MATERNAL OVERWEIGHT AND OBESITY AS INDEPENDENT RISK FACTORS FOR THE DEVELOPMENT OF PREECLAMPSIA: A SYSTEMATIC REVIEW
Keywords:
preeclampsia; maternal obesity; overweight; body mass index; gestational weight gain; risk factors; systematic reviewAbstract
DOI: https://doi.org/10.46296/gt.v9i18.0405
Abstract
Introduction: Preeclampsia is a leading cause of maternal and perinatal morbidity and mortality, and maternal excess weight is a potentially modifiable risk factor. The aim was to evaluate maternal overweight and obesity as independent risk factors for preeclampsia and to analyze gestational weight gain according to pre-pregnancy body mass index (BMI). Methodology: Systematic review with narrative synthesis, following PRISMA 2020, in PubMed/MEDLINE, SciELO and LILACS (2021–2026); quality was appraised with CASP and JBI tools. Results: Of 1068 records, 28 studies were included (five meta-analyses and 23 primary studies), of high quality in 11, moderate in 14 and low in three. Compared with normal weight, meta-analyses estimated ORs of 1.70 to 2.15 for overweight and 2.82 to 3.89 for obesity, with a dose-response gradient. The association persisted after adjustment for confounders (adjusted ORs 2.15 to 4.34) and in Mendelian randomization (OR 1.47 per standard deviation of BMI). Weight gain above recommendations increased the risk (OR 1.85), with lower rate thresholds as BMI increased (0.54, 0.38 and 0.25 kg/week). Discussion: Adjusted estimates and genetic evidence support the independence of the effect, although several meta-analyses used crude data and Latin American evidence is scarce. Conclusions: Maternal overweight and obesity are independent risk factors for preeclampsia, and the gestational weight gain curve, interpreted according to pre-pregnancy BMI, is a useful tool for prevention in prenatal care.
Keywords: preeclampsia; maternal obesity; overweight; body mass index; gestational weight gain; risk factors; systematic review.
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Abdi, F., Alizadeh, S., Roozbeh, N., Montazeri, F., Banaei, M., Mehrnoush, V., & Darsareh, F. (2025). Prepregnancy overweight and obesity and the risk of adverse pregnancy outcomes. Scientific Reports, 15(1), 16846. https://doi.org/10.1038/s41598-025-02113-9
Abraham, T., & Romani, A. M. P. (2022). The relationship between obesity and pre-eclampsia: Incidental risks and identification of potential biomarkers for pre-eclampsia. Cells, 11(9), 1548. https://doi.org/10.3390/cells11091548
Alston, M. C., Redman, L. M., & Sones, J. L. (2022). An overview of obesity, cholesterol, and systemic inflammation in preeclampsia. Nutrients, 14(10), 2087. https://doi.org/10.3390/nu14102087
American College of Obstetricians and Gynecologists. (2020). Gestational hypertension and preeclampsia: ACOG Practice Bulletin, Number 222. Obstetrics & Gynecology, 135(6), e237–e260. https://doi.org/10.1097/AOG.0000000000003891
Atalah, E., Castillo, C., Castro, R., & Aldea, A. (1997). Propuesta de un nuevo estándar de evaluación nutricional en embarazadas. Revista Médica de Chile, 125(12), 1429–1436.
Bolzán, A. G., Di Marco, Í., Mangialavori, G. L., & Duhau, M. (2022). Índice de masa corporal preconcepcional en 1 079 171 mujeres atendidas en hospitales públicos de las 24 provincias argentinas. Revista Argentina de Salud Pública, 14, e74. https://rasp.msal.gov.ar/index.php/rasp/article/view/745
Borges, M. C., Clayton, G. L., Freathy, R. M., Felix, J. F., Fernández-Sanlés, A., Soares, A. G., Kilpi, F., Yang, Q., McEachan, R. R. C., Richmond, R. C., Liu, X., Skotte, L., Irizar, A., Hattersley, A. T., Bodinier, B., Scholtens, D. M., Nohr, E. A., Bond, T. A., Hayes, M. G., . . . Lawlor, D. A. (2024). Integrating multiple lines of evidence to assess the effects of maternal BMI on pregnancy and perinatal outcomes. BMC Medicine, 22(1), 32. https://doi.org/10.1186/s12916-023-03167-0
Carpio-Arias, V., Vinueza Veloz, A. F., Tapia Veloz, E. C., Tapia Veloz, G., & Nicolalde Cifuentes, M. (2023). Estado nutricional de los adultos ecuatorianos y su distribución según las características sociodemográficas. Estudio transversal. Nutrición Hospitalaria, 40(1), 102–108. https://doi.org/10.20960/nh.04083
Chang, C. Y., Kuo, T. Y., Lin, M. H., Ku, Y. L., Peng, Y. S., & Lin, Y. H. (2026). Association of maternal glucose and body mass index with adverse pregnancy outcomes among women with normal oral glucose tolerance test results. Diabetes & Metabolic Syndrome: Clinical Research & Reviews, 20(6), 103439. https://doi.org/10.1016/j.dsx.2026.103439
Chappell, L. C., Cluver, C. A., Kingdom, J., & Tong, S. (2021). Pre-eclampsia. The Lancet, 398(10297), 341–354. https://doi.org/10.1016/S0140-6736(20)32335-7
Chehab, R. F., Barcellos, A. L., Ngo, A. L., Greenberg, M. B., Wang, E. Z., Chen, L., Ferrara, A., & Zhu, Y. (2026). Preeclampsia and eclampsia: A complex interplay between prepregnancy obesity, race, and ethnicity. Journal of the American Heart Association, 15(12), e044260. https://doi.org/10.1161/JAHA.125.044260
Chen, J., Zhu, Y., Liu, J., Li, Q., Shi, H., Liu, W., Gao, H., Li, W., Wu, Z., Sun, B., Zhang, Q., & Li, H. (2026). Interaction between maternal obesity and metabolic dysfunction in gestational hypertension and preeclampsia: A prospective birth cohort study. The Journal of Clinical Hypertension, 28(1), e70205. https://doi.org/10.1111/jch.70205
Chicana Muñoz, J., Asencio Cámac, M., Galdos-Bejar, M., & Yhuri Carreazo, N. (2024). Riesgo de preeclampsia en primigestas adolescentes. Ginecología y Obstetricia de México, 92(9), 386–395. https://doi.org/10.24245/gom.v92i9.9601
Creanga, A. A., Catalano, P. M., & Bateman, B. T. (2022). Obesity in pregnancy. New England Journal of Medicine, 387(3), 248–259. https://doi.org/10.1056/NEJMra1801040
Cresswell, J. A., Alexander, M., Chong, M. Y. C., Link, H. M., Pejchinovska, M., Gazeley, U., Ahmed, S. M. A., Chou, D., Moller, A.-B., Simpson, D., Alkema, L., Villanueva, G., Sguassero, Y., Tunçalp, Ö., Long, Q., Xiao, S., & Say, L. (2025). Global and regional causes of maternal deaths 2009–20: A WHO systematic analysis. The Lancet Global Health, 13(4), e626–e634. https://doi.org/10.1016/S2214-109X(24)00560-6
Critical Appraisal Skills Programme. (2017). CASP checklist for cohort studies. CASP UK. https://casp-uk.net/casp-tools-checklists/
Critical Appraisal Skills Programme. (2018a). CASP systematic review checklist. CASP UK. https://casp-uk.net/casp-tools-checklists/
Critical Appraisal Skills Programme. (2018b). CASP case control study checklist. CASP UK. https://casp-uk.net/casp-tools-checklists/
Dimitriadis, E., Rolnik, D. L., Zhou, W., Estrada-Gutierrez, G., Koga, K., Francisco, R. P. V., Whitehead, C., Hyett, J., da Silva Costa, F., Nicolaides, K., & Menkhorst, E. (2023). Pre-eclampsia. Nature Reviews Disease Primers, 9(1), 8. https://doi.org/10.1038/s41572-023-00417-6
Gao, J., & Wang, Y. (2026). Pre-pregnancy obesity, not gestational weight gain, is a high-risk factor for pre-eclampsia: A retrospective study in Bengbu, China. PeerJ, 14, e21216. https://doi.org/10.7717/peerj.21216
Gaur, P., Power, M. L., Schulkin, J., & Jelin, A. C. (2025). Associations of preconception body weight, body mass index, and hypertension with preeclampsia. Journal of Women's Health, 34(11), 1374–1380. https://doi.org/10.1089/jwh.2023.0083
Goldstein, R. F., Bahri Khomami, M., Tay, C. T., Sethi, P., Liew, J., Moran, L., Harrison, C. L., Reddy, A., Lang, S., Brammall, B., Ranasinha, S., Flores-Urrutia, M. C., Muñoz-Manrique, C., Arruda Silva, M., Borghi, E., Phelan, S., Teede, H., & Mousa, A. (2025). Gestational weight gain and risk of adverse maternal and neonatal outcomes in observational data from 1.6 million women: Systematic review and meta-analysis. BMJ, 391, e085710. https://doi.org/10.1136/bmj-2025-085710
Gong, X., Li, J., Jiang, Y., Yuan, P., Chen, L., Yang, Y., Li, Y., Sun, M., Zhao, Y., Shi, H., & Wei, Y. (2022). Risk of preeclampsia by gestational weight gain in women with varied prepregnancy BMI: A retrospective cohort study. Frontiers in Endocrinology, 13, 967102. https://doi.org/10.3389/fendo.2022.967102
Gonzalez-Ballano, I., Saviron-Cornudella, R., Esteban, L. M., Sanz, G., & Castán, S. (2021). Pregestational body mass index, trimester-specific weight gain and total gestational weight gain: How do they influence perinatal outcomes? The Journal of Maternal-Fetal & Neonatal Medicine, 34(8), 1207–1214. https://doi.org/10.1080/14767058.2019.1628942
González-Plaza, E., Bellart, J., Martínez-Verdú, M. Á., Arranz, Á., Luján-Barroso, L., & Seguranyes, G. (2022). Pre-pregnancy overweight and obesity prevalence and relation to maternal and perinatal outcomes. Enfermería Clínica (English Edition), 32(Supl. 1), S23–S30. https://doi.org/10.1016/j.enfcle.2021.04.006
Grandi, C., Luchtenberg, G., & Sola, H. (2007). Evaluación nutricional durante el embarazo. Nuevo estándar. Medicina (Buenos Aires), 67(6/2), 677–684. https://www.medicinabuenosaires.com/demo/revistas/vol67-07/n6-2/v67_6-2_p677_684_.pdf
Hu, H., Lee, V., Elhindi, J., & Zen, M. (2026). Gestational weight gain and its association with preeclampsia and blood pressure trends: A retrospective cohort study. Australian and New Zealand Journal of Obstetrics and Gynaecology, 66(2), e70101. https://doi.org/10.1111/ajo.70101
Institute of Medicine & National Research Council. (2009). Weight gain during pregnancy: Reexamining the guidelines (K. M. Rasmussen & A. L. Yaktine, Eds.). National Academies Press.
Ito, M., Kyozuka, H., Yamaguchi, T., Sugeno, M., Murata, T., Hiraiwa, T., Ito, F., Suzuki, D., Fukuda, T., Yasuda, S., Fujimori, K., & Nomura, Y. (2023). Association between gestational weight gain and risk of hypertensive disorders of pregnancy among women with obesity: A multicenter retrospective cohort study in Japan. Nutrients, 15(11), 2428. https://doi.org/10.3390/nu15112428
Kent, L., McGirr, M., & Eastwood, K. A. (2024). Global trends in prevalence of maternal overweight and obesity: A systematic review and meta-analysis of routinely collected data retrospective cohorts. International Journal of Population Data Science, 9(2), 2401. https://doi.org/10.23889/ijpds.v9i2.2401
Kyozuka, H., Jin, T., Fujimori, M., Nomura, S., Suzuki, D., Fukuda, T., Murata, T., Yasuda, S., Yamaguchi, A., Nomura, Y., & Fujimori, K. (2022). Effect of gestational weight gain on preeclampsia among underweight women: A single tertiary referral center study in Japanese women. Journal of Obstetrics and Gynaecology Research, 48(5), 1141–1148. https://doi.org/10.1111/jog.15200
Lazzari, C., Bosco, M., Garzon, S., Simonetto, C., Casarin, J., Paolucci, S., Cromi, A., Ghezzi, F., & Uccella, S. (2025). The impact of maternal age and body mass index on hypertensive disorders of pregnancy: Moving beyond the cut-off effect. Pregnancy Hypertension, 40, 101219. https://doi.org/10.1016/j.preghy.2025.101219
Loza Cevallos, M. A., & Méndez Carvajal, E. P. (2023). Estado nutricional como factor de riesgo de preeclampsia en gestantes atendidas en el Hospital San Vicente de Paúl, en el periodo enero-julio del año 2022. La U Investiga, 10(1), 12–22. https://doi.org/10.53358/lauinvestiga.v10i1.796
Magee, L. A., Brown, M. A., Hall, D. R., Gupte, S., Hennessy, A., Karumanchi, S. A., Kenny, L. C., McCarthy, F., Myers, J., Poon, L. C., Rana, S., Saito, S., Staff, A. C., Tsigas, E., & von Dadelszen, P. (2022). The 2021 International Society for the Study of Hypertension in Pregnancy classification, diagnosis & management recommendations for international practice. Pregnancy Hypertension, 27, 148–169. https://doi.org/10.1016/j.preghy.2021.09.008
Marshall, N. E., Abrams, B., Barbour, L. A., Catalano, P., Christian, P., Friedman, J. E., Hay, W. W., Jr., Hernandez, T. L., Krebs, N. F., Oken, E., Purnell, J. Q., Roberts, J. M., Soltani, H., Wallace, J., & Thornburg, K. L. (2022). The importance of nutrition in pregnancy and lactation: Lifelong consequences. American Journal of Obstetrics and Gynecology, 226(5), 607–632. https://doi.org/10.1016/j.ajog.2021.12.035
Mensah, N. A., Fassett, M. J., Peltier, M. R., Shi, J., Chiu, V. Y., Khadkha, N., & Getahun, D. (2026). Joint effect of body mass index and obstructive sleep apnea on preeclampsia risk. American Journal of Perinatology, 43(1), 15–22. https://doi.org/10.1055/a-2576-4082
Ministerio de Salud Pública del Ecuador. (2016). Control prenatal. Guía de práctica clínica. Dirección Nacional de Normatización. https://www.salud.gob.ec/wp-content/uploads/2014/05/GPC-CPN-final-mayo-2016-DNN.pdf
Ministerio de Salud Pública del Ecuador. (2017). Evaluación del estado nutricional de la mujer gestante. MSP.
Ministerio de Salud Pública del Ecuador. (2024). Gaceta epidemiológica de muerte materna: Ecuador 2023. https://salud.gob.ec/wp-content/uploads/2024/11/Gaceta-MM-final-2023.pdf
Ministerio de Salud Pública del Ecuador. (2025). Score MAMÁ y claves obstétricas. Protocolo. Viceministerio de Atención Integral en Salud. https://www.salud.gob.ec
Mitchell, M., Deussen, A. R., Poprzeczny, A. J., Slade, L. J., Louise, J., & Dodd, J. M. (2026). What is the contribution of maternal BMI to the risk of adverse pregnancy outcomes? Australian and New Zealand Journal of Obstetrics and Gynaecology, 66(4), e70163. https://doi.org/10.1111/ajo.70163
Moola, S., Munn, Z., Tufanaru, C., Aromataris, E., Sears, K., Sfetcu, R., Currie, M., Qureshi, R., Mattis, P., Lisy, K., & Mu, P.-F. (2020). Chapter 7: Systematic reviews of etiology and risk. En E. Aromataris & Z. Munn (Eds.), JBI manual for evidence synthesis. JBI. https://doi.org/10.46658/JBIMES-20-08
Moreira-Flores, M. M., & Montes-Vélez, R. S. (2022). Incidencia y severidad de la preeclampsia en el Ecuador. Dominio de las Ciencias, 8(1), 876–884. https://doi.org/10.23857/dc.v8i1.2528
Mussanova, A., Bishekova, B., Lokshin, V., Zhabchenko, I., Dzhardemaliyeva, N., Nurbayeva, T., & Baimussanova, G. (2025). Association between maternal pre-pregnancy BMI and preeclampsia: An updated systematic review and meta-analysis of cohort studies. Acta Biomedica, 96(2), 16409. https://doi.org/10.23750/abm.v96i2.16409
Organización Mundial de la Salud. (2024). Obesidad y sobrepeso [Nota descriptiva]. https://www.who.int/es/news-room/fact-sheets/detail/obesity-and-overweight
Page, M. J., McKenzie, J. E., Bossuyt, P. M., Boutron, I., Hoffmann, T. C., Mulrow, C. D., Shamseer, L., Tetzlaff, J. M., Akl, E. A., Brennan, S. E., Chou, R., Glanville, J., Grimshaw, J. M., Hróbjartsson, A., Lalu, M. M., Li, T., Loder, E. W., Mayo-Wilson, E., McDonald, S., . . . Moher, D. (2021). The PRISMA 2020 statement: An updated guideline for reporting systematic reviews. BMJ, 372, n71. https://doi.org/10.1136/bmj.n71
Shirvanifar, M., Ahlqvist, V. H., Lundberg, M., Kosidou, K., Herraiz-Adillo, Á., Berglind, D., Magnusson, C., & Henriksson, P. (2024). Adverse pregnancy outcomes attributable to overweight and obesity across maternal birth regions: A Swedish population-based cohort study. The Lancet Public Health, 9(10), e776–e786. https://doi.org/10.1016/S2468-2667(24)00188-9
Song, W., Zhang, Z., Zheng, W., Gao, L., Liang, S., Cheng, D., Wang, X., Guo, C., & Li, G. (2023). Patterns of gestational weight gain among women with obesity and its correlation with hypertensive disorders of pregnancy in Chinese women. Maternal & Child Nutrition, 19(3), e13416. https://doi.org/10.1111/mcn.13416
Sun, M., Gao, M., Luo, M., Wang, T., Ruan, X., Tang, J., Chen, Q., Liu, H., Li, L., & Qin, J. (2024). Impact of multiple obesity metrics on hypertensive disorders of pregnancy: A meta-analysis and Mendelian randomisation study. Heart, 110(20), 1216–1222. https://doi.org/10.1136/heartjnl-2024-324038
Sun, M., Luo, M., Wang, T., Wei, J., Zhang, S., Shu, J., Zhong, T., Liu, Y., Chen, Q., Zhu, P., & Qin, J. (2023). Effect of the interaction between advanced maternal age and pre-pregnancy BMI on pre-eclampsia and GDM in Central China. BMJ Open Diabetes Research & Care, 11(2), e003324. https://doi.org/10.1136/bmjdrc-2023-003324
Tang, Y., Song, M., Wu, Q., Xing, X., Miao, Y., & You, X. (2026). The mediating role of platelet indices on pre-pregnancy body mass index and late-onset preeclampsia. The Journal of Maternal-Fetal & Neonatal Medicine, 39(1), 2713353. https://doi.org/10.1080/14767058.2026.2713353
Teede, H. J., Bailey, C., Moran, L. J., Bahri Khomami, M., Enticott, J., Ranasinha, S., Rogozińska, E., Skouteris, H., Boyle, J. A., Thangaratinam, S., & Harrison, C. L. (2022). Association of antenatal diet and physical activity–based interventions with gestational weight gain and pregnancy outcomes: A systematic review and meta-analysis. JAMA Internal Medicine, 182(2), 106–114. https://doi.org/10.1001/jamainternmed.2021.6373
Ulhaq, R. A., Anis, W., Fatmaningrum, W., & Akbar, M. I. A. (2021). Association between pre-pregnancy body mass index and gestational weight gain and the risk of preeclampsia: A systematic review and meta-analysis. Asian Pacific Journal of Reproduction, 10(1), 1–10. https://doi.org/10.4103/2305-0500.306431
Vaca-Merino, V., Maldonado-Rengel, R., Tandazo-Montaño, P., Ochoa-Camacho, A., Guamán-Ayala, D., Riofrio-Loaiza, L., Vaca-Sarango, C., & del Sol, M. (2022). Estado nutricional de la mujer embarazada y su relación con las complicaciones de la gestación y el recién nacido. International Journal of Morphology, 40(2), 384–388. https://doi.org/10.4067/S0717-95022022000200384
World Health Organization. (2025). WHO recommendations on maternal health: Guidelines approved by the WHO Guidelines Review Committee (2.ª ed.). https://www.who.int/publications/i/item/9789240080591
Zhang, J., An, W., & Lin, L. (2022). The association of prepregnancy body mass index with pregnancy outcomes in Chinese women. Journal of Diabetes Research, 2022, 8946971. https://doi.org/10.1155/2022/8946971
Zhang, L., Ding, J., Liu, J., Ma, J., Shi, R., Chen, T., & Ding, G. (2025). Relationship between prepregnancy BMI and gestational weight gain (GWG) with preeclampsia: A study based on restricted cubic spline. BMC Pregnancy and Childbirth, 25(1), 360. https://doi.org/10.1186/s12884-025-07449-8
Zhang, Y., Lu, M., Yi, Y., Xia, L., Zhang, R., Li, C., & Liu, P. (2024). Influence of maternal body mass index on pregnancy complications and outcomes: A systematic review and meta-analysis. Frontiers in Endocrinology, 15, 1280692. https://doi.org/10.3389/fendo.2024.1280692
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