Body Mass Index Impact and Predictability on Preeclamptic Toxemia

Preeclampsia is a widespread vascular endothelial dysfunction and vasospasm that occurs after 20 weeks’ gestational age and could clinically present as late as 4-6 weeks postpartum. It is clinically defined by hypertension and proteinuria, with or without pathologic edema. The global incidence of PET has been expected TO be around 5-14% of all gestations [1-5]. Hypertensive disorders of pregnancy, involving PET, affect up to 10% of gestations worldwide, forming one of the chief causes of maternal and perinatal morbidity and mortality worldwide. Hypertensive disorders of gestation are major contributing factors to prematurity [6-10]. Preeclampsia is a well-known risk factor for future development of cardiovascular disease and metabolic disease in females.

In spite of extensive research performed worldwide, the etiology of pre-eclampsia stays vague. In the previous decade, tremendous updates in the knowledge and understanding of PET pathophysiological pathways as well as raised efforts to acquire evidence to advance management protocols have emerged. On the other hand, this knowledge acquired has not been applied into advanced clinical practice [11,12]. New guidelines are required to guide obstetricans to care of cases with all clinical types of PET and hypertension that exist during gestation, especially females suffering acute severe hypertension and superimposed PET. A system for continually updating these guidelines is also required and integrating them into daily clinical practice. Proper clinical Identification of cases with severe Clinical forms of PET is a great challenge for clinicians. Enhanced patient education and counseling protocols are required to manage more efficiently the hazards of PET and hypertension and the significance of early detection and predictability to females with varying levels of health literacy. Research studies for PET and other hypertensive disorders of gestation in both the laboratory and clinical regions require continued prominence and funding [13-15].

Obesity is a chief epidemic globally , obesity in pregnancy was displayed to raise the risk of gestational DM, hypertension, PET, cesarean delivery, postpartum weight retention, pretermature delivery, still birth, congenital anomalies involving neural tube defects, spontaneous abortion, recurrent miscarriage, macrosomia, birth injury, difficulties related to anesthesia management, and emergency cesarean delivery, postpartum haemorrhage, the delivery of large-for-dates babies, and stillbirth. Maternal obesity is a distinguished risk factor for the pathological development of PET [16-20].

The relationship that obesity raises the risk of PET has been reported for several populations all over the world signifying that this is not a phenomenon limited to western communities. It is also evident that this relationship is not limited to obese and overweight women because increases in BMI in the normal range is also correlated with a raised hazardous risk of developing PET [21-23].

The research study was performed on 400 recruited cases attending the antenatal care unit of Al-Azhar University Hospital (Assiut) they were recruited at 20 weeks of gestation and follow up was performed at 28 and 36 weeks of gestation. They were divided into 5 research groups (each n=80) according to the selectivity criteria of their Body Mass Index BMI (kg/m²) at 20 weeks of gestational age. Research group A (n=80): normal BMI (18.50-24.99 kg/m²) research group B (n=80): overweight BMI (25-29.99 kg/m²)Group C (n=80): obese class I BMI (30-34.99 kg/m²) research group D (n=80): obese class II BMI (35-39.99 kg/m²) Research group E (n=80): obese class III BMI (>40 kg/m²). All the recruited study subjects undergone the following: Complete history taking involving personal history, history of present illness, past history, menstrual history, obstetric history, medical history and family history to confirm exclusion and inclusion criteria. At 20 weeks of gestational age: Complete history taking, Examination with particular emphasis as regards: Body Mass Index BMI.

BMI = Weight(kg) (heighinmeters) 2 MathType@MTEF@5@5@+=feaaguart1ev2aaatCvAUfeBSjuyZL2yd9gzLbvyNv2CaerbuLwBLnhiov2DGi1BTfMBaeXafv3ySLgzGmvETj2BSbqefm0B1jxALjhiov2Daebbfv3ySLgzGueE0jxyaibaiKc9yrVq0xXdbba91rFfpec8Eeeu0xXdbba9frFj0=OqFfea0dXdd9vqaq=JfrVkFHe9pgea0dXdar=Jb9hs0dXdbPYxe9vr0=vr0=vqpWqaaeaabiGaciaacaqabeaadiqacqaaaOqaaiaabkeacaqGnbGaaeysaiaabccacaqG9aWaaSaaaeaacaqGxbGaaeyzaiaabMgacaqGNbGaaeiAaiaabshacaqGOaGaae4AaiaabEgacaqGPaaabaGaaeikaiaabIgacaqGLbGaaeyAaiaabEgacaqGObGaaeyAaiaab6gacaqGTbGaaeyzaiaabshacaqGLbGaaeOCaiaabohacaqGPaWaaWbaaSqabeaacaqGYaaaaaaaaaa@56FD@, the patients were categorized into the five research groups (each n=80) according to BMI.

Arterial Blood pressure estimation was performed by measuring systolic blood pressure and diastolic blood pressure using a simple mercury sphygmomanometer on right arm in a comfortable sitting position after 10 minutes of rest. Obstetric ultrasound was done to confirm fetal viability, gestational age using biparietal diameter (BPD) and femoral length (FL), and to exclude multiple gestation. Full Laboratory investigations. Follow-up visits: Re-evaluation of the following parameters was done at twenty eight weeks and thirty six weeks of gestation: Body mass index (kg/m²), arterial blood pressure estimation, full Laboratory investigations. If the systolic BP is ≥ 140 mmHg or the diastolic BP is ≥ 90mmHg re-evaluation was performed after 6 hours to confirm elevated blood pressure. Cases of preeclampsia were diagnosed according to the following criteria: Systolic BP ≥ 140 mmHg or diastolic BP ≥ 90mmHg on two occasions 6 hours apart after 20 weeks of gestation in a woman known not to have chronic hypertension prior to the pregnancy, proteinuria ≥ 0.3 g in a 24-hour urine collection or 2+ proteinuria on qualitative examination or urinalysis, edema and excessive weight gain may be present in preeclampsia but are no longer necessary for the diagnosis of preeclampsia.

Results

Table 1 demonstrates demographic data of studied population showing mean and range of age of studied population, residence and socioeconomic level

Table 2 compares the mean of age among research groups showing no statistical significant difference as p value =>0.5.

Figure 1 Pie chart demonstrating residence of studied population being 85 % from rural areas.

Figure 2 Pie chart demonstrating socio economic level showing low socioeconomic level 77% to be most of the studied population.

Figure 3 Bar chart demonstrating the mean age of different study groups Group A=27 years, Group B=26.7 years, Group C=27.4 years, Group D=27.6 years, Group E=27.8 years

Table 3 demonstrates clearly no statistically significant difference as regards residence among study groups as p value=0.67

Table 4 demonstrates clearly the difference between various research groups as regards socioeconomic levels showing no statistical significant difference p value=0.76 .

Table 5 displays the BMI in a comparative manner between various research groups showing statistically significant difference among the groups with a p value <0.001.

Figure 4 The bar chart above demonstrates the mean BMI among the study groups as group A=21.4, group B=27.6, group C=32.8, group D=37.4, group E=42.7.

Table 6 displays and demonstrates clearly the incidence of preeclampsia among the study groups showing a statistically significant difference between groups as incidence of PET increases as BMI increases with a p value =0.035.

Figure 5 bar chart displays the incidence of PET among various study groups group A=6.2%, group B=7.5%, group C=11.2%, group D=16.2%, group E=20%.

Table 7 shows that the relative risk is 2.21 i.e that the risk of PET nearly doubles with increased BMI.

Figure 6 bar chart compares the percentage of preeclampsia and normotensive cases among the study population regarding cases with increased BMI normotensive =6.2 %, preeclampsia =13.75%.

Table 8 demonstrates clearly the frequency of severe preeclampsia among various research groups as group A= 0%, group B=9.1%, group C=18.2%, group D=27.3%, group E=45.4%.

Figure 7 The bar chart above demonstrates the frequency of PET among various research groups.