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. With a BMI of 33.1 kg/m², she falls into the obesity category (BMI ≥30), which is associated with higher rates of these complications, as noted in a recent study 1. While her hypertension is also concerning, her current blood pressure of 133/80 mmHg is relatively controlled. Her age (33) is not considered advanced maternal age (typically defined as ≥35 years), multiparity carries lower risks than primiparity for certain complications, and white race is generally not considered a major risk factor compared to other racial groups for most pregnancy complications.
Key Risk Factors
- Obesity: increases risk for gestational diabetes, preeclampsia, cesarean delivery, and fetal macrosomia
- Hypertension: although relatively controlled, still a concern
- Age: not considered advanced maternal age
- Multiparity: carries lower risks than primiparity for certain complications
- White race: not considered a major risk factor compared to other racial groups
Recommendations
- Weight management strategies should be prioritized in her care plan
- Close monitoring for complications like gestational diabetes and preeclampsia is necessary
- Regular prenatal physical activity may reduce the risks associated with obesity, as suggested by a study on the benefits of exercise during pregnancy 1
Considerations
- The patient's glucose tolerance test result of 160 mg/dL suggests gestational diabetes, which is a significant concern
- Preeclampsia is a severe pregnancy complication that can be associated with obesity, and close monitoring is necessary, as recommended by the USPSTF 1
- The patient's obesity and potential gestational diabetes increase her risk for long-term health sequelae, including cardiovascular and metabolic diseases, as noted in a study on maternal lipids in overweight and obesity 1
From the Research
Risk Factors for Adverse Pregnancy Outcomes
The patient's profile suggests several risk factors for adverse pregnancy outcomes, including:
- Age: 33 years old
- Gravida: 3, Para: 2 (multiparity)
- Hypertension
- Migraine
- Obesity (BMI: 33.1 kg/m²)
- Caucasian race
Greatest Risk Factor
Based on the provided evidence, the greatest risk factor for this patient is her obesity (BMI: 33.1 kg/m²) 2, 3, 4, 5, 6. Obesity has been consistently associated with an increased risk of adverse pregnancy outcomes, including:
- Gestational diabetes mellitus (GDM) 2, 3, 4, 6
- Pre-eclampsia 2, 3, 6
- Caesarean section 3, 4, 6
- Macrosomia (large-for-gestational-age fetuses) 2, 3, 4, 6
- Shoulder dystocia and birth trauma 2, 3
Comparison of Risk Factors
While the patient's age, hypertension, multiparity, and Caucasian race may also contribute to her risk profile, the evidence suggests that obesity is the most significant risk factor for adverse pregnancy outcomes in this case 2, 3, 4, 5, 6. The combination of obesity and GDM has been shown to have a greater impact on pregnancy outcomes than either condition alone 6.