Corresponding author
Professor Lionel Carbillon
Department of Obstetrics and Gynecology
Avenue du 14 juillet
Hôpital Jean Verdier
93143 Bondy Cedex, FRANCE
Tel.: +33 1 48-02-67-96
Hildén et al recently published in the journal (1) a nested
case–control study investigating “if the preeclampsia association with
the future risk of cardiovascular disease (CVD) was independent of
gestational diabetes mellitus (GDM) and modified by body mass index
(BMI) or GDM”. From “2639 cases and 13 310 controls with “complete
data” in the Swedish National Board of Health and Welfare for the years
1991–2008. Using the ICD
9th/10threvisions, precise
definitions for GDM and hypertensive disorders, a classification of body
mass index (BMI) into underweight, normal weight, overweight and obese
categories, and adjusting for potential confounding variables but not
for gestational weight gain (GWG) , they concluded that the
association between pre-eclampsia and future CVD “is not modified by
body mass index (BMI)”.
In actuality, stratifying by maternal BMI, they indeed found that
“adjusted association of pre-eclampsia with CVD did not change
substantially, among normal weight (OR 2.65, 95% CI 1.90–3.69),
overweight (OR 2.67, 95% CI 1.52–4.68) and obese (OR 3.03, 95% CI
0.74–12.4) women”, but without adjustment for GWG and with large
confidence intervals of OR.
However, GWG has emerged in recent years as an essential associated
factor in the link between obesity and the risk of preeclampsia, in
which compliance with dietary recommendations (with GWG neither
excessive nor insufficient) emerged as a cornerstone of management (2).
More specifically, from an observational cohort study of 15,551 women
without pregravid diabetes or hypertension and including 2097 GDM (3),
we found that in the GDM group of patients, GWG was a clue for dietary
compliance. In addition, the prevalence of pre-eclampsia remained
associated in a dose-response relationship with adherence to the
Institute of Medicine GWG guidelines (4) in the obese group, after
logistic regression analysis (3).
- Hildén
K , Magnuso
An, Montgomery
S , Schwarc
E, Hanson
U, Simmons
D et al. Previous pre-eclampsia, gestational diabetes mellitus and the
risk of cardiovascular disease: A nested case-control study in Sweden.
BJOG. 2023 Mar 27.
- Goldstein
RF, Abell
SK, Ranasinha
S, Misso
M, Boyle
JA, Black
MH et al. Association of Gestational Weight Gain With Maternal and
Infant Outcomes: A Systematic Review and Meta-analysis. JAMA. 2017 Jun
6;317:2207-2225.
- Cosson
E, Cussac-Pillegand
C, Benbara
A, PharisieI
I, Nguyen
MT, Chiheb
S et al .
Pregnancy adverse
outcomes related to pregravid body mass index and gestational weight
gain, according to the presence or not of gestational diabetes
mellitus: A retrospective observational study. Diabetes Metab.
2016;42:38-46.
- Institute of Medicine (US). Weight gain during pregnancy: reexamining
the guidelines. Washington, DC. National Academies Press; 2009. ©2009
National Academy of Sciences.