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Delivery-to-Delivery Weight Gain and Risk of Hypertensive Disorders in a Subsequent Pregnancy

Dude, Annie M., MD, PhD; Shahawy, Sarrah, MD; Grobman, William A., MD, MBA

doi: 10.1097/AOG.0000000000002874
Contents: Hypertension: Original Research

OBJECTIVE: To estimate whether weight gain between deliveries is associated with an increased risk of hypertensive disorders in a subsequent pregnancy.

METHODS: This is a case–control study of women who had two live singleton births of at least 24 weeks of gestation at a single maternity hospital from January 1, 2005, to December 31, 2015, with no hypertensive disorder documented in the index pregnancy. Maternal weight gain between deliveries was measured as the change in body mass index (BMI) at delivery. Women who were diagnosed with any hypertensive disorder in the subsequent pregnancy were compared with those who experienced no hypertensive disorder in the subsequent pregnancy using χ2 statistics for categorical variables and t tests for continuous variables. Logistic regression was used to determine whether weight gain remained independently associated with hypertensive disorders after adjusting for potential confounders.

RESULTS: Of 1,033 women, 188 (18.2%) were diagnosed with a hypertensive disorder in the subsequent pregnancy. Of these, 166 (88.3%) had a hypertensive disorder specific to pregnancy (gestational hypertension; preeclampsia; superimposed preeclampsia; or hemolysis, elevated liver enzymes, and low platelet count syndrome), and 22 (11.7%) had chronic hypertension only. Greater weight gain between deliveries was significantly associated with a higher frequency of hypertensive disorders, which remained significant for a BMI increase of at least 2 kg/m2 in multivariable analyses (adjusted odds ratio [OR] 1.76, 95% CI 1.14–2.74 for 2 to less than 4 kg/m2, adjusted OR 3.19, 95% CI 1.86–5.47 for 4 kg/m2 or more). Conversely, weight loss of 2 kg/m2 or more was associated with a decreased risk of a hypertensive disorder (adjusted OR 0.41, 95% CI 0.21–0.81).

CONCLUSION: Among women with no hypertensive disorder noted in an index pregnancy, an increase in BMI of at least 2 kg/m2 between deliveries was independently associated with an increased risk of a hypertensive disorder in a subsequent pregnancy.

Among women with no hypertension in an index pregnancy, increased delivery-to-delivery weight gain was associated with an increased risk of hypertensive disorders in a subsequent pregnancy.

Division of Maternal-Fetal Medicine, Department of Obstetrics & Gynecology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois.

Corresponding author: Annie M. Dude, MD, PhD, 250 East Superior Street, Suite 5-2185, Chicago, IL 60611; email:

Research reported in this publication was supported, in part, by the National Institutes of Health's National Center for Advancing Translational Sciences, Grant Number UL1TR001422. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

Financial Disclosure The authors did not report any potential conflicts of interest.

Presented at the 38th Annual Meeting of the Society for Maternal-Fetal Medicine, January 29–February 3, 2018, Dallas, Texas.

Each author has indicated that he or she has met the journal's requirements for authorship

Received May 04, 2018

Received in revised form June 28, 2018

Accepted July 12, 2018

© 2018 by The American College of Obstetricians and Gynecologists. Published by Wolters Kluwer Health, Inc. All rights reserved.