Department of Obstetrics and Gynecology
Medical Subject Headings
Pre-Eclampsia; Body Mass Index; Pregnancy; Weight Gain; Obesity; Biological Markers; Angiogenic Proteins
Obstetrics and Gynecology
Objective: In May 2009, after considering short and long-term maternal/child outcomes, the Institute of Medicine (IOM) revised recommendations for gestational weight gain (GWG); however preeclampsia was dismissed due to insufficient evidence. Our objective was to evaluate preeclampsia risk by angiogenic-biomarker profile by both BMI and GWGadherence. Given numerous studies showing adipose tissue's ability to stimulate angiogenesis, we hypothesized that overweight/obese (OW-OB) women and over-gainers (OG) would have altered angiogenic profiles as compared to underweight/normal-weight (UN) women and under-/appropriate-gainers (U-AG), respectively.
Methods: Between 5/04-1/06, serial serum specimens collected from 94 women at high preeclampsia risk between 22-36 weeks. Soluble fms-like tyrosine kinase-1 (sFlt1), placental growth factor (PlGF) and soluble endoglin (sEng) measured by ELISA. BMI and GWG adherence categories determined by 1990 IOM recommendations. Within-women correlation and right-skewness handled by estimating linear mixed models for ln-transformed biomarkers and then exponentiating on ln scale (i.e.geometric means). T-test compared means in 3 windows.
Results: Analytic sample included 82 subjects (342 specimens) without multiples or pregnancy-related hypertension diagnosis. Mean sFlt1 lower in all windows in OW-OB compared to U-N - significant only at 22-26wks [506.2 (95% CI 438.1-584.9) vs 745.5 (95% CI 595.9-932.6) p=0.04] and in OG compared to U-AG with significant comparisons (p=0.05) [22-26wks: 492.1 (95% CI 420.1-576.3) vs 691.3 (95% CI 574.0-832.6); 27-30 wks: 570.1 (95% CI 488.1-665.9) vs 788.8 (95% CI 656.8-947.4)]. Mean PIGF lower in all windows in OW-OB compared to U-N [22-26wks: 430.5 (95% CI 359.0-516.3) vs 588.6 (95% CI 444.3-779.7) p=0.06; 27-30wks: 475.8 (95% CI 398.7-567.8) vs 811.8 (95% CI 614.3-1072.9) p=0.005; 31-36wks: 428.5 (95% CI 358.0-513.0) vs 724.6 (95% CI 548.5-957.1) p=0.01] and in OG compared to U-AG with no significant comparisons. Mean ratio [(sFlt1+sEng):PIGF] trended higher in OW-OB compared to U-N women at 27-30 and 31-36 wks and in OG compared to UAG at 31-36wks; however no windows with significant comparisons.
Conclusion: Findings suggest trends that OW-OB BMI and excessive GWG associated with angiogenic biomarker profiles consistent with higher preeclampsia risk. Exploratory study limited by small numbers. BMI and GWG as potentially modifiable factors merit furtherinvestigation for preeclampsia risk alteration.
Presented at the Society of Gynecologic Investigation 2011 Annual Meeting, March 2011, Miami Beach, Florida.