title: Body Mass Index, Weight Gain, and Hypertensive Disorders in Pregnancy.
abstract: This study examines the interrelationship between gestational weight gain, pre-pregnancy body mass index (BMI), race/ethnicity, and their association with hypertensive disorders during pregnancy (HDP).
  
  
  
  Data from the 2004-2011 national Pregnancy Risk Assessment Monitoring System (PRAMS) were analyzed. Women with singleton live births were included in the analysis (N = 270,131). Gestational weight gain was categorized reflecting the Institute of Medicine (IOM) weight gain recommendation (no gain/weight loss; ≤11, 12-14; 15-25; 26-35; ≥36 pounds). Pre-pregnancy BMI (underweight; normal; overweight; obese) and race/ethnicity (non-Hispanic (NH) White, NH-Black, Hispanic, and NH-other) were examined. Hypertensive disorders during pregnancy were dichotomized (HDP; no HDP). Data were stratified by BMI and race/ethnicity, and multiple logistic regression analysis was conducted to generate odds ratios and 95% confidence intervals (CIs).
  
  
  
  Compared to normal and overweight women who gained the IOM recommended weight, higher odds of HDP was observed in those who gained ≥36 pounds regardless of their race/ethnicity. Among obese NH-White (odds ratio (OR) = 1.29, 95% CI = 1.11, 1.50) and Hispanic women (OR = 1.64, 95% CI = 1.05, 2.54), the odds of HDP was higher among those who gained 25-35 pounds and those who gained ≥36 pounds (OR = 1.59, 95% CI = 1.37, 1.85) and (OR = 2.20, 95% CI = 1.41, 3.44), respectively. However, for NH-Black obese women, higher odds of HDP was observed among those who gained ≥36 pounds (OR = 1.34, 95% CI = 1.04, 1.73).
  
  
  
  Although there are some ethnic/racial variations, pregnant women who exceeded gestational weight gain recommendations are at increased risk of HDP. Health care providers should consider the interrelationship between pre-pregnancy gestational weight gain (GWG) and BMI when counseling patients regarding HDP.
authors.affiliation: Department of Family Medicine and Population Health, Virginia Commonwealth University, School of Medicine, Richmond, Virginia, USA. Department of Obstetrics and Gynecology, Virginia Commonwealth University, Richmond, Virginia, USA; Virginia Commonwealth University Institute of Women's Health, Richmond, Virginia, USA. swmasho@vcu.edu.
authors.forename: Saba W
authors.initials: SW
authors.lastname: Masho
authors.affiliation: Department of Family Medicine and Population Health, Virginia Commonwealth University, School of Medicine, Richmond, Virginia, USA.
authors.forename: Peter
authors.initials: P
authors.lastname: Urban
authors.affiliation: Department of Family Medicine and Population Health, Virginia Commonwealth University, School of Medicine, Richmond, Virginia, USA.
authors.forename: Susan
authors.initials: S
authors.lastname: Cha
authors.affiliation: Department of Obstetrics and Gynecology, Virginia Commonwealth University, Richmond, Virginia, USA;
authors.forename: Ronald
authors.initials: R
authors.lastname: Ramus
mesh_terms: D000293:Adolescent; D000328:Adult; D015992:Body Mass Index; D005260:Female; D006801:Humans; D046110:Hypertension, Pregnancy-Induced / Q000208:ethnology / Q000209:etiology*; D011247:Pregnancy; D014481:United States / Q000453:epidemiology; D015430:Weight Gain; D055815:Young Adult
keywords: PRAMS; blood pressure; body mass index; gestational weight gain; hypertension; hypertensive disorders during pregnancy; racial disparities.