@article{article_1749370, title={Separate and combined effects of maternal obesity and preeclampsia on perinatal outcomes: a retrospective four-group analysis}, journal={Journal of Health Sciences and Medicine}, volume={8}, pages={1089–1098}, year={2025}, DOI={10.32322/jhsm.1749370}, author={Sağlam, Erkan}, keywords={Preeclampsia, obesity, perinatal outcomes, gestational weight gain, preterm birth}, abstract={Aims: Obesity and preeclampsia are common complications that can negatively affect maternal and perinatal outcomes. However, their combined impact and the modifying role of gestational weight gain (GWG) remain unclear. Methods: This retrospective cohort included 400 women classified into four groups by first-trimester BMI (obesity ≥30 kg/m²) and the presence of preeclampsia (PE): PE(-) Ob(-), PE(+) Ob(-), PE(-) Ob(+), and PE(+) Ob(+). From 2,600 eligible records, we used stratified random sampling to select 100 women per group (no covariate matching) to ensure balanced precision. Demographic, obstetric, and neonatal outcomes were compared across groups. Risks of preterm birth ( <37 and <34 weeks), low birth weight, neonatal intensive care unit (NICU) admission, and low Apgar scores were estimated with logistic regression adjusted for maternal age, smoking, in vitro fertilization, and gestational weight gain (GWG); a PE×Ob interaction term was tested. To examine GWG as a continuous exposure, we fitted restricted cubic spline models. Analyses were complete-case. Results: The PE(+) Ob(+) group had the highest absolute event rates: preterm birth <37 weeks occurred in 38% compared with 5% in the PE(-) Ob(-) group; preterm birth <34 weeks in 12% vs 1%; low birth weight in 37% vs 4%; NICU admission in 25% vs 3%; 1-minute Apgar <7 in 22% vs 4%; and 5-minute Apgar <7 in 13% vs 2%. Adjusted analyses confirmed markedly elevated odds for these outcomes-preterm birth <37 weeks (aOR 12.17; 95% CI 4.36-33.97), preterm birth <34 weeks (aOR 18.44; 95% CI 2.24-151.86), low birth weight (aOR 19.61; 95% CI 6.22-61.81), NICU admission (aOR 12.41; 95% CI 3.45-44.62), and low Apgar scores at 1 and 5 minutes (all p <0.05). The PE(+) Ob(-) group also showed increased risks for most of these outcomes except preterm birth <34 weeks and low 5-minute Apgar scores, whereas the PE(-) Ob(+) group did not demonstrate significant associations. Restricted cubic spline analysis suggested that inadequate gestational weight gain may further increase these risks in the PE(+) Ob(+) group. Conclusion: Obesity alone was not associated with increased risk, whereas co-occurrence with preeclampsia was associated with substantially higher risks; no significant PE×Ob interaction was detected. Careful monitoring of gestational weight gain in such pregnancies is warranted.}, number={6}, publisher={MediHealth Academy Yayıncılık}