Relationship Between Maternal Obesity And Increased Risk Of Preeclampsia

Abstract

Introduction: The incidence of obesity has risen over the past several decades and in spite of advancement in modern medicine, it remains a risk factor for maternal morbidity and mortality. Objective: To determine the association between obesity (increased body mass index) and increased risk of preeclampsia. The possible role of serum leptin was also evaluated. Methods: 250 pregnant women were included in this study. They were selected according to their BMI at 20 weeks of gestation and allocated into 5 study groups (each n= 50). At 20 weeks of gestation, BMI, mean arterial blood pressure was calculated. Proteinuria, serum uric acid and leptin were measured. At 28 weeks of gestation reevaluation of BMI, mean arterial blood pressure and serum uric acid were done. While serum leptin estimation was only reevaluated on the 37 weeks. Cases of preeclampsia were diagnosed and classified either mild or severe. Results: It was found that preeclampsia was diagnosed in 20 cases. Among them 12 cases were diagnosed as mild preeclampsia in group A , 2 cases ( 4% of normal BMI) , 2 cases in group C ( 4% of obese class 1 ) , 6 cases in group D ( 12 % of obese class 11 ) and 2 cases in group E ( 4 % of obese class 111). Severe preeclampsia was diagnosed in 4 cases of group C ( 8 % of obese class 1 ) , 2 cases of group D ( 4% of obese class 11 ) and 2 cases of group E ( 4 % of obese class 111 ) . The relative risk of preeclampsia in cases of increased BMI was 2.25. The cases that developed preeclampsia had statistically significant elevated serum uric acid when compared to the normotensive cases at 28 and 37 weeks of gestation. Serum leptin level increased significantly with the increase in BMI and preeclamptic cases had statistically significant higher mean serum leptin at 28 and 37 weeks than normotensive cases. Conclusion: Maternal obesity is associated with a higher risk of adverse maternal and perinatal outcomes including preeclampsia.The dyslipidemia and the exaggerated inflammatory response associated with maternal obesity are thought to contribute to widespread endothelial dysfunction and the subsequent maternal syndrome in preeclampsia. Obesity is associated with higher mean serum leptin level. The levels of serum leptin are significantly higher in pre-eclampsia when compared to normotensive pregnant women and may contribute to endothelial dysfunction involved in the pathogenesis of preeclampsia.

Keywords: preeclampsia –maternal obesity