Effect of obesity on incidence of preeclampsia
2013; Elsevier BV; Volume: 210; Issue: 4 Linguagem: Inglês
10.1016/j.ajog.2013.10.014
ISSN1097-6868
Autores Tópico(s)Gestational Diabetes Research and Management
ResumoThe recent article by Lisonkova and Joseph1Lisonkova S. Joseph K.S. Incidence of preeclampsia: risk factors and outcomes associated with early- versus late-onset disease.Am J Obstet Gynecol. 2013; 209: 544.e1-544.e12Abstract Full Text Full Text PDF PubMed Scopus (497) Google Scholar found an increased risk of preeclampsia in African Americans for early-onset and diabetes for late-onset preeclampsia, as well as an overall increased risk in Hispanics and Native Americans and a marked increase as gestation approaches term. The authors found that an increased body mass index was associated with an increased risk of early preeclampsia, but did not emphasize the issue of weight on the risk of preeclampsia. It is predictable that there would be an increased severity of preeclampsia and poor fetal outcomes in early gestation, which may be a problem secondary to the effects of obesity leading to early-onset disease. It is my hypothesis that preeclampsia is secondary to an increased intraabdominal pressure (IAP), which reduces venous flow from the uterus/placenta and throughout the body.1Lisonkova S. Joseph K.S. Incidence of preeclampsia: risk factors and outcomes associated with early- versus late-onset disease.Am J Obstet Gynecol. 2013; 209: 544.e1-544.e12Abstract Full Text Full Text PDF PubMed Scopus (497) Google Scholar A prior study has documented an increased IAP in women with central obesity.2Sugerman H.J. Hypothesis: preeclampsia is a venous disease secondary to an increased intra-abdominal pressure.Med Hypotheses. 2011; 77: 841-849Abstract Full Text Full Text PDF PubMed Scopus (28) Google Scholar Many of the phenomena found in this study could be related to that problem, as diabetes is often seen in obese women and obesity is a major problem in Hispanics, Native Americans, and African Americans as compared to Caucasians and, clearly, there would be an increased IAP as pregnancy approaches term. The smooth rate of increased risk of preeclampsia noted by Lisonkova and Joseph1Lisonkova S. Joseph K.S. Incidence of preeclampsia: risk factors and outcomes associated with early- versus late-onset disease.Am J Obstet Gynecol. 2013; 209: 544.e1-544.e12Abstract Full Text Full Text PDF PubMed Scopus (497) Google Scholar supports this concept and argues against >1 etiology for early vs late preeclampsia. There are several studies showing that the risk of preeclampsia decreases profoundly after surgically induced weight loss.3Sugerman H. Windsor A. Bessos M. Wolfe L. Intra-abdominal pressure, sagittal abdominal diameter and obesity comorbidity.J Intern Med. 1997; 241: 71-79Crossref PubMed Scopus (389) Google Scholar, 4Hazelgrave N.L. Oteng-Ntim E. Pregnancy after bariatric surgery: a review.J Obes. 2011; 2011: 501939PubMed Google Scholar I am currently conducting a study to determine if lowering the IAP will reverse the pathophysiology of preeclampsia. The recent article by Lisonkova and Joseph1Lisonkova S. Joseph K.S. Incidence of preeclampsia: risk factors and outcomes associated with early- versus late-onset disease.Am J Obstet Gynecol. 2013; 209: 544.e1-544.e12Abstract Full Text Full Text PDF PubMed Scopus (497) Google Scholar found an increased risk of preeclampsia in African Americans for early-onset and diabetes for late-onset preeclampsia, as well as an overall increased risk in Hispanics and Native Americans and a marked increase as gestation approaches term. The authors found that an increased body mass index was associated with an increased risk of early preeclampsia, but did not emphasize the issue of weight on the risk of preeclampsia. It is predictable that there would be an increased severity of preeclampsia and poor fetal outcomes in early gestation, which may be a problem secondary to the effects of obesity leading to early-onset disease. It is my hypothesis that preeclampsia is secondary to an increased intraabdominal pressure (IAP), which reduces venous flow from the uterus/placenta and throughout the body.1Lisonkova S. Joseph K.S. Incidence of preeclampsia: risk factors and outcomes associated with early- versus late-onset disease.Am J Obstet Gynecol. 2013; 209: 544.e1-544.e12Abstract Full Text Full Text PDF PubMed Scopus (497) Google Scholar A prior study has documented an increased IAP in women with central obesity.2Sugerman H.J. Hypothesis: preeclampsia is a venous disease secondary to an increased intra-abdominal pressure.Med Hypotheses. 2011; 77: 841-849Abstract Full Text Full Text PDF PubMed Scopus (28) Google Scholar Many of the phenomena found in this study could be related to that problem, as diabetes is often seen in obese women and obesity is a major problem in Hispanics, Native Americans, and African Americans as compared to Caucasians and, clearly, there would be an increased IAP as pregnancy approaches term. The smooth rate of increased risk of preeclampsia noted by Lisonkova and Joseph1Lisonkova S. Joseph K.S. Incidence of preeclampsia: risk factors and outcomes associated with early- versus late-onset disease.Am J Obstet Gynecol. 2013; 209: 544.e1-544.e12Abstract Full Text Full Text PDF PubMed Scopus (497) Google Scholar supports this concept and argues against >1 etiology for early vs late preeclampsia. There are several studies showing that the risk of preeclampsia decreases profoundly after surgically induced weight loss.3Sugerman H. Windsor A. Bessos M. Wolfe L. Intra-abdominal pressure, sagittal abdominal diameter and obesity comorbidity.J Intern Med. 1997; 241: 71-79Crossref PubMed Scopus (389) Google Scholar, 4Hazelgrave N.L. Oteng-Ntim E. Pregnancy after bariatric surgery: a review.J Obes. 2011; 2011: 501939PubMed Google Scholar I am currently conducting a study to determine if lowering the IAP will reverse the pathophysiology of preeclampsia. Incidence of preeclampsia: risk factors and outcomes associated with early- versus late-onset diseaseAmerican Journal of Obstetrics & GynecologyVol. 209Issue 6PreviewThe population-based incidence of early-onset (<34 weeks) and late-onset preeclampsia (≥34 weeks) has not been adequately studied. We examined the gestational age–specific incidence of preeclampsia onset and identified the associated risk factors and birth outcomes. 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