Pregnancy in metabolic healthy and unhealthy obese women

Abstract

Introduction Obesity‐associated adverse obstetric outcomes are well‐known but still relatively rare and difficult to predict. Not all obese individuals are unhealthy, some have metabolically healthy obesity (MHO) and others have metabolic unhealthy obesity (MUO). Our aim was to investigate if the MHO and MUO classification could be used for prediction of obesity‐associated complications in pregnancy. Material and methods We included 547 pregnant women with obesity, 2302 pregnant women with overweight, and 5852 normal weight pregnant women. The women with obesity were classified as MUO (n = 181, 33.1%) and MHO (n = 366, 66.9%) based on first trimester blood pressure, lipoprotein levels and non‐fasting glucose levels. The risk of obstetric outcomes was evaluated by multivariable logistic regression. We compared cardiovascular risk markers in blood between obese pregnant women with MUO and MHO. Results Overall, 45.9% of women with MUO developed at least one adverse obesity‐associated obstetric outcome, whereas corresponding proportions in women with MHO, overweight and normal weight were 35.0%, 27.6% and 21.2%, respectively. Following adjustment, the overall risk of at least one obesity‐associated obstetric or perinatal complication in women with MUO, versus women with MHO, was increased, AOR 1.49 (95% CI 1.03 – 2.15), but the predictive value of the model was low. Women with MUO had altered levels of cardiovascular risk markers such as cathepsin S, adiponectin, and cystatin C in comparison to women with MHO. Conclusions Women with MUO had an overall increased risk of adverse obstetric outcomes in comparison to women with MHO, but the classification had little relevance for risk prediction beyond that of body mass index.