(675) Prediction of term hypertensive disorders of pregnancy utilizing anthropometric measurements of central adiposity versus BMI

Friday, February 10, 2023

10:30 AM – 12:00 PM

Objective: Central adiposity is a known risk factor for cardiovascular disease in the non-pregnant patient. As such, we sought to evaluate the relationship between 3^rd trimester anthropometric measures of central adiposity and the development of hypertensive disorders of pregnancy (HDP) at term and compare these to the predictive value of BMI alone.

Study Design: Secondary analysis of a prospective cohort study from 2017-2020 of patients with viable singletons at a single center. Patients underwent a study visit at 36 weeks at which 19 measurements of central adiposity and BMI were obtained by trained personnel: 1) ultrasound (min/max subcutaneous and pre-peritoneal fat depth above umbilicus, below umbilicus, subxiphoid) 2) anthropometric skinfold thicknesses (tricep, flank, abdomen, thigh) and 3) waist, hip, arm circumferences. The primary outcome was diagnosis of a HDP (gestational hypertension, preeclampsia, eclampsia) at term. Measurement exposures were evaluated at alpha=0.05 using backward elimination multivariable logistic regression to generate a best-fit model. Receiver operator characteristic (ROC) curves with area under the curve (AUC) assessed the models’ predictive ability. AUCs, the best-fit model and its component predictors were compared to BMI.

Results: Of 201 women analyzed, 42 (21%) developed HDP at term. Patients with HDP had slightly higher BMIs (42.6 vs. 38.5), were more likely to be AMA, have public insurance, and a lower education level (all p< 0.05). Arm, waist, and hip circumference as well as waist-hip ratio were associated with the development of HDP (p< 0.05). The best fit model was a poor predictor of HDP at term (AUC 0.69 [0.59-0.78]), and was no more predictive than BMI alone, also a poor predictor (AUC 0.62 [0.53-0.71], p=0.24) (Table).

Conclusion: Our study demonstrated that measures of central obesity are no more predictive of HDP at term than BMI, itself a poor predictor. Future study is warranted to see if markers of central obesity improve prediction of hypertensive disorders if measured at earlier gestational ages.

Primary Author(s)

Ashley E. Shea, MD MPH
MFM Fellow
University of Alabama at Birmingham
Birmingham, Alabama, United States

Presenting Author(s)

Ashley E. Shea, MD MPH
MFM Fellow
University of Alabama at Birmingham
Birmingham, Alabama, United States

Coauthor(s)

JO
John Owen, MD,MSPH
Professor
Center for Women's Reproductive Health, University of Alabama at Birmingham
Birmingham, Alabama, United States
PC
Paula Chandler-Laney, PhD
Center for Women's Reproductive Health, University of Alabama at Birmingham
Birmingham, Alabama, United States
MP
Mickey Parks, N/A
Center for Women’s Reproductive Health, University of Alabama at Birmingham
Birmingham, Alabama, United States
Akila Subramaniam, MD,MPH
Associate Professor
Center for Women’s Reproductive Health, University of Alabama at Birmingham
Birmingham, Alabama, United States