Obesity, hypertension, and preeclampsia

Abstract Obesity is increasing throughout the West in pregnant and nonpregnant women. This is associated with increased incidence of gestational hypertension (GH) and preeclampsia (PE), but not all obese women develop PE, so obesity is presumably an amplifying mechanism. Conversely, some diagnoses of “pre-eclampsia” in the obese may in fact relate to the unmasking of underlying hypertension by pregnancy. Requirements for the measurement of blood pressure in the obese are summarized. About a third of the total effect of body mass index (BMI) on the risk of PE is mediated through triglyceride concentrations; insulin resistance, glucose homeostasis, fat oxidation and amino acid synthesis also contribute to adverse outcomes. Obesity is a type of chronic inflammatory condition, which will itself lead to impaired immune response and predispose to PE. Adipocytes synthesize and release adipokines such as leptin, adiponectin, PAI-1, TNF-α, and angiotensinogen; their function and the impact of obesity on that function, are summarized. Miscarriage is also associated with obesity and overexpression of various proinflammatory cytokines, including IL-6 and TNFα□ The postnatal check is important in all women, but especially the obese woman who developed hypertension during her pregnancy, who can be counseled about weight loss and follow-up instituted.