High body mass index and hypercholesterolemia: Risk of hypertensive disorders of pregnancy

Objective: To examine the relationship between pregravid body mass index (BMI), elevated cholesterol level, and the development of hypertensive disorders of pregnancy. Methods: We studied 15,262 women who gave birth between 1991 and 1995. Pregravid exposures including BMI and self-reported history of elevated cholesterol were ascertained by biennial mailed questionnaires. Gestational hypertension or preeclampsia was confirmed by medical record review according to standard criteria. Proportional hazards analysis was used to adjust for potential confounding variables. Results: We confirmed 216 cases of gestational hypertension and 86 cases of preeclampsia. The risk of gestational hypertension increased as pregravid BMI increased (P <.01). Compared with women with a pregravid BMI of 21-22.9 kg/m(2), the relative risk (RR) of gestational hypertension was 1.6 (95% confidence interval [CI] 1.0, 2.3) for women with BMI of 23-24.9 kg/m(2), 2.0 (95% CI 1.3, 3.0) for BMI 25-29.9 kg/m(2), and 2.6 (95% CI 1.6, 4.4) for BMI over 30 kg/m(2). Leaner women (BMI less than 21 kg/m(2)) had a reduced risk (RR 0.7, 95% CI 0.4, 1.0). For preeclampsia, the RR of women with pregravid BMI over 30 kg/m(2) was 2.1 (95% CI 1.0, 4.6) (P for trend 0.09). A history of elevated cholesterol was not associated with the risk of gestational hypertension (RR 0.9, 95% CI, 0.6, 1.4). In contrast, the RR of preeclampsia in women with a history of elevated cholesterol was 2.0 (95% CI 1.2, 3.3). Conclusion: Pregravid BMI and hypercholesterolemia could identify women at higher risk for hypertensive disorders during pregnancy. (Obstet Gynecol 1999;94:543-50. (C) 1999 by The American College of Obstetricians and Gynecologists.).