Lisa M Bodnar1, Katherine P Himes2, Barbara Abrams3, Sara M Parisi4, Jennifer A Hutcheon5. 1. Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, 130 DeSoto Street, Pittsburgh, PA 15261, United States; Department of Obstetrics, Gynecology, and Reproductive Sciences, School of Medicine, University of Pittsburgh, 300 Halket Street, Pittsburgh, PA 15213, United States. Electronic address: bodnar@edc.pitt.edu. 2. Department of Obstetrics, Gynecology, and Reproductive Sciences, School of Medicine, University of Pittsburgh, 300 Halket Street, Pittsburgh, PA 15213, United States; Magee-Womens Research Institute, 204 Craft Avenue, Pittsburgh, PA 15213, United States. 3. Division of Epidemiology, School of Public Health, University of California, Berkeley, 50 University Ave Hall, Berkeley, CA 94720, United States. 4. Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, 130 DeSoto Street, Pittsburgh, PA 15261, United States. 5. Department of Obstetrics & Gynaecology, University of British Columbia, 2329 West Mall, Vancouver, British Columbia V6T 1Z4, Canada.
Abstract
OBJECTIVE: To investigate the association between early-pregnancy weight gain and risk of preeclampsia to inform pregnancy weight gain recommendations. STUDY DESIGN: We performed a case-cohort study using a hospital database including 80,812 singleton deliveries from Magee-Womens Hospital, Pittsburgh, Pennsylvania (1998-2011). In each of 6 prepregnancy body mass index (BMI) groups, we abstracted serial antenatal weight measurements from the records of up to 339 preeclampsia cases and 1254 randomly selected pregnancies. Early gestational weight gain (16-19 weeks' gestation) was standardized for gestational duration using BMI-specific z-score charts. Multivariable log-binomial regression was used to assess the association between weight gain z-score and risk of preeclampsia. We determined the impact of preeclampsia misclassification using probabilistic bias analysis. MAIN OUTCOME MEASURE: Risk of preeclampsia. RESULTS: For normal weight women, there was a steady increase in preeclampsia risk with increasing early gestational weight gain z-score. For example, compared with a weight gain of 1.2 kg (z-score = -1 SD), a 7.2-kg weight gain (z-score = +1 SD) at 16 weeks was associated with 1.3 (0.50, 2.2) excess preeclampsia cases per 100 deliveries. Weight loss at 16-19 weeks among grade 2 or 3 obese women was associated with a reduced risk of preeclampsia. Associations were null among overweight and grade 1 obese women. The bias analysis supported the validity of the conventional analysis. CONCLUSIONS: Early-pregnancy weight gain may be associated with preeclampsia in some BMI groups. Future revisions of pregnancy weight gain recommendations should account for preeclampsia risks from this and additional studies.
OBJECTIVE: To investigate the association between early-pregnancy weight gain and risk of preeclampsia to inform pregnancy weight gain recommendations. STUDY DESIGN: We performed a case-cohort study using a hospital database including 80,812 singleton deliveries from Magee-Womens Hospital, Pittsburgh, Pennsylvania (1998-2011). In each of 6 prepregnancy body mass index (BMI) groups, we abstracted serial antenatal weight measurements from the records of up to 339 preeclampsia cases and 1254 randomly selected pregnancies. Early gestational weight gain (16-19 weeks' gestation) was standardized for gestational duration using BMI-specific z-score charts. Multivariable log-binomial regression was used to assess the association between weight gain z-score and risk of preeclampsia. We determined the impact of preeclampsia misclassification using probabilistic bias analysis. MAIN OUTCOME MEASURE: Risk of preeclampsia. RESULTS: For normal weight women, there was a steady increase in preeclampsia risk with increasing early gestational weight gain z-score. For example, compared with a weight gain of 1.2 kg (z-score = -1 SD), a 7.2-kg weight gain (z-score = +1 SD) at 16 weeks was associated with 1.3 (0.50, 2.2) excess preeclampsia cases per 100 deliveries. Weight loss at 16-19 weeks among grade 2 or 3 obesewomen was associated with a reduced risk of preeclampsia. Associations were null among overweight and grade 1 obesewomen. The bias analysis supported the validity of the conventional analysis. CONCLUSIONS: Early-pregnancy weight gain may be associated with preeclampsia in some BMI groups. Future revisions of pregnancy weight gain recommendations should account for preeclampsia risks from this and additional studies.
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