review, we described
the epidemiology, possible mechanistic background, transgenerational effect, and
lifestyle interventions concerning the association between maternal obesity and risk
of preeclampsia.
INTRODUCTION
The global epidemic of obesity is unfolding, resulting in
new challenges for all health-care professionals. Obesity is
often associated with insulin resistance, dyslipidemia, and
hypertension, which has led to the concept of metabolic syndrome
[1,2]. Recent evidence has suggested that the prevention of
obesity may begin before conception [3,4].
The rapid shift in populations towards a more obese
phenotype in a relatively short period of time, less than half
a century, has led to a marked increase in the incidence of
overweight and obese women of childbearing age, which has
raised specific issues for the management of pregnancy in obese
women. The National Health and Nutrition Examination Survey
revealed that more than half of pregnant women are overweight
or obese, and 8% of reproductive-aged women are extremely
obese in United States [5]. Numerous studies have reported
that maternal obesity is associated with an increased risk of
adverse pregnancy outcomes including preeclampsia, gestational
diabetes, infectious morbidity, postpartum haemorrhage, the
delivery of large-for-dates babies, and stillbirth [6-16]. This
review highlights the relationship between maternal obesity and
the risk of preeclamsia,
Preeclampsia
ISSN: 2333-6439
Copyright
2014 Hiroaki et al.
OPEN ACCESS
Keywords
Pregnancy
Hypertension
Pregnancy-induced hypertension (PIH)
Developmental origins of health and diseases
(DOHaD)
Obesity in pregnancy
Cite this article: Itoh H, Kanayama N (2014) Obesity and Risk of Preeclampsia. Med J Obstet Gynecol 2(2): 1024.
Central
development of preeclampsia [12,49-51]. Several large
population studies have shown that obese women are two to
three times more likely to develop preeclampsia than their leaner
counterparts [35,36,42,51]. A population-based study of 159,072
singleton births in U.S.A. reveled that not only obese women
(prepregnancy body mass index [BMI]30.0),but also overweight
women (prepregnancy BMI=25.029.9) were at a significantly
higher risk for preeclampsia (Odds ratio 2.0 and 3.3, respectively)
than women with a prepregnancy BMI of less than 20.0 [35]. A
British population-based study of 287,213 births reported that
the incidence of preeclampsia was significantly higher in obese
women (prepregnancy BMI30.0; Odd ratio 2.14)as well as
overweight women (prepregnancyBMI=25.029.9; Odd ratio
1.44) than in women with aprepregnancy BMI of 20.0-24.9 [36].A
population-based study of 972,806 births in Sweden revealed that
obese women (prepregnancy BMI 29.1-30.0, prepregnancy BMI
35.1-40.0, prepregnancy BMI >40) were at a significantly higher
risk of preeclampsia (Odds ratio 2.62, 3.90 and 4.82, respectively)
than women with a prepregnancy BMI of 19.8-26.0 [42]. Kumari
et al., reported that 57 cases of preeclampsia (28.7%) among 188
extremely obese women with BMI>40 [52]. Lisonkova et. al., also
reported a strong association between maternal obesity and the
risk of early-onset preeclampsia [53].
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prevalence of obesity in developing as well as developed countries
[87]. Evidence for lifestyle interventions resulting in improved
pregnancy outcomes in obese pregnant women is conflicting [88].
Oteng-Ntim performed a systemic review and meta-analysis and
concluded that antenatal lifestyle interventions for obese women
before pregnancy were only effective in reducing gestational
diabetes, but not other complications [88]. Thangaratinam et al,.
carried out systemic reviews and meta-analysis and reported
that weight management interventions or dietary interventions
in obese pregnant women resulted in a significant reduction
in the incidence of preeclampsia [89]. The American College
of Obstetricians and Gynecologists (ACOG) recommended
that nutrition and exercise counseling should continue not
only antepartum, but also postpartum until attempting
another pregnancy for obese pregnant women [31]. A recent
Cochrane database showed that no randomized control trials
demonstrated the effectiveness of reducing maternal weight in
obese pregnant women and also that there can be no practical
recommendation for obese pregnant women to intentionally
lose weight during the pregnancy period [90].To the best of our
knowledge, no studies have scientifically proven the effectiveness
of antepartum exercise to reduce the incidence of preeclampsia
in obese mothers, although Sui et al., proposed the possibility
that exercise during pregnancy may provide obese mothers with
positive psychological feelings and family influences, and advice
from health professionals [91].
CONCLUSIONS
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