Impact of excessive pre-pregnancy body mass index and abnormal gestational weight gain on pregnancy outcomes in women with chronic hypertension.

OBJECTIVES

To investigate the effects of excessive pre-pregnancy body mass index (BMI) and abnormal gestational weight gain on adverse outcomes in women with chronic hypertension (CH).

STUDY

DESIGN

A retrospective cohort study of CH women with singleton pregnancy delivered at our Institution in 2002-2013. Women were categorized as normal, overweight, and obese, according to their pre-pregnancy BMI. Further stratification was based on gestational weight gain (insufficient, adequate, and excessive) as defined by 2009 IOM guidelines.

MAIN OUTCOMES MEASURES: Gestational diabetes, hypothyroidism, superimposed preeclampsia, preterm birth <37 weeks, cesarean section, and delivery of a small or large for gestational age neonate.

RESULTS

309 women met inclusion criteria. Obese women had increased odds of gestational diabetes (aOR, 3.18; 95% CI, 1.46-6.90), hypothyroidism (aOR, 2.41; 95% CI, 1.15-5.54), and superimposed preeclampsia (aOR, 2.36; 95% CI, 1.20-4.65), compared to normal BMI. Overweight women also displayed higher risk of diabetes (aOR 2.19; 95% CI, 1.05-5.03). Insufficient weight gain increased odds of small for gestational age neonate in normal BMI women (aOR, 1.82; 95% CI 1.31-2.07), whereas excessive gain was associated with superimposed preeclampsia in normal BMI patients (aOR, 3.51; 95% CI, 1.16-7.89) and with cesarean delivery in obese women (aOR, 2.96; 95% CI, 1.09-5.81).

CONCLUSIONS

Excessive pre-conception BMI and abnormal gestational weight gain increase odds of pregnancy complications in CH women. Our results stress the importance of pre-conception counseling for weight normalization in CH women, and support IOM recommendations for adequate weight gain during CH pregnancies.