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).
  1. 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.
  2. 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.
  3. 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.
  4. Institute of Medicine (US). Weight gain during pregnancy: reexamining the guidelines. Washington, DC. National Academies Press; 2009. ©2009 National Academy of Sciences.