Adult pre-pregnancy weight change and risk of developing hypertensive disorders during pregnancy

摘要

Background: While the association of pre-pregnancy body mass index (BMI) and hypertensive disorders during pregnancy (HDP) is well documented, little is known about the relationship between pre-pregnancy weight change over the reproductive course of life and the risk of developing HDP. In a population-based cohort study, we examined the impact of adult pre-pregnancy weight change on the development of HDP. Methods: We included 2914 women, surveyed about every three years since 1996, from the 1973-78 cohort of the Australian Longitudinal Study on Women's Health. Women without hypertension or HDP were followed-up between 2003 and 2012. Generalized estimating equations, which account for correlations in repeated pregnancies of a woman, were used to assess the effect of baseline BMI (mean age 20 years) and pre-pregnancy weight change on the incidence of HDP. The full models were adjusted for time-varying (sociodemographic, lifestyle and reproductive) factors. Results: Over 9 years of follow-up, 301 incident cases of HDP (6.3%) were reported from 4813 pregnancies. Overweight and obese women at the baseline survey were 1.67 [95% CI: 1.3, 2.2] and 2.15 [95% CI: 1.4, 3.3] times more likely to develop HDP than normal weight women, respectively. Compared with stable weight (loss or gain up to 1.5%/year) women, women with small (1.5-2.5%) or moderate/high (>2.5%) annual weight gain had elevated risk of HDP (RR: 1.67 95% CI: 1.3, 2.2; RR: 2.31; 95% CI: 1.8, 3.0, respectively). Women who reported annual weight loss (>1.5%) between baseline and the average age of 24 years were 46% [95% CI: 0.4, 0.8] less likely to develop HDP. Conclusions: Pre-pregnancy weight gain is associated with an increased risk of HDP, whereas early adult weight loss is associated with lower risk of HDP.