## Super-obesity and risk for early and late PE

### Re : Super-obesity and risk for early and late PE

As soon as I started reading about this study, the exact question that popped into my head was the one about water weight, too! Overall, it sounded like I gained a lot of weight in pregnancy...45lbs! But taking into account the fact that I gained 9lbs in one week due to PE, I'd have to say it was a lot of water weight. My OB even said she didn't think I could put on that kind of weight just by eating too much. Very interesting article and commentary, Caryn!

### Re : Super-obesity and risk for early and late PE

is the risk the same for underweight as normal?

### Re : Super-obesity and risk for early and late PE

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

### Re : Super-obesity and risk for early and late PE

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.

### Re : Super-obesity and risk for early and late PE

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..

### Re : Super-obesity and risk for early and late PE

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. :)

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. :)

### Re : Super-obesity and risk for early and late PE

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?

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?

### Re : Super-obesity and risk for early and late PE

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?

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?

### Re : Super-obesity and risk for early and late PE

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. :)

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. :)

### Re : Super-obesity and risk for early and late PE

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.

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