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Early Pregnancy Central Obesity and Risk of Prenatal and Postpartum Diabetes and Hypertensive Disorders

Ana K Rosen Vollmar1,2, Monique M Hedderson1, Amanda L Ngo1

  • 1Division of Research, Kaiser Permanente Northern California, Pleasanton, CA.

Diabetes Care
|April 13, 2026
PubMed

Insights

Central obesity during pregnancy increases risks for gestational diabetes and postpartum hypertension, even with a healthy BMI. Early pregnancy central obesity measures improve cardiometabolic risk assessment beyond BMI alone.

Area of Science:

  • Obstetrics and Gynecology
  • Cardiology
  • Endocrinology

Background:

  • Body Mass Index (BMI) has limitations in assessing obesity.
  • Central obesity's role in pregnancy and postpartum cardiometabolic conditions is understudied.
  • Investigating central obesity independently and with BMI is crucial for risk assessment.

Purpose of the Study:

  • To investigate associations between central obesity measures and perinatal cardiometabolic conditions.
  • To evaluate central obesity's role independently and jointly with BMI.
  • To determine if central obesity enhances risk prediction beyond BMI.

Main Methods:

  • Examined early pregnancy central obesity measures (waist circumference, waist-to-hip ratio, waist-to-height ratio, body roundness index).
  • Assessed associations with gestational diabetes mellitus, hypertensive disorders of pregnancy, postpartum prediabetes/diabetes, and postpartum chronic hypertension.
  • Utilized modified Poisson and Cox regression models for outcome analysis.

Main Results:

  • A dose-response relationship was observed between increasing central obesity and all cardiometabolic outcomes, independent of BMI.
  • Individuals with healthy prepregnancy BMI and central obesity showed increased risk for gestational diabetes mellitus (RR 1.92-2.42).
  • Central obesity was linked to higher risks of postpartum prediabetes/diabetes (HR 1.50-2.16) and chronic hypertension (HR 2.04-3.63).

Conclusions:

  • Early pregnancy central obesity measures can enhance perinatal cardiometabolic risk assessment.
  • Central obesity identifies individuals at risk who may be missed by BMI alone.
  • Incorporating central obesity metrics improves identification of at-risk pregnancies.
Abstract

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