Chatzakis Christos, Magee Laura A, Castello Renata, Miranda Gerardo, von Dadelszen Peter, Nicolaides Kypros H, Charakida Marietta
Fetal Medicine Research Institute, King's College Hospital, London, United Kingdom (C.C., R.C., G.M., K.H.N., M.C.).
Institute of Women and Children's Health, School of Life Course and Population Sciences, King's College London, United Kingdom (L.A.M., P.v.D., K.H.N.).
Hypertension. 2025 Sep;82(9):1433-1442. doi: 10.1161/HYPERTENSIONAHA.124.24394. Epub 2025 Jun 18.
Overweight and obesity greatly increase the risk of preeclampsia. There is a need to better risk-stratify these women in pregnancy and channel resources to those who can benefit most.
Prospective observational study of 11 962 women with singleton pregnancies attending a routine assessment at 35+0 to 36+6 weeks' gestation at King's College Hospital, London, United Kingdom. Women were categorized by their body mass index at 11 to 13 weeks' gestation as normal weight (18.5-24.9 kg/m), overweight (25.0-29.9 kg/m), or obese (≥30 kg/m). We recorded maternal demographics, assessed uterine artery pulsatility index and ophthalmic artery peak systolic velocity ratio, and measured carotid-to-femoral pulse-wave velocity. Preeclampsia development was retrieved from medical records. Multivariable logistic regression was undertaken to examine determinants of preeclampsia. Mediation analysis was performed to assess causal relationships.
In this cohort, 28.4% were overweight and 17.9% were obese. Preeclampsia developed more often in overweight/obese (versus normal weight) women (6.0% versus 1.7%, respectively; <0.001); women of Black and South Asian ethnicity were at particularly increased risk (=0.02 and 0.004, respectively). Determinants of preeclampsia development did not differ by body mass index. Mediation analysis suggested that the effect of overweight/obesity on preeclampsia development may be mediated partly by changes in maternal cardiovascular indices, particularly aortic stiffness (as reflected by carotid-to-femoral pulse-wave velocity, proportion mediated=72.6%).
Risk factors for term preeclampsia are largely similar between overweight/obese and normal-weight women, except for Black and South Asian women, who face a particularly high risk within the overweight/obese group. Maternal vascular assessment may serve as a valuable tool for stratifying the risk for term preeclampsia in these populations.
超重和肥胖会大幅增加子痫前期的风险。有必要在孕期对这些女性进行更好的风险分层，并将资源导向能从预防措施中获益最大的人群。
对英国伦敦国王学院医院11962名单胎妊娠女性进行前瞻性观察研究，这些女性在妊娠35⁺⁰至36⁺⁶周时接受常规评估。根据妊娠11至13周时的体重指数，将女性分为正常体重（18.5 - 24.9kg/m²）、超重（25.0 - 29.9kg/m²）或肥胖（≥30kg/m²）。我们记录了产妇的人口统计学信息，评估了子宫动脉搏动指数和眼动脉收缩期峰值速度比值，并测量了颈动脉 - 股动脉脉搏波速度。从医疗记录中获取子痫前期的发病情况。进行多变量逻辑回归以检查子痫前期的决定因素。进行中介分析以评估因果关系。
在该队列中，28.4%为超重，17.9%为肥胖。超重/肥胖女性（与正常体重女性相比）患子痫前期的情况更常见（分别为6.0%和1.7%；P<0.001）；黑人和南亚族裔女性的风险尤其增加（分别为P = 0.02和0.004）。子痫前期发病的决定因素在体重指数方面没有差异。中介分析表明，超重/肥胖对子痫前期发病的影响可能部分由产妇心血管指标的变化介导，特别是主动脉僵硬度（由颈动脉 - 股动脉脉搏波速度反映，中介比例 = 72.6%）。
除黑人和南亚女性外，超重/肥胖女性和正常体重女性发生足月子痫前期的风险因素在很大程度上相似，而这两个群体在超重/肥胖人群中面临特别高的风险。产妇血管评估可能是对这些人群足月子痫前期风险进行分层的有价值工具。
