Preeclampsia With Severe Features: Examining the Phenotype of Disease [28L

Abstract

INTRODUCTION: To characterize the impact of increasing body mass index (BMI) on the likelihood of developing preeclampsia (PE) with severe features (SPE). METHODS: We performed a retrospective cohort study using the Consortium on Safe Labor database (CSL). Women without chronic hypertension with a diagnosis of PE delivering a singleton, non-anomalous fetus were included. The odds of developing SPE versus PE without severe features (MPE) between women with a pre-pregnancy BMI in the underweight or normal weight categories (<25 kg/m2) versus those in the overweight (25-29.9 kg/m2) or obese (at least 30 kg/m2) categories were compared. Multiple logistic regression was used to adjust for potential confounders. RESULTS: There were 228,438 records in the cohort, of which 6,706 had a diagnosis of PE and a documented pre-pregnancy BMI. Of women with PE, 25% were overweight, 30% were obese. Among all BMIs, 34% of women had SPE. Compared to pregnancies with a normal or underweight BMI, overweight and obese women had a decreased odds of developing SPE when adjusted for race, maternal age, parity, insurance, diabetes, and marital status (adjusted OR [aOR] 0.84, 95% CI 0.72-0.96 and aOR 0.75, 95% CI 0.65-0.87, respectively). CONCLUSION: Among women who develop PE, women with an overweight or obese pre-pregnancy BMI are less likely to develop SPE than normal or underweight weight women. Potential differences in the metabolic phenotypes between the two groups may contribute to this finding. Further research is needed to characterize the pathophysiology behind these differences in order to find methods of preventing the development of SPE.