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Joint Effect of Body Mass Index and Obstructive Sleep Apnea on Preeclampsia Risk

Nana A Mensah1,2, Michael J Fassett3,4, Morgan R Peltier5,6

  • 1Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, California.

American Journal of Perinatology
|April 7, 2025
PubMed

Insights

Obesity and obstructive sleep apnea (OSA) independently increase preeclampsia risk. When occurring together, these conditions have an additive effect, highlighting the need for monitoring modifiable risk factors in overweight pregnant individuals.

Area of Science:

  • Obstetrics and Gynecology
  • Perinatal Medicine
  • Sleep Medicine

Background:

  • Preeclampsia is a leading cause of maternal and infant mortality globally.
  • Identifying modifiable risk factors early in pregnancy is crucial for reducing preeclampsia incidence and adverse outcomes.
  • The combined impact of prepregnancy body mass index (BMI) and obstructive sleep apnea (OSA) on preeclampsia risk requires further investigation.

Purpose of the Study:

  • To investigate the potential synergistic effect of prepregnancy BMI and OSA on the risk of developing preeclampsia.
  • To quantify the independent and combined risks associated with elevated BMI and OSA in singleton pregnancies.

Main Methods:

  • Retrospective cohort study of over 340,000 singleton pregnancies.
  • Ascertainment of preeclampsia and OSA using clinical diagnosis codes.
  • Analysis of prepregnancy BMI categories (normal, overweight, obese) and OSA diagnosis using multivariable logistic regression.

Main Results:

  • Overweight and obese BMI were independently associated with increased preeclampsia risk (aRR 1.6 and 2.5, respectively).
  • Obstructive sleep apnea (OSA) was independently associated with increased preeclampsia risk (aRR 2.2).
  • The combination of overweight or obese BMI with OSA significantly elevated preeclampsia risk (aRR 4.6 and 3.8, respectively), demonstrating an additive, not synergistic, effect.

Conclusions:

  • Elevated prepregnancy BMI and OSA are independent risk factors for preeclampsia.
  • The combined presence of obesity and OSA results in an additive increase in preeclampsia risk.
  • Pregnant individuals with overweight BMI and OSA should receive close monitoring and early intervention for these modifiable risk factors.

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