title: Prepregnancy body mass index, hypertensive disorders of pregnancy, and long-term maternal mortality.
abstract: OBJECTIVE
  Recent studies have shown increased maternal mortality rates after hypertensive disorders of pregnancy (HDP), but the reasons for this increase remain unclear. This study examines the relationship between elevated prepregnancy body mass index (BMI), HDP, and postpregnancy mortality.
  
  
  METHODS
  Data came from a 1975-1976 subset (n = 13,722 women) of a population-based cohort. Multiple logistic regression was used to examine the risk of HDP by BMI; age-adjusted Cox proportional hazards models were used to examine survival rates.
  
  
  RESULTS
  Overweight (BMI, 25-29.9 kg/m2) and obesity (BMI, > or = 30 kg/m2) were associated with increased HDP (odds ratio [OR], 2.82; 95% confidence interval [CI], 2.40-3.31 and OR, 5.51; 95% CI, 4.15-7.31]) and decreased survival (hazard ratio [HR], 1.42; 95% CI, 1.10-1.83 and HR, 2.43; 95% CI, 1.61-3.68), compared with normal weight (BMI, 18.5-24.9 kg/m2). HDP was significantly associated with increased mortality rates for women who survived > 15 years (HR, 1.94; 95% CI, 1.42-2.67]; HR adjusted for BMI, 1.65; 95% CI, 1.19-2.79]). A greater increase in risk of death after HDP was seen in the overweight women (HR, 1.86; 95% CI, 1.07-3.20) and obese women (HR, 2.90; 95% CI, 1.28-6.58), compared with normal weight women (HR, 1.26; 95% CI, 0.74-2.14).
  
  
  CONCLUSIONS
  Elevated prepregnancy BMI is associated with increased risk of HDP, which are in turn is associated with increased long-term maternal mortality rates. This association between HDP and mortality rates increases with elevated prepregnancy BMI.
authors: Department of Obstetrics, Gynecology and Reproductive Sciences, Yale University School of Medicine, New Haven, CT 06520-8063, USA.
authors: Margaret E
authors: ME
authors: Samuels-Kalow
authors: Edmund F
authors: EF
authors: Funai
authors: Catalin
authors: C
authors: Buhimschi
authors: Errol
authors: E
authors: Norwitz
authors: Mary
authors: M
authors: Perrin
authors: Ronit
authors: R
authors: Calderon-Margalit
authors: Lisa
authors: L
authors: Deutsch
authors: Ora
authors: O
authors: Paltiel
authors: Yechiel
authors: Y
authors: Friedlander
authors: Orly
authors: O
authors: Manor
authors: Susan
authors: S
authors: Harlap
mesh_terms: D015992:Body Mass Index; D005260:Female; D006801:Humans; D046110:Hypertension, Pregnancy-Induced / Q000453:epidemiology* / Q000401:mortality / Q000503:physiopathology; D008428:Maternal Mortality; D016017:Odds Ratio; D011247:Pregnancy; D016016:Proportional Hazards Models; D012307:Risk Factors; D016019:Survival Analysis