Research www. AJOG.

org

OBSTETRICS
Prepregnancy body mass index, gestational weight gain,
and risk of hypertensive pregnancy among Latina women
Renée Turzanski Fortner, BS; Penelope Pekow, PhD; Caren G. Solomon, MD, MPH;
Glenn Markenson, MD; Lisa Chasan-Taber, ScD

OBJECTIVE: Prepregnancy body mass index (BMI) and gestational
weight gain have been associated with hypertensive disorders of preg-
nancy, but previous studies have included few Latinas, a group at in-
creased risk.
STUDY DESIGN: We examined these associations in the Latina Gesta-
tional Diabetes Mellitus Study, a prospective cohort of 1231 women
conducted from 2000 to 2004.
RESULTS: In multivariable analysis, obese women (BMI ⬎ 29.0 kg/
m2) had 2.5 times the risk of hypertensive pregnancy (95% confidence
interval [CI], 1.3-4.8) and 2.7 times the risk of preeclampsia (95% CI,
1.2-5.8), compared with women whose BMI was 19.8 to 26.0 kg/m2.
Women with excessive gestational weight gain had a 3-fold increased
risk of a hypertensive disorder of pregnancy (95% CI, 1.1-7.2) and a
4-fold risk of preeclampsia (95% CI, 1.2-14.5), compared with women
achieving weight gain guidelines.
CONCLUSION: These findings suggest prepregnancy obesity and ex-
cessive weight gain are associated with hypertension in pregnancy in a
Latina population and could be potentially modifiable risk factors.
Key words: body mass index, hypertensive pregnancy, weight gain

Cite this article as: Fortner RT, Pekow P, Solomon CG, et al. Prepregnancy body mass index, gestational weight gain, and risk of hypertensive pregnancy among
Latina women. Am J Obstet Gynecol 2009;200:167.e1-167.e7.

H ypertensive disorders of preg-

nancy are associated with mater-
nal, fetal, and neonatal morbidity and
ulation in 1990 to 12.5% in 2000.6 Lati-
nas have a higher birth rate than non-
Latinas, with 23.1 births per 1000
sive disorders of pregnancy for over-
weight or obese women.8-10
Excessive gestational weight gain has
mortality.1,2 In the long term, hyperten- population for Latinas vs 13.2 births per been suggested as a risk factor for gesta-
sion in pregnancy has been linked to sub- 1000 population for non-Latinas,7 un- tional hypertension11 and preeclamp-
sequent chronic hypertension and car- derscoring the importance of studying sia.12 However, prior studies have been
diovascular disease in women.3 Studies maternal outcomes in this population. limited by inconsistent categorizations
to date indicate a higher risk of pre- There are few modifiable risk factors of maternal weight gain, and in some
eclampsia in Latina women as compared for pregnancy-related hypertensive dis- cases, restriction of the study population
with non-Latina white women,4 al- orders, and recent evidence suggests that to 1 BMI class (ie, restricted to normal
though findings have varied among dif- body mass index (BMI) and maternal weight women). In addition, there are
ferent Latina subgroups.5 weight gain may be important factors. few data on this relationship in Latina
The Latina population has grown over Prior research on prepregnancy BMI has women, although some risk factors for
the past decade, from 9% of the US pop- suggested an increased risk of hyperten- preeclampsia vary between women of
different ethnic origins.13 We evaluated
the relationship between prepregnancy
From the Division of Biostatistics and Epidemiology, Department of Public Health, School of body mass index and gestational weight
Public Health and Health Sciences, University of Massachusetts, Amherst, MA (Ms Fortner gain and hypertensive disorders of preg-
and Drs Pekow and Chasan-Taber); Brigham and Women’s Hospital and Harvard Medical
nancy among Latina participants, pri-
School, Boston, MA (Dr Solomon); and the Department of Maternal-Fetal Medicine,
marily of Puerto Rican descent, in the
Baystate Medical Center, Springfield, MA (Dr Markenson).
Latina Gestational Diabetes Mellitus
Presented at the 40th Annual Meeting of the Society for Epidemiologic Research, Boston MA,
June 19-22, 2007; and the 20th Annual Meeting of the Society for Perinatal and Pediatric
Study.
Epidemiology, Boston, MA, June 18-19, 2007.
Received April 23, 2008; revised July 14, 2008; accepted Aug. 11, 2008.
M ATERIALS AND M ETHODS
Reprints: Lisa Chasan-Taber, ScD, Division of Biostatistics and Epidemiology, School of Public Study design and population
Health and Health Sciences, 405 Arnold House, University of Massachusetts, 715 North Pleasant
St, Amherst, MA 01003-9304. lct@schoolph.umass.edu.
Details of the study design have been pre-
This study was supported in part by an American Diabetes Association Career Development
sented elsewhere.14,15 Briefly, the Latina
Award (7-00-CD-02) (to L.C.-T.). Gestational Diabetes Mellitus Study was a
0002-9378/$36.00 • © 2009 Mosby, Inc. All rights reserved. • doi: 10.1016/j.ajog.2008.08.021 prospective cohort study conducted from
2000 to 2004 at Baystate Medical Center, a

FEBRUARY 2009 American Journal of Obstetrics & Gynecology 167.e1

Research Obstetrics
tertiary care hospital in Springfield, MA.
The overall goal of the study was to evalu-
ate the association between physical activ-
ity and gestational diabetes mellitus
(GDM). Women who self-identified as
Latina were recruited into the study from
Baystate’s public obstetrics and midwifery
clinics by trained interviewers prior to 24
weeks’ gestation (mean, 15 weeks’
gestation).
Exclusion criteria for this study in-
cluded multiple gestation, preexisting
diabetes, hypertension, heart disease,
chronic renal disease, and use of medica-
tions thought to affect glucose tolerance.
Additionally, women younger than 16
years old or older than 40 years old and
those who previously participated in this
study were excluded.
For the purposes of the current analy-
sis, women who terminated their preg-
nancies or had a miscarriage (n ⫽ 34) or
for whom no delivery information was
available (n ⫽ 154) were excluded, re-
sulting in a final sample size of 1043
women. We then excluded 19 women
with missing pregravid height or weight
from the analysis, with pregravid BMI as
the primary exposure variable, and 168
women missing gestational weight gain
data from the analysis, with gestational
weight gain as the primary exposure
variable. The study was approved by the
institutional review boards of the Uni-
versity of Massachusetts-Amherst and
Baystate Medical Center.
Assessment of prepregnancy BMI
Prepregnancy weight was recorded in the
medical record and was defined as weight
at last menstrual period (LMP) as self-re-
ported by the patient at the time of her first
prenatal care visit. In those cases in which
prepregnancy weight was not recorded in
the medical record (12%), self-reported
prepregnancy weight, obtained by the bi-
lingual interviewers at the time of enroll-
ment, was used. Height was obtained from
medical records as self-reported by pa-
tients at their first prenatal care visit. BMI
was classified using the Institute of Medi-
cine classifications: underweight, BMI less
than 19.8 kg/m2; normal weight, BMI 19.8
to 26.0 kg/m2; overweight, BMI 26.1 to
29.0 kg/m2; and obese, BMI ⬎ 29.0
kg/m2.16
167.e2 American Journal of Obstetrics & Gynecology FEBRUARY 2009
Assessment of gestational
weight gain
Gestational weight gain was derived by
subtracting weight at LMP from last re-
corded pregnancy weight recorded from
the antepartum obstetrical record. Ges-
tational weight gain was classified as in-
adequate, adequate, or excessive based
on the Institute of Medicine guidelines
for gestational weight gain.16 These
guidelines indicate a weight gain of 12.5
to 18 kg (28-40 pounds) for women with
a prepregnancy BMI of less than 19.8 kg/
m2; 11.5 to 16 kg (25-35 pounds) for
women with a prepregnancy BMI of 19.8
to 26.0 kg/m2; and 7 to 11.5 kg (15-25
pounds) for women with a prepregnancy
BMI greater than 26.0 to 29.0 kg/m2. The
recommendation for obese women
(BMI ⬎ 29.0 kg/m2) is at least 6.8 kg (15
pounds), but an upper limit for weight
gain is not suggested. For the purpose of
this analysis, we assigned obese women the
same upper guideline as overweight
women, as have others.17,18
Assessment of hypertensive
disorders of pregnancy
Cases of gestational hypertension and
preeclampsia were identified through
postdelivery review of medical records
and confirmed by a single obstetrician.
Gestational hypertension and pre-
eclampsia were defined according to the
criteria of the National High Blood Pres-
sure Education Program Working
Group on High Blood Pressure in Preg-
nancy19 as 2 blood pressure measure-
ments greater than 140/90 mm Hg re-
corded after the 20th week of pregnancy,
with no laboratory evidence or symp-
toms of preeclampsia.
Preeclampsia was defined as blood
pressure greater than 140/90 mm Hg on
2 occasions, with proteinuria or neuro-
logic symptoms. HELLP (hemolysis, ele-
vated liver enzymes, and low platelets)
syndrome diagnoses were included
within the diagnosis of preeclampsia.
Women with gestational hypertension
and preeclampsia were analyzed to-
gether as general hypertensive disorders
of pregnancy, and an additional analysis
was performed for preeclampsia inde-
pendent of gestational hypertension.
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Assessment of covariates
Information on potential risk factors
for gestational hypertension and pre-
eclampsia was obtained through both
medical record abstraction and a struc-
tured interview at the time of recruit-
ment. Age and parity were obtained
from the medical records. Education and
income were self-reported, as were
smoking status and drug use. Accultura-
tion was measured via birthplace and
language preference (English or Span-
ish). Diagnosis of GDM was abstracted
from medical records.
Statistical analysis
Multivariable logistic regression was
used to model the relationship between
prepregnancy BMI and gestational
weight gain and risk of overall hyperten-
sive disorders of pregnancy, as well as
preeclampsia alone. Confounders were
evaluated by running the models with
and without the potential confounder.
Any covariate that changed the estimate
for prepregnancy BMI or gestational
weight gain by 10% or greater was re-
tained in the final model.
We calculated odds ratios (ORs) and
95% confidence intervals (CIs), as well as
the P value for trend. Given that prior
studies have noted differences in birth
outcomes according to acculturation to
the US culture,20 we hypothesized that
acculturation may modify the effect of
BMI or gestational weight gain on risk of
hypertensive disorders of pregnancy.
Therefore, we evaluated interaction ac-
cording to birthplace as a proxy for ac-
culturation. Additionally, we evaluated
potential interaction between prepreg-
nancy BMI and gestational weight gain.
Interaction was evaluated by inspec-
tion of stratum-specific ORs, and in-
cluding multiplicative interaction terms
in the multivariable models, and assess-
ing their statistical significance using
likelihood ratio ␹2 tests. Tests for trend
across ordered categories were per-
formed by modeling the categorical BMI
and gestational weight gain variables as
continuous variables (ie, 1, 2, 3, and 4,
corresponding to low, normal, over-
weight, and obese BMI and 1, 2, and 3,
corresponding to low weight gain, ade-
quate weight gain, and high weight gain,
www.AJOG.org
respectively). The data analysis was per-
formed using SAS software, version 9.1
(SAS Institute, Cary, NC).
R ESULTS
Details of the study population have
been reported elsewhere.14,15 The major-
ity of participants were aged 24 years and
younger (71%), with a mean age of 22.5
years; had not completed high school
(56%); and reported an income less than
$15,000 per year (57%). Hypertensive
disorders of pregnancy were diagnosed
in 5% (n ⫽ 50) of the study population,
with gestational hypertension diagnosed
in 2% (n ⫽ 20) and preeclampsia diag-
nosed in 3% (n ⫽ 30) of participants.
A majority of participants (53.5%)
were born in the continental United
States, whereas 46.5% were Puerto Rican
or foreign born. Among participants
born in the continental United States,
the majority reported both parents as
born outside the continental United
States (67.5%), and 90% had at least 1
parent born in Puerto Rico. Participants
born outside the continental United
States were most commonly born in
Puerto Rico (84.5%), followed by Mex-
ico (2.4%), and the Dominican Republic
(2.0%), with smaller proportions born
in Central and South America.
Nulliparity was strongly and positively
associated with risk of hypertensive dis-
orders of pregnancy, whereas age, educa-
tion, income, birthplace, language pref-
erence, smoking, and drug use were not
significantly associated with this risk
(Table 1). Findings were similar for risk
of preeclampsia, with nulliparity as well
as drug use being strongly and positively
associated.
Among the participants, 27.9% were
categorized as obese, 14.4% were over-
weight, 46.0% were normal weight, and
11.7% were underweight before preg-
nancy (Table 2). In unadjusted analyses,
obese women had a 2-fold increased risk
of hypertensive disorders (95% CI, 1.1-
3.8) and preeclampsia (95% CI, 0.9-4.2)
as compared with normal-weight
women (Table 2).
In multivariable analyses, findings
were strengthened. Specifically, obese
women had 2.5 times the risk (95% CI,
1.3-4.8; Ptrend ⫽ .003) of developing a hy-
pertensive disorder of pregnancy and 2.7
times the risk (95% CI, 1.2-5.8, Ptrend ⫽
.003) of developing preeclampsia as
compared with normal-weight women.
In addition, a significant trend from
low to obese BMI categories was ob-
served. When we evaluated BMI as a
continuous variable, we observed a sig-
nificant 9% increase in risk of hyperten-
sive disorder of pregnancy (95% CI,
1.05-1.13) and 7% increase in risk of pre-
eclampsia (95% CI, 1.02-1.12) for every
unit increase in BMI.
In terms of gestational weight gain,
32.3% of the participants experienced
adequate weight gain, 24.3% had inade-
quate weight gain, and 43.4% had exces-
sive weight gain (Table 3). Women with
excessive weight gain had a 4-fold in-
creased risk of hypertensive disorders
(OR, 4.0; 95% CI, 1.6-9.6) and almost a
6-fold increased risk of preeclampsia
(OR, 5.8; 95% CI, 1.7-19.6) as compared
with women with adequate weight gain
(Table 3). After controlling for prepreg-
nancy BMI and parity, findings were at-
tenuated but remained strong and statis-
tically significant for hypertensive
disorders (OR, 2.9; 95% CI, 1.1-7.2;
Ptrend ⫽ .07) and preeclampsia (OR, 4.2;
95% CI, 1.2-14.5; Ptrend ⫽ .02). When we
evaluated gestational weight gain as a
continuous variable, we found an in-
creased risk of hypertensive disorders
(OR, 1.09; 95% CI, 0.99-1.2) and pre-
eclampsia (OR, 1.14; 95% CI, 1.02-1.28)
with each 5-pound increase in gesta-
tional weight gain.
We did not observe significant inter-
actions between prepregnancy BMI and
gestational weight gain, prepregnancy
BMI and birthplace, or gestational
weight gain and birthplace, although it is
important to note that this analysis was
limited by the small number of cases.
Prior studies have suggested an associa-
tion between GDM and development of
hypertension in pregnancy.21 Therefore,
we repeated the analysis, adjusting for
current diagnosis of GDM. The findings
were essentially unchanged.
Finally, we compared the mean gesta-
tional weight gain as well as the gesta-
tional age at delivery for women who de-
veloped preeclampsia as compared with
FEBRUARY 2009 American Journal of Obstetrics & Gynecology
Obstetrics Research
those who were free from hypertensive
disorders of pregnancy. The preeclamp-
tic group gained a mean of 39.8 pounds
(SD, 16.8) whereas the normotensive
group gained on average 30.6 pounds
(SD, 15.6; P ⫽ .002). In terms of gesta-
tional age at delivery, the preeclamptic
group delivered slightly earlier (mean,
36.7 weeks; SD, 4.1) as compared with
the normotensive group (mean, 38.5
weeks; SD, 2.6; P ⫽ .04).
A total of 168 participants (16%) were
missing gestational weight gain data be-
cause of missing information on delivery
weight (n ⫽ 160), prepregnancy weight
(n ⫽ 3), or height (n ⫽ 5). However, we
observed no significant differences be-
tween women with weight gain data and
those missing weight gain data with re-
gard to BMI, education, income, parity,
smoking, or drug use, although women
missing weight gain data were older (P ⫽
.001), more frequently born outside the
United States (P ⫽ .001), and more likely
to prefer to speak Spanish (P ⫽ .0005).
C OMMENT
In this prospective cohort of Latina
women of predominantly Puerto Rican
descent, we found that women with
prepregnancy obesity had nearly a 3-fold
risk for both hypertensive disorders and
preeclampsia relative to women with a
prepregnancy BMI in the normal range. In
addition, women with excessive gesta-
tional weight gain had an almost 3-fold risk
of hypertensive disorders of pregnancy
and a 4-fold risk of preeclampsia relative to
women who gained weight within the In-
stitute of Medicine guidelines.
The results of this analysis are in the
same direction and of the same general
magnitude of those reported in previous
studies in predominantly non-Latina
white populations.10,22-25 Wolf et al4
conducted a prospective cohort study of
3244 women, 863 (27%) of whom were
Latina and primarily from Central and
South America and Puerto Rico. Find-
ings were not stratified by ethnicity.
However, in the total sample, the relative
risk for gestational hypertension associ-
ated with each unit increase in BMI (in
kilograms per meter squared) was 1.04
(95% CI, 1.01-1.07) and, for preeclamp-
167.e3
Research Obstetrics www.AJOG.org

TABLE 1
Odds ratios of hypertensive disorder of pregnancy and preeclampsia by participant
characteristics: Latina Gestational Diabetes Mellitus Study, 2000-2004
Hypertensive disorder (n ⴝ 50) Preeclampsia (n ⴝ 30)
a
Variable n % Cases % OR 95% CI Cases % OR 95% CI
Age, y
.......................................................................................................................................................................................................................................................................................................................................................................
16-19 417 33.9 20 5.6 1.0 Referent 16 4.6 1.0 Referent
.......................................................................................................................................................................................................................................................................................................................................................................
20-24 455 36.9 17 4.4 0.8 0.4-1.5 9 2.4 0.5 0.2-1.6
.......................................................................................................................................................................................................................................................................................................................................................................
25-29 225 18.3 5 2.7 0.5 0.2-1.2 2 1.1 0.2 0.05-1.0
.......................................................................................................................................................................................................................................................................................................................................................................
30-40 134 10.9 8 6.8 1.2 0.5-2.9 3 2.7 0.6 0.2-1.9
................................................................................................................................................................................................................................................................................................................................................................................
Parity
.......................................................................................................................................................................................................................................................................................................................................................................
0 live births 466 38.7 32 7.9 1.0 Referent 22 5.4 1.0 Referent
.......................................................................................................................................................................................................................................................................................................................................................................
1 live birth 368 30.5 9 2.8 0.3 0.2-0.7 5 1.5 0.3 0.1-0.7
.......................................................................................................................................................................................................................................................................................................................................................................
ⱖ 2 live births 371 30.8 9 2.8 0.3 0.2-0.7 3 0.9 0.2 0.05-0.5
................................................................................................................................................................................................................................................................................................................................................................................
Diagnosis of GDM
.......................................................................................................................................................................................................................................................................................................................................................................
No 940 91.4 41 4.4 1.0 Referent 23 2.5 1.0 Referent
.......................................................................................................................................................................................................................................................................................................................................................................
Yes 33 3.2 4 12.1 3.0 1.0-9.0 3 9.4 4.0 1.1-14.2
.......................................................................................................................................................................................................................................................................................................................................................................
Not screened 55 5.3 2 3.6 0.8 0.2-3.5 2 3.6 1.5 0.3-6.4
................................................................................................................................................................................................................................................................................................................................................................................
Education
.......................................................................................................................................................................................................................................................................................................................................................................
⬍ high school 603 55.6 19 3.6 1.0 Referent 12 2.3 1.0 Referent
.......................................................................................................................................................................................................................................................................................................................................................................
High school/trade or technical school 345 31.8 19 6.3 1.8 0.9-3.5 12 4.0 1.8 0.8-4.0
.......................................................................................................................................................................................................................................................................................................................................................................
Some college 137 12.6 7 6.1 1.7 0.7-4.2 4.0 3.5 1.5 0.5-4.9
................................................................................................................................................................................................................................................................................................................................................................................
Income
.......................................................................................................................................................................................................................................................................................................................................................................
ⱕ $15,000 390 57.2 22 6.4 1.0 Referent 11 3.3 1.0 Referent
.......................................................................................................................................................................................................................................................................................................................................................................
$15-29,999 219 32.1 8 4.4 0.7 0.3-1.5 7 3.8 1.2 0.5-3.1
.......................................................................................................................................................................................................................................................................................................................................................................
ⱖ $30,000 73 10.7 2 3.3 0.5 0.1-2.2 1 1.7 0.5 0.1-4.0
................................................................................................................................................................................................................................................................................................................................................................................
Birthplace
.......................................................................................................................................................................................................................................................................................................................................................................
United States 597 54.6 24 4.7 1.0 Referent 17 3.4 1.0 Referent
.......................................................................................................................................................................................................................................................................................................................................................................
Other 496 45.4 20 4.6 0.97 0.5-1.8 11 2.6 0.7 0.3-1.6
................................................................................................................................................................................................................................................................................................................................................................................
Preferred language
.......................................................................................................................................................................................................................................................................................................................................................................
English only 808 66.8 31 4.6 1.0 Referent 19 2.9 1.0 Referent
.......................................................................................................................................................................................................................................................................................................................................................................
Spanish only 182 14.3 5 3.3 1.42 0.7-2.8 5 3.3 0.9 0.3-2.4
.......................................................................................................................................................................................................................................................................................................................................................................
Either 229 18.9 13 6.4 0.69 0.3-1.8 5 2.6 1.1 0.4-3.1
................................................................................................................................................................................................................................................................................................................................................................................
Smoking
.......................................................................................................................................................................................................................................................................................................................................................................
No 823 80.0 35 5 1.0 Referent 21 3.0 1.0 Referent
.......................................................................................................................................................................................................................................................................................................................................................................
Yes 205 20.0 8 4.7 0.94 0.4-2.1 6 3.6 1.2 0.5-3.0
................................................................................................................................................................................................................................................................................................................................................................................
Drug use
.......................................................................................................................................................................................................................................................................................................................................................................
No 986 94.5 38 4.5 1.0 Referent 23 2.8 1.0 Referent
.......................................................................................................................................................................................................................................................................................................................................................................
Yes 56 5.5 5 10.6 2.5 0.9-6.7 4 8.7 3.3 1.1-10.0
................................................................................................................................................................................................................................................................................................................................................................................
a
Numbers do not total 1043 because of missing data.
................................................................................................................................................................................................................................................................................................................................................................................

Fortner. Prepregnancy BMI, gestational weight gain, and risk of hypertensive pregnancy among Latina women. Am J Obstet Gynecol 2009.

167.e4 American Journal of Obstetrics & Gynecology FEBRUARY 2009

www.AJOG.org Obstetrics Research

TABLE 2
Odds ratios of hypertensive disorders of pregnancy by prepregnancy
BMI: Latina Gestational Diabetes Mellitus Study, 2000-2004
Adjusted parity
Total Cases Unadjusted and age
Variable n % n % OR 95% CI OR 95% CI
Hypertensive disorders
................................................................................................................................................................................................................................................................................................................................................................................
2
Prepregnancy BMI (kg/m )
.......................................................................................................................................................................................................................................................................................................................................................................
Normal weight (⬍ 19.8) 471 46.0 14 4.2 1.0 Referent 1.0 Referent
.......................................................................................................................................................................................................................................................................................................................................................................
Underweight (19.8-26.0) 120 11.7 1 0.8 0.2 0.03-1.4 0.2 0.02-1.3
.......................................................................................................................................................................................................................................................................................................................................................................
Overweight (26.1-29.0) 147 14.4 10 2.0 0.5 0.1-1.6 0.5 0.2-1.8
.......................................................................................................................................................................................................................................................................................................................................................................
Obese (⬎ 29.0) 286 27.9 23 8.4 2.1 1.1-3.8 2.5 1.3-4.8
......................................................................................................................................
P trend ⫽ .002 a
P trend ⫽ .003 a
................................................................................................................................................................................................................................................................................................................................................................................
Preeclampsia
................................................................................................................................................................................................................................................................................................................................................................................
2
Prepregnancy BMI (kg/m )
.......................................................................................................................................................................................................................................................................................................................................................................
Normal weight (⬍ 19.8) 471 46.0 13 2.8 1.0 Referent 1.0 Referent
.......................................................................................................................................................................................................................................................................................................................................................................
Underweight (19.8-26.0) 120 11.7 1 0.8 0.3 0.04-2.2 0.3 0.03-2.03
.......................................................................................................................................................................................................................................................................................................................................................................
Overweight (26.1-29.0) 147 14.4 1 0.7 0.2 0.03-1.9 0.3 0.04-2.2
.......................................................................................................................................................................................................................................................................................................................................................................
Obese (⬎ 29.0) 286 27.9 15 5.4 2.0 0.9-4.2 2.7 1.2-5.8
......................................................................................................................................
P trend ⫽ .02 a
P trend ⫽ .003 a
................................................................................................................................................................................................................................................................................................................................................................................
a
Test for trend across ordered categories was performed by modeling the categorical BMI variable as a continuous variable (ie, 1, 2, 3, or 4, corresponding to underweight, normal weight,
overweight, and obese BMI).
................................................................................................................................................................................................................................................................................................................................................................................

Fortner. Prepregnancy BMI, gestational weight gain, and risk of hypertensive pregnancy among Latina women. Am J Obstet Gynecol 2009.

sia, was 1.07 (95% CI, 1.04-1.10).4 Find- In a retrospective cohort study among number of cases of hypertensive disor-
ings were similar in the current study; 245,526 predominantly white women, ders of pregnancy and preeclampsia in
specifically we observed relative risks of Cedergren12 observed a 2-fold increase this cohort.
1.09 for hypertensive disorders and 1.07 in the risk of preeclampsia among partic- Gestational weight gain was calculated
for preeclampsia with each unit increase ipants with excessive weight gain (⬎ 16 using measured weight in the antepar-
in BMI. kg), regardless of pregravid BMI, as com- tum chart and self-reported prepreg-
Whereas there are few previous studies pared with women with normal weight nancy weight as recorded in the medical
of gestational weight gain and hyperten- gain (8-16 kg). Women with gestational record. Oken et al26 recently reported an
sion in pregnancy, some prior reports weight gain less than 8 kg had a signifi- overall correlation coefficient of 0.99 be-
have noted positive associations between cantly reduced risk of preeclampsia tween self-reported and measured pre-
excessive gestational weight gain accord- (ORs, 0.52-0.73) as compared with gravid weights. The authors found that
ing to Institute of Medicine recommen- women who gained 8-16 kg, with the ex-
underreporting of weight (mean, 2.2
dations and gestational hypertension11 ception of those who were underweight
pounds) did not differ by race/ethnicity,
and preeclampsia.12 For example, in a prior to pregnancy.12 In the current
gestational age, or pregravid weight. In
cohort of 615 women with normal study, we found that those with excessive
our study, we observed a mean maternal
prepregnancy weight, Thorsdottir et al11 weight gain had a 3-fold increase in risk
found a significantly higher incidence of of a hypertensive disorder and a 4-fold weight gain in early pregnancy (from re-
gestational hypertension among those increased risk of preeclampsia after con- corded pregravid weight to weight at en-
who had excessive weight gain (⬎ 20 kg) trolling for pregravid BMI. rollment in prenatal care) of 2.3 kg,
relative to women with low weight gain We observed an incidence of gesta- which is within the range of mean weight
(⬍ 11.5 kg) (9.2% vs 1.5%, respectively) tional hypertension in this population of gain observed by prior studies, which
but not for preeclampsia. However, the women of primarily Puerto Rican origin used measured rather than recalled pre-
authors noted a significant difference in consistent with rates noted previously gravid weight.27 It is also important to
weight gain as a proportion of prepreg- among Latina women primarily of Cen- note that the Institute of Medicine
nancy weight between preeclamptic and tral and South American origin4 or pri- weight gain guidelines are controversial
normotensive patients (31 ⫾ 7% vs 27 ⫾ marily of Mexican origin.5 However, this and have been criticized as lacking scien-
8%).11 analysis was limited, because of the small tific supporting evidence.18,28

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Research Obstetrics www.AJOG.org

TABLE 3
Odds ratios of hypertensive disorders of pregnancy by gestational weight gain: Latina GDM Study, 2000-2004
Adjusted parity
Total Cases Unadjusted and BMI
Variable n % n % OR 95% CI OR 95% CI
Hypertensive disorders
................................................................................................................................................................................................................................................................................................................................................................................
a
Gestational weight gain
.......................................................................................................................................................................................................................................................................................................................................................................
Adequate 283 32.3 6 2.1 1.0 Referent 1.0 Referent
.......................................................................................................................................................................................................................................................................................................................................................................
Inadequate 212 24.3 7 3.3 1.7 0.6-4.6 1.6 0.5-4.8
.......................................................................................................................................................................................................................................................................................................................................................................
Excessive 380 43.4 30 7.9 3.9 1.6-9.6 2.9 1.1-7.2
............................................................................................................................................
P trend ⫽ .05 b
P trend ⫽ .07 b
................................................................................................................................................................................................................................................................................................................................................................................
Preeclampsia
................................................................................................................................................................................................................................................................................................................................................................................
a
Gestational weight gain
.......................................................................................................................................................................................................................................................................................................................................................................
Within 283 32.3 3 1.1 1.00 Referent 1.0 Referent
.......................................................................................................................................................................................................................................................................................................................................................................
Below 212 24.3 3 1.4 1.35 0.3-6.8 1.4 0.3-7.0
.......................................................................................................................................................................................................................................................................................................................................................................
Above 380 43.4 22 5.9 5.80 1.7-19.6 4.2 1.2-14.5
............................................................................................................................................
P trend ⫽ .002 b
P trend ⫽ .02 b
................................................................................................................................................................................................................................................................................................................................................................................
a
Weight gain of 12.5-18 kg (28-40 pounds) for women with a prepregnancy BMI ⬍ 19.8 kg/m ; 11.5-16 kg (25-35 pounds) for women with a prepregnancy BMI of 19.8-26.0 kg/m2; 7-11.5 2

kg (15-25 pounds) weight gain for women with a prepregnancy BMI ⬎ 26.0-29.0 kg/m2. Obese women (BMI ⬎ 29.0 kg/m2) were assigned same weight gain parameters as overweight women.
b
Test for trend across ordered categories was performed by modeling the categorical gestational weight gain variable as a continuous variable (ie, 1, 2, or 3, corresponding to low weight gain,
adequate weight gain, and excessive weight gain).
................................................................................................................................................................................................................................................................................................................................................................................

Fortner. Prepregnancy BMI, gestational weight gain, and risk of hypertensive pregnancy among Latina women. Am J Obstet Gynecol 2009.

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