Abstract 13744: The Association of Pre-Pregnancy Obesity on Postpartum Blood Pressure in Preeclampsia

Abstract

Background: Women with preeclampsia have elevated risk of long-term cardiovascular disease, in part mediated by postpartum hypertension. Little is known about the association of pre-pregnancy obesity with postpartum blood pressure. Hypothesis: We hypothesized that women with pre-pregnancy obesity and preeclampsia will have higher postpartum blood pressure compared to women without preeclampsia. Methods: We included women with preeclampsia followed between 2021-2022 at a tertiary care academic center. An equal number of women without preeclampsia were then included, matched for body mass index (BMI). Pre-pregnancy weight (exposure variable) was categorized according to BMI (in kg/m 2 ) at the initial antenatal visit as follows: normal weight (<25), overweight (25-<30), class I obesity (30-<35) and class II+ obesity ( > 35 kg/m 2 ). MAP from the 6 week postpartum visit was the outcome variable. Adjusted linear regression was performed for the association of BMI category with MAP, stratified by preeclampsia status. Interaction between BMI category and preeclampsia on the outcome of MAP was tested in the fully adjusted model. Results: Among 426 women, 247 had preeclampsia. Mean age was 31 + 6 and 32 + 5 years for women with and without preeclampsia, respectively. 54% of women with preeclampsia and 43% without identified as Black. Chronic hypertension was present in 30% vs 11% of women with vs without preeclampsia. Among women with preeclampsia, obesity class II/III was associated with higher postpartum MAP than normal weight (Table). This association was not seen in women without preeclampsia (p-value interaction = 0.004). Conclusion: Higher pre-pregnancy BMI is associated with greater postpartum MAP in women with preeclampsia, but not in women without preeclampsia. These findings underscore the importance of reducing the burden of pre-pregnancy obesity in populations at risk for preeclampsia, to prevent long-term adverse cardiovascular outcomes after pregnancy.