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

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

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