Abstract
Objective This study aimed to examine the effects of interpregnancy weight change on pregnancy
outcomes, including recurrent preeclampsia, preterm birth, small-for-gestational age
(SGA), large-for-gestational age (LGA), and cesarean delivery, among women with a
history of preeclampsia. We also evaluated whether these associations were modified
by prepregnancy body mass index (BMI) category in the first pregnancy (BMI < 25 vs.
≥25 kg/m2) and if associations were present among women who maintained a healthy BMI category
in both pregnancies.
Study Design We conducted a population-based retrospective cohort study including 15,108 women
who delivered their first two nonanomalous singleton live births in Missouri (1989–2005)
and experienced preeclampsia in the first pregnancy. We performed Poisson regression
with robust error variance to estimate relative risks and 95% confidence intervals
for outcomes of interest after controlling for potential confounders.
Results Interpregnancy weight gain was associated with increased risk of recurrent preeclampsia,
LGA, and cesarean delivery. These risks increased in a “dose–response” manner with
increasing magnitude of interpregnancy weight gain and were generally more pronounced
among women who were underweight or normal weight in the first pregnancy. Interpregnancy
weight loss exceeding 1 BMI unit was associated with increased risk of SGA among underweight
and normal weight women, while interpregnancy weight loss exceeding 2 BMI units was
associated with reduced risk of recurrent preeclampsia among overweight and obese
women.
Conclusion Even small changes in interpregnancy weight may significantly affect pregnancy outcomes
among formerly preeclamptic women. Appropriate weight management between pregnancies
has the potential to attenuate such risks.
Key Points
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Interpregnancy weight change among formerly preeclamptic women significantly affects
pregnancy outcomes.
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Interpregnancy weight gain is associated with increased risk of recurrent preeclampsia,
large-for-gestational-age and cesarean delivery.
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Interpregnancy weight loss is associated with increased risk of small-for-gestational
age and recurrent preeclampsia.
Keywords
interpregnancy - preeclampsia - pregnancy outcomes - weight change
