Obesity-Related Risk Factors in Preeclampsia

Obesity before and during pregnancy substantially elevates the risk of preeclampsia, a hypertensive disorder marked by new-onset hypertension and proteinuria after 20 weeks’ gestation. A high pre-pregnancy body mass index (BMI) and excessive gestational weight gain (GWG) converge to create a pro-inflammatory and insulin-resistant state that impairs normal placental development. Adipose tissue in obesity secretes inflammatory cytokines and adipokines, which promote endothelial dysfunction and oxidative stress. These disturbances compromise spiral-artery remodelling, leading to placental ischaemia and the release of anti-angiogenic factors such as soluble fms-like tyrosine kinase-1 (sFlt-1). The resulting angiogenic imbalance and vascular injury underpin the clinical manifestations of preeclampsia. Globally, rising maternal obesity rates have driven increases in preeclampsia incidence, with important implications for long-term cardiovascular health in mother and child. Effective strategies to reduce risk include optimisation of maternal weight prior to conception, targeted nutritional interventions in early pregnancy and vigilant monitoring of weight gain trajectories.

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Obesity-Related Risk Factors in Preeclampsia publication trend

The graph below shows the total number of articles in obesity-related risk factors in preeclampsia across all publications each year (not limited to Nature Index journals).

Technical terms

Body mass index (BMI): A measure of weight relative to height (kg/m²) used to categorise underweight, normal weight, overweight and obesity.

Gestational weight gain (GWG): The amount of maternal weight gained during pregnancy, typically assessed against trimester-specific standards.

Placental ischaemia: A state of reduced blood flow to the placenta due to inadequate spiral-artery remodelling, leading to hypoxia and release of pathogenic factors.

Angiogenic imbalance: Disruption of the normal ratio of pro-angiogenic and anti-angiogenic factors, notably elevated sFlt-1 relative to vascular endothelial growth factor (VEGF).

Endothelial dysfunction: Impairment of the inner lining of blood vessels, characterised by reduced nitric oxide bioavailability and increased vascular resistance.

References

1. Obesity and Preeclampsia: Common Pathophysiological Mechanisms. Frontiers in Physiology (2018).
2. Untargeted metabolomics on first trimester serum implicates metabolic perturbations associated with BMI in development of hypertensive disorders: a discovery study. Frontiers in Nutrition (2023).
3. Gestational weight gain of multiparas and risk of primary preeclampsia: a retrospective cohort study in Shanghai. Clinical Hypertension (2023).
4. Immune Mechanisms Linking Obesity and Preeclampsia. Biomolecules (2015).