Adverse Maternal Outcomes Differ between Obese and Nonobese Women with Severe Preeclampsia

Christina Paidas Teefey; Celeste P. Durnwald; Sindhu K. Srinivas; Lisa D. Levine

doi:10.1055/s-0038-1661403

American Journal of Perinatology, Table of Contents

Am J Perinatol 2019; 36(01): 074-078
DOI: 10.1055/s-0038-1661403

SMFM Fellowship Series Article

Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Adverse Maternal Outcomes Differ between Obese and Nonobese Women with Severe Preeclampsia

Authors

Christina Paidas Teefey

¹The Maternal and Child Health Research Center, Department of Obstetrics and Gynecology, Perelman School of Medicine – University of Pennsylvania, Philadelphia, Pennsylvania
Celeste P. Durnwald

¹The Maternal and Child Health Research Center, Department of Obstetrics and Gynecology, Perelman School of Medicine – University of Pennsylvania, Philadelphia, Pennsylvania
Sindhu K. Srinivas

¹The Maternal and Child Health Research Center, Department of Obstetrics and Gynecology, Perelman School of Medicine – University of Pennsylvania, Philadelphia, Pennsylvania
Lisa D. Levine

¹The Maternal and Child Health Research Center, Department of Obstetrics and Gynecology, Perelman School of Medicine – University of Pennsylvania, Philadelphia, Pennsylvania

Abstract

Objective This article evaluates the differences in adverse maternal outcomes related to severe preeclampsia in obese versus nonobese women.

Study Design Retrospective cohort study and planned secondary analysis of women with severe preeclampsia comparing a composite adverse maternal outcome related to preeclampsia among obese (body mass index [BMI] ≥ 30 kg/m²) and nonobese (BMI < 30 kg/m²) women. The composite outcome was defined as ≥ 1 of the following prior to discharge: renal failure, liver abnormality, thrombocytopenia, blood transfusion, pulmonary edema, disseminated intravascular coagulation, stroke, or eclampsia. Multivariable logistic regression was used to control for confounders.

Results Of the 152 women included, 37.5% were obese and 62.5% were nonobese. The prevalence of the primary outcome was 15.8% with obese women less likely to have the composite outcome compared with nonobese women (7% vs. 21.1%, p = 0.02). This remained after adjusting for confounders including maternal age, race, and chronic hypertension (adjusted odds ratio, 0.33 [0.12–0.89], p = 0.03). Obese women were, however, more likely to require intravenous antihypertensive medication peripartum compared with nonobese women (49.1% vs. 28.4%, p = 0.01).

Conclusion Obese women with severe preeclampsia may have a different phenotype of severe preeclampsia that is more associated with severe hypertension rather than end-organ damage.

Keywords

obesity - severe preeclampsia - preeclampsia with severe features - adverse maternal outcome - phenotype

Full Text

References

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