Super-obesity and risk for early and late PE

[caryn]

...BMI and rate of weight gain are synergistic risk factors that amplify the burden of pre-eclampsia among super-obese women...

http://www.ncbi.nlm.nih.gov/pubmed/20482533

So the heavier you are going into pregnancy, the higher your risk, and the more weight you gain in pregnancy, the higher your risk.

It's not yet known for certain whether or not losing weight between pregnancies will lower your risk, but it is known that women who undergo bariatric surgery have a much lower rate of preeclampsia. Talk to your docs about what recommendations are appropriate for you.

(That second part about rate of gain always seems messy to me, though. I gained a lot of weight but it was *all* water -- I was actually 30 pounds below my pregnancy starting weight 6 weeks postpartum and I wasn't overweight going in -- and I'm not convinced that cutting back on my calories would have done anything to protect me. There are some early studies into lifestyle changes where they've recommended women eat diets designed to help them gain less weight during pregnancy, and while those women didn't gain as much weight while pregnant, their rate of preeclampsia didn't change. And since the problem in preeclampsia has to do with the initial implantation of the placenta, which is what the data increasingly confirm, diet *in pregnancy* wouldn't affect preeclampsia rate because it couldn't affect placentation. So I wonder if the research isn't just picking up on the fact that women with preeclampsia tend to gain more water weight. That would be useful -- it means women gaining at a high rate can be moved to closer observation to catch preeclampsia -- but not theraputic.)

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[alexa5]

Completely agree about what you said about the weight thing during pregnancy... many of those that develop pre-e gain more weight in pregnancy because of the swelling/water weight--not typically because they ate a lot. In my case I gained weight very regularly starting in my 2nd trimester, and it never stopped. I wasn't eating more than usual, and actually once I hit 3rd trimester I was probably eating a little less due to heartburn issues, but gained weight quickly. I think I put on 30 pounds, and I delivered at 33 weeks--changing my diet wouldn't have changed my weight gain.

My doctor, just prior to my PIH setting in, had noticed I was curving up a bit high on the weight gain and suggested watching that, but I guess we both found out later that I was right in that I was gaining due to my eventual pre-e.

[jgrumet]

this again confuses me. I was 93 lbs when I got pregnant! I was around 140 when I delivered and two weeks later was 106lbs (I have weighed 102 for the past two years)- so, I am guessing the vast majority of that was water weight.

[caryn]

Not everyone who gets PE is overweight! It only increases the risk, but everyone runs *some* risk of PE in pregnancy.

Normal odds are about 1:20, so in a first pregnancy with no other risk factors the math works like this: you have a deck of 20 cards. One is the joker. If you draw it, you will get preeclampsia.

If you start gaining a lot of weight, more of the cards are jokers. If you're obese going in, more cards are jokers. IIRC (on my phone right now, so I can't look at the study again!) either one about doubles your risk. So that means two cards out of the pack of 20 are jokers if you're gaining a lot of weight, or if you're obese.

Gaining a lot of weight *and* being obese makes 4 cards jokers (again, IIRC.)

Being a chronic hypertensive outside pregnancy makes 5 cards of the 20 jokers. The Experts say it's about a 25% risk, or one in four.

Having a history of preeclampsia symptoms that onset before 28 weeks makes 12 cards of the 20 jokers. If symptom onset was after 32 weeks, 8 cards of the 20 are jokers. After 37 weeks, 4 cards of the 20 are jokers.

Of course, getting pregnant draws the card. You just don't get to flip it over until either you get sick, or you're 8 weeks postpartum and haven't gotten sick. :)

[jean]

That is a great analogy Caryn! Thanks for the info!
Does the overweight talk mainly apply to people who are "obese", or is "overweight" bad too? Do you know what the BMI number is that is considered to be more risky?

[sam10]

What a great way to describe risk factors and/or the recurrence rate of PE.

Just curious, where did you get the numbers from? I had early onset (before 28 weeks) - 12 cards of the 20 are jokers, which is the equivalent of 60%. But both my MFM and OB talked about a 30% recurrence rate for me. They took out 6 cards, but why?

[caryn]

The study says The body mass index (BMI) was used to classify women as normal weight (BMI = 18.5-24.9 kg/m(2)), class I obesity (BMI = 30-34.9 kg/m(2)), class II obesity (BMI = 35-39.9 kg/m(2)), class III obesity (BMI = 40-49.9 kg/m(2)) or super-obesity (BMI > or = 50 kg/m(2)). If you go to this NHLBI site you can enter your height and weight and it will calculate your BMI for you.

I was remembering one part of the study and not the other. The odds ratio for women with a BMI equal to or greater than 30 was 2.56 -- this means they are 2.56 times more likely than women of normal weight to develop PE. I called this around twice as likely, although it's really right in the middle between two and three and technically you'd round up to three. Since normal risk is 1:20, we multiply 1 by 2.56 and get 2.56:20, or about two and a half jokers in a deck of 20.

Of course, you can't have two and a half jokers in 20 cards. But you can have 5 jokers in 40 cards. :)

But the thing I didn't mention was the odds ratio for super-obese women with a BMI greater than 50, which was 7.52. So they have seven and a half jokers in a deck of 20, or 15 in a deck of 40.

I got the numbers for risk by gestational risk from the Expert comments here, but those are for the whole population of women who develop symptoms at that time. In an individual consult, a doc can take your particular set of risk factors into account, and that might well change the estimate of your risk. So, I suspect your risk got downgraded because when they assessed all your underlying conditions, you looked more like a 30% type of person. :)

[jean]

It's weird that they skip some numbers in the classifications of weight..so if people are a BMI of 25-29 are they normal or class 1? That's right where I sit..

[sam10]

Thanks Caryn. I guess I must look like a 30% type of person. Normal weight, and basically no underlying conditions, and whatever else was put into MY equation.

[caryn]

That range is "overweight" -- I guess the study wanted to contrast "obese" with "normal"? There's an "underweight" group as well.