Impact of Body Mass Index on Disease Severity and Maternal–Neonatal Outcomes in Preeclampsia: A Retrospective Study

Öz

ABSTRACT Objective: This study aimed to evaluate the effect of different classes of maternal obesity on neonatal intensive care unit (NICU) admission and to identify independent predictors of neonatal outcomes in pregnancies complicated by preeclampsia. Methods: In this retrospective cohort study, 635 pregnant women diagnosed with preeclampsia who delivered between 2019 and 2025 were included. Participants were grouped according to body mass index (BMI) based on World Health Organization classifications. Maternal and neonatal outcomes were compared across BMI categories. Multivariate logistic regression analysis was also used to identify independent predictors of NICU admission. Results: Overall, 44.4% of neonates required NICU admission. Admission rates were similar across BMI categories (p = 0.516), and BMI was not identified as an independent predictor in multivariate analysis (all p > 0.05). Gestational age at delivery showed the strongest association with NICU admission, with each additional week significantly lowering the risk (OR = 0.64, 95% CI: 0.59–0.70, p < 0.001). Severe preeclampsia (OR = 1.61, p = 0.015) and maternal comorbidities (OR = 1.60, p = 0.027) were associated with increased risk, whereas higher parity was associated with a reduced risk (OR = 0.72, p < 0.001). Conclusion: In pregnancies complicated by preeclampsia, NICU admission is mainly associated with gestational age at delivery, disease severity, and maternal comorbidities rather than maternal BMI. Although maternal obesity is linked to the development of preeclampsia, it does not appear to independently affect neonatal outcomes once the condition has developed. Neonatal prognosis seems to be driven largely by clinical factors, particularly prematurity.

Anahtar Kelimeler

• Preeclampsia
• Body Mass Index
• Disease Severity
• Maternal Outcomes
• Neonatal Outcomes

Destekleyen Kurum

This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.

Etik Beyan

This study was approved by the Institutional Ethics Committee, and all procedures were conducted in accordance with the principles of the Declaration of Helsinki. Due to the retrospective design of the study, the requirement for informed consent was waived.

Teşekkür

The authors would like to thank all healthcare professionals who contributed to the management of the patients included in this study.

Preeklampside Vücut Kitle İndeksinin Hastalık Şiddeti ve Maternal–Neonatal Sonuçlar Üzerine Etkisi: Retrospektif Bir Çalışma

Öz

ÖZET Amaç: Bu çalışmanın amacı, maternal obezitenin farklı sınıflarının yenidoğan yoğun bakım ünitesi (YYBÜ) yatışı üzerindeki etkisini değerlendirmek ve preeklampsi ile komplike gebeliklerde neonatal sonuçların bağımsız belirleyicilerini saptamaktır. Yöntemler: Bu retrospektif kohort çalışmasına, 2019–2025 yılları arasında doğum yapan ve preeklampsi tanısı almış 635 gebe dahil edildi. Katılımcılar, Dünya Sağlık Örgütü sınıflamasına göre vücut kitle indeksine (VKİ) göre gruplandırıldı. Maternal ve neonatal sonuçlar VKİ kategorileri arasında karşılaştırıldı. Ayrıca, YYBÜ yatışının bağımsız belirleyicilerini belirlemek amacıyla çok değişkenli lojistik regresyon analizi kullanıldı. Bulgular: Yenidoğanların %44,4’ü YYBÜ yatışı gerektirdi. Yatış oranları VKİ kategorileri arasında benzerdi (p = 0.516) ve çok değişkenli analizde VKİ bağımsız bir belirleyici olarak saptanmadı (tüm p > 0.05). Doğum haftası, YYBÜ yatışı ile en güçlü ilişkili değişken olup, her bir haftalık artış riski anlamlı şekilde azaltmaktaydı (OR = 0.64, %95 GA: 0.59–0.70, p < 0.001). Şiddetli preeklampsi (OR = 1.61, p = 0.015) ve maternal komorbiditeler (OR = 1.60, p = 0.027) artmış risk ile ilişkili bulunurken, yüksek parite azalmış risk ile ilişkiliydi (OR = 0.72, p < 0.001). Sonuç: Preeklampsi ile komplike gebeliklerde YYBÜ yatışı, maternal VKİ’den ziyade doğum haftası, hastalık şiddeti ve maternal komorbiditeler ile ilişkilidir. Maternal obezite preeklampsi gelişimi ile ilişkili olsa da, hastalık geliştikten sonra neonatal sonuçları bağımsız olarak etkilememektedir. Neonatal prognoz büyük ölçüde klinik faktörler, özellikle prematürite tarafından belirlenmektedir.

Anahtar Kelimeler

• Preeklampsi
• Vücut Kitle İndeksi
• Hastalık Şiddeti
• Maternal Sonuçlar
• Neonatal Sonuçlar

Destekleyen Kurum

Bu çalışma, kamu, ticari veya kar amacı gütmeyen kuruluşlardan herhangi bir özel fon almamıştır.

Etik Beyan

Bu çalışma, Kurumsal Etik Kurul tarafından onaylanmış olup, tüm prosedürler Helsinki Deklarasyonu ilkelerine uygun olarak yürütülmüştür. Çalışmanın retrospektif tasarımı nedeniyle bilgilendirilmiş onam alınması gerekliliği kaldırılmıştır.

Teşekkür

Yazarlar, bu çalışmaya dahil edilen hastaların yönetiminde katkı sağlayan tüm sağlık çalışanlarına teşekkür eder.

Kaynakça

1. 1. Alves FCR, Moreira A, Moutinho O. Maternal and long-term offspring outcomes of obesity during pregnancy. Arch Gynecol Obstet. 2024;309(6):2315-21.
2. 2. Yang Z, Feng G, Gao X, Yan X, Li Y, Wang Y, et al. Maternal adiposity and perinatal and offspring outcomes: an umbrella review. Nat Hum Behav. 2024;8(12):2406-22.
3. 3. Mackeen AD, Boyd VE, Schuster M, Young AJ, Gray C, Angras K. The impact of prepregnancy body mass index on pregnancy and neonatal outcomes. J Osteopath Med. 2024;124(10):447-53.
4. 4. Jones SI, Rosenthal EA, Pruszynski JE, Cunningham FG. The Dose-Dependent Effect of Obesity on Adverse Maternal and Neonatal Outcomes in a Hispanic Population. Am J Perinatol. 2025;42(12):1594-602.
5. 5. Ali M, Ahmed M, Memon M, Chandio F, Shaikh Q, Parveen A, et al. Preeclampsia: A comprehensive review. Clin Chim Acta. 2024;563:119922.
6. 6. Xiong Y, Chen J, Wu Y, Zhao P, Liao M, Guo J, et al. The effect of maternal pre-pregnancy body mass index on hypertensive disorders of pregnancy (HDP): a systematic review and dose-response meta-analysis of cohort studies involving 50 million pregnancies. EClinicalMedicine. 2025;86:103395.
7. 7. Xiang C, Sui L, Ding X, Cao M, Li G, Du Z. Maternal adiposity measures and hypertensive disorders of pregnancy: a meta-analysis. BMC Pregnancy Childbirth. 2024;24(1):675.
8. 8. Neal K, Ullah S, Glastras SJ. Obesity Class Impacts Adverse Maternal and Neonatal Outcomes Independent of Diabetes. Front Endocrinol (Lausanne). 2022;13:832678.

9. 9. Addicott K, Nudelman M, Putty K, Prasher P, Preston D, Yoost JL, et al. Adverse Perinatal Outcomes Associated with Increasing Maternal Obesity. Am J Perinatol. 2024;41(9):1275-81.
10. 10. Lisonkova S, Sabr Y, Mayer C, Young C, Skoll A, Joseph KS. Maternal Morbidity Associated With Early- Onset and Late-Onset Preeclampsia. Obstet Gynecol 2014;124(4):771-781.
11. 11. Rocha G. Consequences of early-onset preeclampsia on neonatal morbidity and mortality. Minerva Pediatr (Torino). 2023;75(1):87-97.
12. 12. Razaz N, Bolk J, Graham H, Tsamantioti E, Johansson K, Persson M, et al. Severe Neonatal Morbidity Across Gestational Age: Monitoring Infants at High Risk of Mortality. Acta Paediatr. 2025;114(8):1847-56.
13. 13. Hutcheon JA, Lisonkova S, Joseph KS. Epidemiology of pre-eclampsia and the other hypertensive disorders of pregnancy. Best Pract Res Clin Obstet Gynaecol. 2011;25(4):391-403.
14. 14. Li X, Kang F, Li X, Du X, Yang Y. Comparison of Characteristics Between Early-Onset and Late-Onset Severe Preeclampsia: A Retrospective Cohort Study from a Tertiary Hospital in China. Reprod Sci. 2025;32(1):139- 49.
15. 15. Wu C, Ling Z, Wang Y, Lv Y, Miao Z, Liu L, et al. Clinical Analysis of Risk Factors and Perinatal Outcomes in Recurrent Pre-Eclampsia with Severe Features. Reprod Sci. 2024;31(9):2763-70.
16. 16. Tanner MS, Malhotra A, Davey MA, Wallace EM, Mol BW, Palmer KR. Maternal and neonatal complications in women with medical comorbidities and preeclampsia. Pregnancy Hypertens. 2022;27:62-8.
17. 17. Chai L, Li S, Yin B, Zhu X, Zhu B, Wu K. Prevalence, risk factors, and adverse perinatal outcomes in Chinese women with preeclampsia: a large retrospective cohort study. J Health Popul Nutr. 2025;44(1):32.
18. 18. Duckitt K, Harrington D. Risk factors for pre-eclampsia at antenatal booking: systematic review of controlled studies. BMJ. 2005;330(7491):565.
19. 19. Dai J, Shi Y, Wu Y, Guo L, Lu D, Chen Y, et al. The interaction between age and parity on adverse pregnancy and neonatal outcomes. Front Med (Lausanne). 2023;10:1056064.
20. 20. van Rensburg EJ, Seopela LB, Snyman LC. Determining the relationship between severity of proteinuria and adverse maternal and neonatal outcomes in patients with preeclampsia. Pregnancy Hypertens. 2024;38:101155.
21. 21. Wu X, Gu H, Wang J. Impact of hypertensive disorders of pregnancy on maternal and neonatal outcomes of twin gestation: a systematic review and meta-analysis. Front Pediatr. 2023;11:1210569.