Association of Hypertensive Disorders of Pregnancy (HDP) with Obesity and Prematurity in an Inner-City Population

Background: Hypertensive Disorders of Pregnancy (HDP) complicate between 6-8% of all pregnancies and have been linked to high rates of maternal morbidity and mortality, premature births, and perinatal mortality. This study aimed to examine the association of maternal obesity and infant prematurity with HDP in an inner-city NY hospital patient population.

Methods: In a case–control study we reviewed medical records of women who delivered singleton babies at an inner-city NY hospital serving a highly diverse minority population during 2005. Cases (n= 80) with a discharge diagnosis of antepartum hypertension were compared to 84 randomly selected women with normal singleton pregnancies (controls).

Results: There were no case-control differences in maternal age, ethnicity, or place of birth. Nulliparity was more common in cases (62.5%) than controls (39.3%) (p=0.004). In comparison to controls, cases were also more likely to be obese or morbidly obese (45% vs. 26.19%, p=0.004); experience more preterm deliveries (62.3% vs.39.3%, p=0.004); have a shorter gestational age (37 weeks vs. 41 weeks, p=0.002); and have higher rates of cesarean sections (38.8% vs.16.7%, p=0.001). These relationships persisted in multivariable logistic regression analyses.

Conclusion: In this inner-city hospital patient population positive association were found between HDP and maternal overweight/obesity, preterm deliveries and cesarean section rate. Our findings have serious public health implications as obesity prevalence continues to rise in the U.S. A resulting increase in the incidence of HDP and premature births may dramatically affect health disparities. Policies and programs promoting healthy pre-conceptual weight may improve both maternal and fetal outcomes.