Editorial
Volume 1 Issue 1 - 2014
Obesity as Risk Factor for Preeclampsia
Emilija Jasovic-Siveska*
Specialist of Gynaecology and Obstetrics, Bitola, Macedonia
*Corresponding Author: Emilija Jasovic-Siveska, MD, PhD, Specialist of Gynaecology and Obstetrics, Bitola, Macedonia, Tel: +38972222256; E-mail: medihelp@t-home.mk
Received: November 22, 2014; Published: November 24, 2014
Citation: Emilija Jasovic-Siveska. “Obesity as Risk Factor for Preeclampsia”. EC Gynaecology 1.1 (2014): 3-6.
Preeclampsia is a common, yet incompletely understood, complication of pregnancy. Women with preeclampsia usually develop hypertension, proteinuria, and varying degrees of ischemic end-organ damage, caused by widespread endothelial dysfunction. Preeclampsia is also associated with abnormalities of coagulation system, disturbed liver function, renal failure and cerebral ischemia [1]. Preeclampsia is characterized by vasospasm, increased peripheral vascular resistance, and thus reduced organ perfusion [1,2]. It complicates an estimated 2–30% of pregnancies and it is a major cause of maternal morbidity, prenatal death and premature delivery, although outcome for most women is good [2,3].
According to the criteria established by The National High Blood Pressure Education Program Working Group, in pregnant women, hypertension is defined as a systolic blood pressure level of 140 mmHg or higher or a diastolic blood pressure level of 90 mmHg or higher that occurs after 20 weeks of gestation in a woman with previously normal blood pressure. As many as one quarter of women with gestational hypertension will develop proteinuria, ie, preeclampsia [4].
Mild Preeclampsia was defined by the occurrence of two or more systolic pressure ≥ 140 mmHg and/or diastolic pressure ≥ 90 mmHg, diastolic blood pressure measurements, with the first elevated blood pressure occurring after 20 weeks gestation up to 24 hours after delivery, combined with proteinuria at least 0.3g or "1+ protein" per 24 hours [5].
Severe preeclampsia was defined as a systolic blood pressure of 160 mmHg or greater and diastolic blood pressure of 110 mmHg or greater on at least two occasions at least 4 hours apart or on one occasion if antihypertensive therapy was administered. Severe proteinuria was defined with a 24-hour urine sample containing ≥ 3.5g of protein or two urine samples of "3+ protein" or greater taken at least 4 hours apart. The syndrome of haemolysis elevated liver enzymes, and low platelets and eclampsia was also categorized as severe PE [5]. The pathogenesis of preeclampsia is complex. It has been suggested that preeclampsia is a two-stage disease: Stage 1: asymptomatic, characterized by abnormal placental development during the first trimester resulting in placental insufficiency. This in turn leads to symptomatic, stage 2, wherein the pregnant women develops characteristic hypertension, renal impairment, and proteinuria and is at risk for the HELLP syndrome, eclampsia and other end-organ damage [6].
Pregnancy per se is a state of oxidative stress arising from the increased metabolic activity in placenta mitochondria and the reduced scavenging power of antioxidants [7]. The aetiology of preeclampsia is still not completely understood, although many facts of the disease have been illuminated. Endothelial cell dysfunction would seem to be the common denominator in the various stages of preeclampsia and appears to be present from the first trimester of pregnancy [8,9].
The physiological response of pregnancy represents a transient excursion into a metabolic syndrome where several components are acquired: a relative insulin resistance, significant hyperlipidemia and an increase in coagulation factors [10].
Preeclampsia is associated with accentuation of many features of the metabolic syndrome, including insulin resistance, hypertriglyceridemia, elevated FFA and LDL, low HDL cholesterol, hyperuricemia and abnormalities in the fibrinolytic system [7,11].
Numerous studies have shown that high maternal pre-pregnancy body mass index (BMI; weight (kg)/height (m)2) is a strong risk factor for preeclampsia. Overweight is associated with alterations in lipid concentrations and an activation of inflammatory markers and both of these metabolic abnormalities are characteristic of preeclamptic pregnancies before the onset of clinically evident disease [12-14]. Pre-pregnancy BMI was categorized as: underweight (< 19.9), normal (20.0-24.9), overweight (25.0-29.9) or obese (> 30.0) [15]. Total maternal weight gain during pregnancy was recorded on admission to delivery ward.
Cigarette smoking is associated with lower maternal sFlt-1 concentrations during pregnancy and PE. Based on this data, cigarette smoke exposure may decrease the risk of PE in part by moderating the anti-angiogenic phenotype observed in syndrome [16].
The prevalence of overweight has increased among women in many countries in recent decades. Pre-pregnancy obesity is becoming a common occurrence in obstetric management. Changes in the treatment of obesity-related infertility have resulted in more of these women achieving a pregnancy. Furthermore, as estimated by the World Health Organization in 2000, 30 million people worldwide are clinically obese. In the United States, the obesity is reported to have risen from 13-27% between 1980 and 1999 [17]. American trends are now being seen among the European population with the prevalence of obesity in women in England rising from 16.4 in 1993 to 23.8% in 2004 [18]. Women who developed preeclampsia had higher rates of overweight prior to pregnancy and gained more weight during pregnancy.
BMI and obesity is a validated and independent risk factor for preeclampsia, but the mechanism of how it imparts increased risk is not completely understood. Obesity might act thought its association with insulin resistance, a syndrome of metabolic derangement characterized by hyperinsulinemia, hyperlipidemia, hypertension, and endothelial dysfunction [8-10].
Women who developed preeclampsia have an increased risk of ischemic heart disease, hypertension, stroke venous thromboembolism, and mortality over the long term [19]. Greater weight gain, and the increased risk of overweight and obesity in middle age, is associated with an increased risk of cardiovascular disease, diabetes, cancers, and overall mortality. There appears to be linear association between increasing BMI (from 20) and adverse health outcome [20]. Increased mean arterial pressure over 85 mmHg in first or over 90 mmHg in second trimester, predicted preeclampsia, late in pregnancy [21].
CRP levels and concentration of triglycerides during pregnancy, especially in first and second trimester at < 20 weeks may be important mediator of the “BMI-preeclampsia” association. The collection of blood specimens in early pregnancy, measuring concentration of CRP, triglycerides, insulin, glucose and inflammatory markers, alongside anthropomorphic assessment, and then followed by a thorough assessment of clinical outcome through a large cohort study, might optimally address the role lipids and the metabolic syndrome in the causation of preeclampsia. These data provide further rationale to examine the potential benefit of preconception weight loss and antenatal exercise [22-24].
At present no management strategy that effectively prevent preeclampsia. It is very important to detect risk women for preeclampsia, especially to differentiate between mild and severe forms, because early or severe preeclampsia is associated with raised rates of maternal and perinatal morbidity and mortality. Women with preeclampsia had higher pre-pregnancy BMI and gain greater amount of weight than women without preeclampsia. We may conclude that pre-pregnancy BMI in combination with blood pressure measurement (especially MAP) appear to be fairly weak predictor for preeclampsia. BMI and blood pressure measurement are virtually free of cost, non-invasive, and ubiquitously available [25].
Future research should concentrate on the development of algorithms that combine biochemical and biophysical markers, including blood pressure measurement-a diagnostic process used in clinical care [25]. These may help improve the predictive accuracy of the tests to clinically important values. An integrated first hospital visit at first trimester combining data from maternal characteristics and history and maternal blood pressure measurement can define the patient at risk for PE.
Bibliography
  1. Hauth JC and FG Cunningham. “Preeclampsia-eclampsia”. Chesley’s Hypertensive disorders in pregnancy. Eds. Lindheimer, M D., et al. 2nd ed. Stamford CT: Appleton & Lange, 1999. 169-99.
  2. James PR and Nelson-Piercy C. “Management of hypertension before, during, and after pregnancy”. Heart 90.12 (2004): 1499-1504.
  3. Assis RT., et al. “Study on the Major Maternal Risk Factors in Hypertensive Syndromes”. Arquivos Brasileiros de Cardiologia 91.1 (2008): 11-16.
  4. ACOG Committee on Practice Bulletins-Obstetrics. “ACOG practice bulletin. Diagnosis and management of preeclampsia and eclampsia. Number 33, January 2002'. Obstetrics & Gynecology 99.1 (2002): 159-167.
  5. Walker PS., et al. “Blood pressure in Late Pregnancy and work outside the home”. Obstetrics & Gynecology 97.3 (2001): 361-365.
  6. Roberts JM. “Preeclampsia: What we know and what we do not know”. Seminars in Perinatology 24.1 (2000): 24-28.
  7. Carl Hubel A. “Dyslipidemia and pre-eclampsia”. Pre-eclampsia, Etiology and Clinical Practice. Eds. Lyall, F, and M, Belfort. 1st ed. Cambridge: Cambrige University Press, 2007. 164-182.
  8. Mona Noori., et al. “Endothelial factors”. Pre-eclampsia, Etiology and Clinical Practice. Eds. Lyall, F, and M, Belfort. 1st ed. Cambridge: Cambrige University Press, 2007. 50-77.
  9. Noris M., et al. “Mechanisms of Disease: pre-eclampsia”. Nature Clinical Practice Nephrology 1.2 (2005): 98-114.
  10. Sattar N., et al. “Lipoprotein subfraction changes in normal pregnancy: threshold effect of plasma triglyceride on appearance of small, dense low density lipoprotein”. The Journal of Clinical Endocrinology and Metabolism 82.8 (1997): 2483-2491.
  11. Blake GJ and Ridker PM. “Novel clinical markers of vascular wall inflammation”. Circulation Research 89.9 (2001): 763-771.
  12. Bodnar LM., et al. “The risk of preeclampsia rises with increasing prepregnancy body mass index”. Annals of Epidemiology 15.7 (2005): 475-482.
  13. O’Brien TE., et al. “Maternal body mass index and the risk of preeclampsia: a systematic overview”. Epidemiology 14.3 (2003): 368-374.
  14. Mayers J and J Brockelsby. “The epidemiology of pre-eclampsia”. Pre-eclampsia, Current Perspectives on Management. Eds. Baker, P N, and J C P, Kingdom. 1st ed. Nashville: The Parthenon Publishing Group, 2004. 25-40.
  15. National Heart Lung and Blood Institute. “Clinical guideline on the identification, evaluation, and treatment of overweight and obesity in adults”. 1998.
  16. Jeyabalan A., et al. “Cigarette smoke exposure and angiogenic factors in pregnancy and preeclampsia”. American Journal of Hypertension 21.8 (2008): 943-947.
  17. Flegal KM., et al. “Overweight and obesity in the United States: prevalence and trends, 1960-1994”. International journal of obesity and related metabolic disorders 22.1 (1998): 39-47.
  18. Lidstone JS., et al. “Independent associations between weight status and disability in adults: results from the Health Survey for England”. Public Health 120.5 (2006): 412-417.
  19. Funai EF., et al. ”Long-term mortality after preeclampsia”. Epidemiology 16.2 (2005): 206-215.
  20. Adams KF., et al. “Overweight, obesity, and mortality in a large prospective cohort of person 50 to 71 years old”. The New England Journal of Medicine 355.8 (2006): 763-778.
  21. Cnossen JS., et al. “Accuracy of mean arterial pressure and blood pressure measurements in predicting preeclampsia: systematic review and meta-analysis”. BMJ 336.7653 (2008):1117-1120.
  22. Hubel CA., et al. “C-reactive Protein is Elevated 30 years after eclamptic pregnancy”. Hypertension 51.6 (2008): 1499-1505.
  23. Baker MA., et al. “Maternal serum dyslipidemia occur early in pregnancy in women with mild but not severe preeclampsia”. American Journal of Obstetrics & Gynecology 201.3 (2009): 293.e1-293.e4.
  24. Baredn A., et al. “Study of pasma factors associated with neutrophil activation and lipid peroxidation in preeclampsia”. Hypertension 38.4 (2001): 803-808.
  25. Jasovic-Siveska E and Jasovic V. “Prediction of mild and severe preeclampsia with blood pressure measurements in first and second trimester of pregnancy”. Ginekologia Polska 82.11 (2011): 845-850.
Copyright: © 2014 Emilija Jasovic-Siveska. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

PubMed Indexed Article

EC Pharmacology and Toxicology
LC-UV-MS and MS/MS Characterize Glutathione Reactivity with Different Isomers (2,2' and 2,4' vs. 4,4') of Methylene Diphenyl-Diisocyanate.

PMID: 31143884 [PubMed]

PMCID: PMC6536005


EC Pharmacology and Toxicology
Alzheimer's Pathogenesis, Metal-Mediated Redox Stress, and Potential Nanotheranostics.

PMID: 31565701 [PubMed]

PMCID: PMC6764777


EC Neurology
Differences in Rate of Cognitive Decline and Caregiver Burden between Alzheimer's Disease and Vascular Dementia: a Retrospective Study.

PMID: 27747317 [PubMed]

PMCID: PMC5065347


EC Pharmacology and Toxicology
Will Blockchain Technology Transform Healthcare and Biomedical Sciences?

PMID: 31460519 [PubMed]

PMCID: PMC6711478


EC Pharmacology and Toxicology
Is it a Prime Time for AI-powered Virtual Drug Screening?

PMID: 30215059 [PubMed]

PMCID: PMC6133253


EC Psychology and Psychiatry
Analysis of Evidence for the Combination of Pro-dopamine Regulator (KB220PAM) and Naltrexone to Prevent Opioid Use Disorder Relapse.

PMID: 30417173 [PubMed]

PMCID: PMC6226033


EC Anaesthesia
Arrest Under Anesthesia - What was the Culprit? A Case Report.

PMID: 30264037 [PubMed]

PMCID: PMC6155992


EC Orthopaedics
Distraction Implantation. A New Technique in Total Joint Arthroplasty and Direct Skeletal Attachment.

PMID: 30198026 [PubMed]

PMCID: PMC6124505


EC Pulmonology and Respiratory Medicine
Prevalence and factors associated with self-reported chronic obstructive pulmonary disease among adults aged 40-79: the National Health and Nutrition Examination Survey (NHANES) 2007-2012.

PMID: 30294723 [PubMed]

PMCID: PMC6169793


EC Dental Science
Important Dental Fiber-Reinforced Composite Molding Compound Breakthroughs

PMID: 29285526 [PubMed]

PMCID: PMC5743211


EC Microbiology
Prevalence of Intestinal Parasites Among HIV Infected and HIV Uninfected Patients Treated at the 1o De Maio Health Centre in Maputo, Mozambique

PMID: 29911204 [PubMed]

PMCID: PMC5999047


EC Microbiology
Macrophages and the Viral Dissemination Super Highway

PMID: 26949751 [PubMed]

PMCID: PMC4774560


EC Microbiology
The Microbiome, Antibiotics, and Health of the Pediatric Population.

PMID: 27390782 [PubMed]

PMCID: PMC4933318


EC Microbiology
Reactive Oxygen Species in HIV Infection

PMID: 28580453 [PubMed]

PMCID: PMC5450819


EC Microbiology
A Review of the CD4 T Cell Contribution to Lung Infection, Inflammation and Repair with a Focus on Wheeze and Asthma in the Pediatric Population

PMID: 26280024 [PubMed]

PMCID: PMC4533840


EC Neurology
Identifying Key Symptoms Differentiating Myalgic Encephalomyelitis and Chronic Fatigue Syndrome from Multiple Sclerosis

PMID: 28066845 [PubMed]

PMCID: PMC5214344


EC Pharmacology and Toxicology
Paradigm Shift is the Normal State of Pharmacology

PMID: 28936490 [PubMed]

PMCID: PMC5604476


EC Neurology
Examining those Meeting IOM Criteria Versus IOM Plus Fibromyalgia

PMID: 28713879 [PubMed]

PMCID: PMC5510658


EC Neurology
Unilateral Frontosphenoid Craniosynostosis: Case Report and a Review of the Literature

PMID: 28133641 [PubMed]

PMCID: PMC5267489


EC Ophthalmology
OCT-Angiography for Non-Invasive Monitoring of Neuronal and Vascular Structure in Mouse Retina: Implication for Characterization of Retinal Neurovascular Coupling

PMID: 29333536 [PubMed]

PMCID: PMC5766278


EC Neurology
Longer Duration of Downslope Treadmill Walking Induces Depression of H-Reflexes Measured during Standing and Walking.

PMID: 31032493 [PubMed]

PMCID: PMC6483108


EC Microbiology
Onchocerciasis in Mozambique: An Unknown Condition for Health Professionals.

PMID: 30957099 [PubMed]

PMCID: PMC6448571


EC Nutrition
Food Insecurity among Households with and without Podoconiosis in East and West Gojjam, Ethiopia.

PMID: 30101228 [PubMed]

PMCID: PMC6086333


EC Ophthalmology
REVIEW. +2 to +3 D. Reading Glasses to Prevent Myopia.

PMID: 31080964 [PubMed]

PMCID: PMC6508883


EC Gynaecology
Biomechanical Mapping of the Female Pelvic Floor: Uterine Prolapse Versus Normal Conditions.

PMID: 31093608 [PubMed]

PMCID: PMC6513001


EC Dental Science
Fiber-Reinforced Composites: A Breakthrough in Practical Clinical Applications with Advanced Wear Resistance for Dental Materials.

PMID: 31552397 [PubMed]

PMCID: PMC6758937


EC Microbiology
Neurocysticercosis in Child Bearing Women: An Overlooked Condition in Mozambique and a Potentially Missed Diagnosis in Women Presenting with Eclampsia.

PMID: 31681909 [PubMed]

PMCID: PMC6824723


EC Microbiology
Molecular Detection of Leptospira spp. in Rodents Trapped in the Mozambique Island City, Nampula Province, Mozambique.

PMID: 31681910 [PubMed]

PMCID: PMC6824726


EC Neurology
Endoplasmic Reticulum-Mitochondrial Cross-Talk in Neurodegenerative and Eye Diseases.

PMID: 31528859 [PubMed]

PMCID: PMC6746603


EC Psychology and Psychiatry
Can Chronic Consumption of Caffeine by Increasing D2/D3 Receptors Offer Benefit to Carriers of the DRD2 A1 Allele in Cocaine Abuse?

PMID: 31276119 [PubMed]

PMCID: PMC6604646


EC Anaesthesia
Real Time Locating Systems and sustainability of Perioperative Efficiency of Anesthesiologists.

PMID: 31406965 [PubMed]

PMCID: PMC6690616


EC Pharmacology and Toxicology
A Pilot STEM Curriculum Designed to Teach High School Students Concepts in Biochemical Engineering and Pharmacology.

PMID: 31517314 [PubMed]

PMCID: PMC6741290


EC Pharmacology and Toxicology
Toxic Mechanisms Underlying Motor Activity Changes Induced by a Mixture of Lead, Arsenic and Manganese.

PMID: 31633124 [PubMed]

PMCID: PMC6800226


EC Neurology
Research Volunteers' Attitudes Toward Chronic Fatigue Syndrome and Myalgic Encephalomyelitis.

PMID: 29662969 [PubMed]

PMCID: PMC5898812


EC Pharmacology and Toxicology
Hyperbaric Oxygen Therapy for Alzheimer's Disease.

PMID: 30215058 [PubMed]

PMCID: PMC6133268


News and Events

November Issue Release

We Always feel pleasure to share an update with you all. Here, notifying you that we have successfully released November issue for the respective journals and can be viewed in the current issue pages.

Submission Deadline for January Issue

E-Cronicon delightfully welcome all the authors around the globe for an effective collaboration with an article submission for the January issue of respective journals. Submissions are accepted on/before December 17, 2019.

Certificate of Publication

E-Cronicon honours with a "Publication Certificate" to the corresponding author by including the names of co-authors as a token of appreciation for publishing the work with our respective journals.

Special Issue Update for the Month of November

Editorial office of E-Cronicon (EC) is here with a great initiation to plan a special edition for the month of November. This special edition is intend to concentrate on new helpful, innovative solutions that are aimed at ensuring better quality in the management of treatment. We firmly believe that sharing of experience and visionary ideas will give beginning to solutions that will give hope for increased effectiveness in the prevention and treatment of various health issues which is considered to be an epidemic of the researchers and society. We would like to encourage you to participate in this unique edition so that we can work together to develop an optimistic concept for a better health perspective for patients. I hope to have the participation of every author who are in association with E-Cronicon to this special issue by making it a successful initiation. List of journals planning for November special edition: 1. EC Ophthalmology (ECOP) 2. EC Paediatrics (ECPE) 3. EC Pulmonology and Respiratory Medicine (ECPRM) 4. EC Gastroenterology and Digestive System (ECGDS) 5. EC Cardiology (ECCY). More information can be found in the special issue pages of these journals. Best paper will be picked by the Editorial office and will be provided with an "Appreciation Certificate". Take a smallest step by dropping your opinions to editor@ecronicon.uk for a biggest success.

Best Article of the Issue

Editors of respective journals will always be very much interested in electing one Best Article after each issue release. The authors of the selected article will be honored with a "Best Article of the Issue" certificate.

Certifying for Review

E-Cronicon certify the Editors for their first review done towards assigned article of the respective journals.

Latest Articles

Latest articles will be updated immediately in the articles in press page of the respective journals.

Immediate Assistance

Prime moto of this team is to clarify all the queries without any delay or hesitation in order to avoid the inconvenience. For an immediate assistance on your queries please don't hesitate to drop an email to editor@ecronicon.uk