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Observational Study
. 2025 Sep;82(9):1433-1442.
doi: 10.1161/HYPERTENSIONAHA.124.24394. Epub 2025 Jun 18.

Vascular Assessment Stratifying Preeclampsia Risk in Overweight/Obese Women

Christos Chatzakis  1 , Laura A Magee  2 , Renata Castello  1 , Gerardo Miranda  1 , Peter von Dadelszen  2 , Kypros H Nicolaides  1   2 , Marietta Charakida  1   3
Affiliations
Observational Study

Vascular Assessment Stratifying Preeclampsia Risk in Overweight/Obese Women

Christos Chatzakis et al. Hypertension. 2025 Sep.

Abstract

Background: Overweight and obesity greatly increase the risk of preeclampsia. There is a need to better risk-stratify these women in pregnancy and channel resources to those who can benefit most.

Methods: Prospective observational study of 11 962 women with singleton pregnancies attending a routine assessment at 35+0 to 36+6 weeks' gestation at King's College Hospital, London, United Kingdom. Women were categorized by their body mass index at 11 to 13 weeks' gestation as normal weight (18.5-24.9 kg/m2), overweight (25.0-29.9 kg/m2), or obese (≥30 kg/m2). We recorded maternal demographics, assessed uterine artery pulsatility index and ophthalmic artery peak systolic velocity ratio, and measured carotid-to-femoral pulse-wave velocity. Preeclampsia development was retrieved from medical records. Multivariable logistic regression was undertaken to examine determinants of preeclampsia. Mediation analysis was performed to assess causal relationships.

Results: In this cohort, 28.4% were overweight and 17.9% were obese. Preeclampsia developed more often in overweight/obese (versus normal weight) women (6.0% versus 1.7%, respectively; P<0.001); women of Black and South Asian ethnicity were at particularly increased risk (P=0.02 and 0.004, respectively). Determinants of preeclampsia development did not differ by body mass index. Mediation analysis suggested that the effect of overweight/obesity on preeclampsia development may be mediated partly by changes in maternal cardiovascular indices, particularly aortic stiffness (as reflected by carotid-to-femoral pulse-wave velocity, proportion mediated=72.6%).

Conclusions: Risk factors for term preeclampsia are largely similar between overweight/obese and normal-weight women, except for Black and South Asian women, who face a particularly high risk within the overweight/obese group. Maternal vascular assessment may serve as a valuable tool for stratifying the risk for term preeclampsia in these populations.

Keywords: body mass index; obesity; preeclampsia; pulse wave analysis; uterine artery.

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Conflict of interest statement

None.

Comment in

  • Is Body Mass Index a Predictor of Preeclampsia?
    Lajeunesse-Trempe F, Piché ME, Bujold E. Lajeunesse-Trempe F, et al. Hypertension. 2025 Sep;82(9):1443-1445. doi: 10.1161/HYPERTENSIONAHA.125.25392. Epub 2025 Aug 20. Hypertension. 2025. PMID: 40834056 No abstract available.

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