From the Guidelines
The greatest risk factor for this 33-year-old pregnant woman at 28 weeks gestation is obesity, as it significantly increases her risk for various pregnancy complications, including gestational diabetes, preeclampsia, cesarean delivery, and fetal macrosomia, as supported by the most recent study 1. With a body mass index (BMI) of 33.1 kg/m², she falls into the obesity category (BMI ≥30), which is associated with higher rates of these complications. Some key points to consider:
- Obesity during pregnancy is associated with higher rates of gestational diabetes, as her glucose tolerance test result suggests impaired glucose tolerance, and preeclampsia, as supported by 1.
- Her hypertension is also concerning, but her current blood pressure is relatively controlled, and her age of 33 is not considered advanced maternal age.
- Her multiparity generally carries lower risks than primiparity, and white race is not typically associated with increased pregnancy complications compared to other racial groups.
- Obesity impacts nearly every aspect of pregnancy physiology, including insulin resistance, inflammatory processes, and cardiovascular function, making it the most significant modifiable risk factor among those listed for this patient, as supported by 1 and 1. Key factors that contribute to the risk:
- Gestational diabetes: associated with increased risk of preeclampsia, cesarean delivery, and fetal macrosomia, as supported by 1 and 1.
- Preeclampsia: a severe, multi-system pregnancy complication affecting approximately 2–5% of pregnancies, as supported by 1 and 1.
- Obesity: significantly increases the risk for various pregnancy complications, including gestational diabetes and preeclampsia, as supported by 1 and 1.
From the Research
Risk Factors
The patient's profile suggests several risk factors, including:
- Age: 33 years old, which is considered advanced maternal age 2, 3
- Hypertension: a history of high blood pressure, which increases the risk of complications during pregnancy 2, 4
- Multiparity: having given birth multiple times, which can increase the risk of certain complications 2, 5
- Obesity: a body mass index (BMI) of 33.1 kg/m², which is considered obese and increases the risk of gestational diabetes, pre-eclampsia, and other complications 2, 3, 4, 5, 6
- Caucasian race: which may be a risk factor for certain complications, but the evidence is not clear 2, 3
Greatest Risk Factor
Based on the evidence, the greatest risk factor for this patient is her obesity, with a BMI of 33.1 kg/m². Obesity increases the risk of:
- Gestational diabetes mellitus (GDM) 2, 3, 4, 5
- Pre-eclampsia 2, 4, 5, 6
- Caesarean section 2, 3, 4, 6
- Macrosomia (large-for-gestational-age fetuses) 2, 3, 5
- Shoulder dystocia and birth trauma 2, 3, 5
- Metabolic syndrome in later life 2, 5
- Childhood obesity and metabolic dysfunction in offspring 2, 5
The evidence suggests that obesity is a significant risk factor for this patient, and management of her weight and related health conditions is crucial to reduce the risk of complications during pregnancy and improve outcomes for both the mother and the offspring 2, 3, 4, 5, 6.