The impact of maternal body mass index on the phenotype of pre-eclampsia: a prospective cohort study.
OBJECTIVE
We hypothesised that among nulliparous women with pre-eclampsia, overweight or obese women would have a different phenotype of pre-eclampsia compared with normal weight women with pre-eclampsia. Specifically, they are more likely to develop term pre-eclampsia and less likely to have indicators of impaired placental perfusion, e.g. abnormal uterine artery Doppler or a small-for-gestational-age (SGA) infant.


METHODS
Prospective, multicentre, cohort SCOPE study (n = 3170).


METHODS
New Zealand and Australia.


METHODS
Nulliparous women who developed pre-eclampsia.


METHODS
Participants were interviewed at 14-16 weeks of gestation, uterine artery Doppler studies were performed at 19-21 weeks and pregnancy outcome was tracked prospectively.


METHODS
Rates of abnormal uterine artery Doppler indices, term/preterm birth and SGA infants were compared between normal, overweight and obese women with pre-eclampsia. Multivariable analysis was performed to examine the association between body mass index (BMI) and term pre-eclampsia.


RESULTS
Of 178 women with pre-eclampsia, one underweight woman was excluded and 66 (37%) were normal weight, 52 (29%) were overweight and 59 (34%) were obese. Pre-eclampsia developed preterm in 26% of women and at term in 74% of women. There were no differences in the rates of term/preterm pre-eclampsia, abnormal uterine artery Doppler indices or SGA infants between BMI groups (P > 0.10). No independent association between BMI and term pre-eclampsia was found (P = 0.56).


CONCLUSIONS
Among women with pre-eclampsia, those who are overweight or obese in early pregnancy are not more likely to have term pre-eclampsia compared with women with a normal BMI. Overweight and obese women require vigilant surveillance for the development of preterm as well as term pre-eclampsia.
Department of Obstetrics and Gynaecology, School of Population Health, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand. ngaire.anderson@auckland.ac.nz
N H
NH
Anderson
L M E
LM
McCowan
E M
EM
Fyfe
E H Y
EH
Chan
R S
RS
Taylor
A W
AW
Stewart
G A
GA
Dekker
R A
RA
North
D000328:Adult; D001315:Australia; D015992:Body Mass Index; D005260:Female; D005320:Fetal Macrosomia; D006801:Humans; D007231:Infant, Newborn; D007236:Infant, Small for Gestational Age; D053208:Kaplan-Meier Estimate; D009520:New Zealand; D050177:Overweight / Q000150:complications*; D021041:Placental Circulation / Q000502:physiology; D011225:Pre-Eclampsia / Q000209:etiology* / Q000503:physiopathology; D011247:Pregnancy; D011256:Pregnancy Outcome; D011263:Pregnancy Trimester, Third; D011446:Prospective Studies; D018608:Ultrasonography, Doppler; D016216:Ultrasonography, Prenatal; D055988:Uterine Artery / Q000502:physiology