Maternal obezite ve preeklampsinin perinatal sonuçlar üzerindeki ayrı ve birleşik etkileri: retrospektif dört gruplu bir analiz

Year 2025, Volume: 8 Issue: 6, 1089 - 1098, 25.10.2025

Erkan Sağlam

https://doi.org/10.32322/jhsm.1749370

Abstract

Giriş:
Obezite ve preeklampsi, maternal ve perinatal sonuçları olumsuz etkileyebilen yaygın gebelik komplikasyonlarıdır. Ancak bu iki durumun birleşik etkisi ve gestasyonel kilo alımının (GKA) değiştirici rolü hâlâ net değildir.
Yöntemler:
Bu retrospektif kohort çalışmaya, birinci trimesterdeki beden kitle indeksi (BKİ) ≥30 kg/m² olanlar obez olarak tanımlanmak üzere, preeklampsi (PE) varlığına göre dört gruba ayrılan 400 kadın dahil edildi: preeklampsisiz obez olmayan [PE(-) Ob(-)], preeklampsili obez olmayan [PE(+) Ob(-)], preeklampsisiz obez [PE(-) Ob(+)] ve preeklampsili obez [PE(+) Ob(+)]. Gruplar arasında demografik, obstetrik ve neonatal sonuçlar karşılaştırıldı. Preterm doğum, düşük doğum ağırlığı (DDA), yenidoğan yoğun bakım ünitesi (YYBÜ) yatışı ve düşük Apgar skorları açısından riskleri değerlendirmek için anne yaşı, sigara kullanımı, tüp bebek (IVF) ile gebe kalma ve GKA ile düzeltilmiş lojistik regresyon modelleri kullanıldı. GKA’nın sonuçlar üzerindeki etkisi kısıtlı kübik spline analizi ile değerlendirildi.
Bulgular:
PE(+) Ob(+) grubu, 37. gebelik haftasından önce preterm doğum [aOR: 12,17; %95 GA: 4,36–33,97], 34. haftadan önce preterm doğum [aOR: 18,44; %95 GA: 2,24–151,86], DDA [aOR: 19,61; %95 GA: 6,22–61,81], YYBÜ yatışı [aOR: 12,41; %95 GA: 3,45–44,62] ve 1. ve 5. dakikada düşük Apgar skoru (tüm p < 0,05) açısından en yüksek risklere sahipti. PE(+) Ob(-) grubunda da, 34. haftadan önce preterm doğum ve 5. dakikada düşük Apgar skoru dışında, benzer şekilde artmış riskler gözlendi. Buna karşılık, PE(-) Ob(+) grubunda bu olumsuz sonuçlara yönelik anlamlı bir risk artışı izlenmedi. Spline analizinde, yetersiz GKA’nın PE(+) Ob(+) grubunda riskleri daha da artırabileceği görüldü.
Sonuç:
Bu çalışmada, obezitenin tek başına preterm doğum, düşük doğum ağırlığı, YYBÜ yatışı veya düşük Apgar skoru açısından anlamlı bir risk oluşturmadığı; ancak preeklampsi ile birlikte görüldüğünde bu olumsuz perinatal sonuçların belirgin şekilde kötüleştiği gösterilmiştir. Klinik uygulamada bu birleşik risk göz önünde bulundurulmalı ve olası advers etkileri azaltmak amacıyla gestasyonel kilo alımı dikkatle izlenmelidir.

Keywords

Preeklampsi , Obezite , Perinatal sonuçlar , Gestasyonel kilo alımı , Preterm doğum

Separate and combined effects of maternal obesity and preeclampsia on perinatal outcomes: a retrospective four-group analysis

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.

Keywords

Preeclampsia , obesity , perinatal outcomes , gestational weight gain , preterm birth

References

• Poston L, Caleyachetty R, Cnattingius S, et al. Preconceptional and maternal obesity: epidemiology and health consequences. Lancet Diabetes Endocrinol. 2016;4(12):1025-1036. doi:10.1016/S2213-8587(16) 30217-0
• Langley-Evans SC, Pearce J, Ellis S. Overweight, obesity and excessive weight gain in pregnancy as risk factors for adverse pregnancy outcomes: a narrative review. J Hum Nutr Diet. 2022;35(2):250-264. doi:10.1111/jhn.12999
• Sun Y, Shen Z, Zhan Y, et al. Effects of pre-pregnancy body-mass index and gestational weight gain on maternal and infant complications. BMC Pregnancy Childbirth. 2020;20(1):390. doi:10.1186/s12884-020-03071-y
• Zehravi M, Maqbool M, Ara I. Correlation between obesity, gestational diabetes mellitus, and pregnancy outcomes: an overview. Int J Adolesc Med Health. 2021;33(6):339-345. doi:10.1515/ijamh-2021-0058
• Marchi J, Berg M, Dencker A, Olander EK, Begley C. Risks associated with obesity in pregnancy, for the mother and baby: a systematic review of reviews. Obes Rev. 2015;16(8):621-638. doi:10.1111/obr.12288
• Crane JM, Murphy P, Burrage L, Hutchens D. Maternal and perinatal outcomes of extreme obesity in pregnancy. J Obstet Gynaecol Can. 2013;35(7):606-611. doi:10.1016/S1701-2163(15)30879-3
• Erez O, Romero R, Jung E, et al. Preeclampsia and eclampsia: the conceptual evolution of a syndrome. Am J Obstet Gynecol. 2022;226(2S): S786-S803. doi:10.1016/j.ajog.2021.12.001
• Suksai M, Geater A, Amornchat P, Suntharasaj T, Suwanrath C, Pruksanusak N. Preeclampsia and timing of delivery: disease severity, maternal and perinatal outcomes. Pregnancy Hypertens. 2024;37:101151. doi:10.1016/j.preghy.2024.101151
• Poniedziałek-Czajkowska E, Mierzyński R, Leszczyńska-Gorzelak B. Preeclampsia and obesity-the preventive role of exercise. Int J Environ Res Public Health. 2023;20(2):1267. doi:10.3390/ijerph20021267
• Gestational hypertension and preeclampsia: ACOG practice bulletin, number 222. Obstet Gynecol. 2020;135(6):e237-e260. doi:10.1097/AOG. 0000000000003891
• Rasmussen KM, Yaktine AL, Institute of Medicine (US) and National Research Council (US) Committee to Reexamine IOM Pregnancy Weight Guidelines, eds. Weight Gain During Pregnancy: Reexamining the Guidelines. Washington (DC): National Academies Press (US); 2009.
• Abalos E, Cuesta C, Carroli G, et al. Pre-eclampsia, eclampsia and adverse maternal and perinatal outcomes: a secondary analysis of the World Health Organization Multicountry Survey on Maternal and Newborn Health. BJOG. 2014;121(Suppl 1):14-24. doi:10.1111/1471-0528. 12629
• Cnattingius S, Villamor E, Johansson S, et al. Maternal obesity and risk of preterm delivery. JAMA. 2013;309(22):2362-2370. doi:10.1001/jama. 2013.6295
• Li L, Chen Y, Lin Z, et al. Association of pre-pregnancy body-mass index with adverse pregnancy outcome among first-time mothers. PeerJ. 2020;8:e10123. doi:10.7717/peerj.10123
• Su XJ, Huang SJ, Li X, Du QL. Prepregnancy overweight and obesity are associated with an ıncreased risk of preterm birth in Chinese women. Obes Facts. 2020;13(2):237-244. doi:10.1159/000506688
• Jeyabalan A. Epidemiology of preeclampsia: impact of obesity. Nutr Rev. 2013;71(Suppl 1):S18-S25. doi:10.1111/nure.12055
• McDonald SD, Han Z, Mulla S, Beyene J; Knowledge Synthesis Group. Overweight and obesity in mothers and risk of preterm birth and low birth weight infants: systematic review and meta-analyses. BMJ. 2010; 341:c3428. doi:10.1136/bmj.c3428
• Lewandowska M. Maternal obesity and risk of low birth weight, fetal growth restriction, and macrosomia: multiple analyses. Nutrients. 2021; 13(4):1213. doi:10.3390/nu13041213
• Phipps E, Prasanna D, Brima W, Jim B. Preeclampsia: updates in pathogenesis, definitions, and guidelines. Clin J Am Soc Nephrol. 2016; 11(6):1102-1113. doi:10.2215/CJN.12081115
• McIntyre HD, Gibbons KS, Flenady VJ, Callaway LK. Overweight and obesity in Australian mothers: epidemic or endemic? Med J Aust. 2012; 196(3):184-188. doi:10.5694/mja11.11120
• Mbah AK, Kornosky JL, Kristensen S, et al. Super-obesity and risk for early and late pre-eclampsia. BJOG. 2010;117(8):997-1004. doi:10.1111/j. 1471-0528.2010.02593.x
• O’Brien TE, Ray JG, Chan WS. Maternal body-mass index and the risk of preeclampsia: a systematic overview. Epidemiology. 2003;14(3):368-374. doi:10.1097/00001648-200305000-00020
• Melchor I, Burgos J, Del Campo A, Aiartzaguena A, Gutiérrez J, Melchor JC. Effect of maternal obesity on pregnancy outcomes in women delivering singleton babies: a historical cohort study. J Perinat Med. 2019;47(6):625-630. doi:10.1515/jpm-2019-0103
• Asemota O, Bryson L, Fogel J. Neonatal outcomes in obese pregnant women who develop preeclampsia. Pregnancy Hypertens. 2020;21:191-196. doi:10.1016/j.preghy.2020.05.016