Annie M Dude1, Michelle A Kominiarek2, David M Haas3, Jay Iams4, Brian M Mercer5, Samuel Parry6, Uma M Reddy7, George Saade8, Robert M Silver9, Hyagriv Simhan10, Ronald Wapner11, Deborah Wing12, William Grobman2. 1. Division of Maternal-Fetal Medicine, Department of Obstetrics & Gynecology, Feinberg School of Medicine, Northwestern University, United States. Electronic address: annie.dude@gmail.com. 2. Division of Maternal-Fetal Medicine, Department of Obstetrics & Gynecology, Feinberg School of Medicine, Northwestern University, United States. 3. Department of Obstetrics & Gynecology, Indiana University School of Medicine, Indianapolis, IN, United States. 4. Department of Obstetrics & Gynecology, The Ohio State University, Columbus, OH, United States. 5. Department of Obstetrics & Gynecology, MetroHealth Medical Center, Case Western Reserve University, Cleveland, OH, United States. 6. Division of Maternal-Fetal Medicine, Department of Obstetrics & Gynecology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States. 7. Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology, and Reproductive Science, Yale University, New Haven, CT, United States. 8. Division of Maternal-Fetal Medicine, Department of Obstetrics & Gynecology, University of Texas Medical Branch - Galveston, Galveston, TX, United States. 9. Division of Maternal-Fetal Medicine, Department of Obstetrics & Gynecology, University of Utah, Salt Lake City, UT, United States. 10. Division Maternal-Fetal Medicine, Department of Obstetrics, Gynecology, and Reproductive Sciences, Magee-Women's Hospital, University of Pittsburgh, United States. 11. Division of Maternal-Fetal Medicine, Department of Obstetrics & Gynecology, Columbia University, New York, NY, United States. 12. Division of Maternal-Fetal Medicine, Department of Obstetrics & Gynecology, University of California-Irvine, Irvine, CA, United States.
Abstract
OBJECTIVE: To examine the relationship of weight change during early, mid, and late pregnancy with the development of a hypertensive disorder of pregnancy (HDP). STUDY DESIGN: These data are from a prospective cohort study of nulliparous women with live singleton pregnancies. "Early" weight change was defined as the difference between self-reported pre-pregnancy weight and weight at the first visit (between 6 and 13 weeks' gestation); "mid" weight change was defined as the weight change between the first and second visits (between 16 and 21 weeks' gestation); "late" weight change was defined as the weight change between the second and third visits (between 22 and 29 weeks' gestation). Weight change in each time period was further characterized as inadequate, adequate, or excessive based on the Institute of Medicine's (IOM's) trimester-specific weekly weight gain goals based on pre-pregnancy body mass index. Multivariable Poisson regression was performed to adjust for potential confounders. MAIN OUTCOME MEASURE: Development of any hypertensive disorder of pregnancy. RESULTS: Of 8296 women, 1564 (18.9%) developed a HDP. Weight gain in excess of the IOM recommendations during the latter two time periods was significantly associated with HDP. Specifically, trimester-specific excessive weight gain in the mid period (aIRR 1.16, 95% CI 1.01-1.35) as well as in the late period (aIRR = 1.19, 95% CI = 1.02-1.40) was associated with increased risk of developing HDP. The weight gain preceded the onset of clinically apparent disease. CONCLUSIONS: Excessive weight gain as early as the early second trimester was associated with increased risks of development of HDP.
OBJECTIVE: To examine the relationship of weight change during early, mid, and late pregnancy with the development of a hypertensive disorder of pregnancy (HDP). STUDY DESIGN: These data are from a prospective cohort study of nulliparous women with live singleton pregnancies. "Early" weight change was defined as the difference between self-reported pre-pregnancy weight and weight at the first visit (between 6 and 13 weeks' gestation); "mid" weight change was defined as the weight change between the first and second visits (between 16 and 21 weeks' gestation); "late" weight change was defined as the weight change between the second and third visits (between 22 and 29 weeks' gestation). Weight change in each time period was further characterized as inadequate, adequate, or excessive based on the Institute of Medicine's (IOM's) trimester-specific weekly weight gain goals based on pre-pregnancy body mass index. Multivariable Poisson regression was performed to adjust for potential confounders. MAIN OUTCOME MEASURE: Development of any hypertensive disorder of pregnancy. RESULTS: Of 8296 women, 1564 (18.9%) developed a HDP. Weight gain in excess of the IOM recommendations during the latter two time periods was significantly associated with HDP. Specifically, trimester-specific excessive weight gain in the mid period (aIRR 1.16, 95% CI 1.01-1.35) as well as in the late period (aIRR = 1.19, 95% CI = 1.02-1.40) was associated with increased risk of developing HDP. The weight gain preceded the onset of clinically apparent disease. CONCLUSIONS:Excessive weight gain as early as the early second trimester was associated with increased risks of development of HDP.
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