American Journal of Epidemiology Advance Access originally published online on November 3, 2005
American Journal of Epidemiology 2005 162(12):1198-1206; doi:10.1093/aje/kwi334
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Original Contribution |
Inflammation and Triglycerides Partially Mediate the Effect of Prepregnancy Body Mass Index on the Risk of Preeclampsia
1 Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA
2 Magee-Women's Research Institute, Pittsburgh, PA
3 Department of Obstetrics, Gynecology, and Reproductive Sciences, School of Medicine, University of Pittsburgh, Pittsburgh, PA
4 Department of Medicine, School of Medicine, University of Pittsburgh, Pittsburgh, PA
Correspondence to Dr. Lisa M. Bodnar, A742 Crabtree Hall, Graduate School of Public Health, University of Pittsburgh, 130 DeSoto Street, Pittsburgh, PA 15261 (e-mail: Bodnar{at}edc.pitt.edu).
The objective of this study was to quantify the mediating role of inflammation and triglycerides in the association between prepregnancy body mass index (weight (kg)/height (m)2) and preeclampsia. The authors conducted a nested case-control study of 55 preeclamptic women and 165 pregnant controls from the Pregnancy Exposures and Preeclampsia Prevention Study (Pittsburgh, Pennsylvania, 1997–2001). Serum samples collected at 
20 weeks' gestation were analyzed for levels of C-reactive protein and triglycerides. The adjusted odds ratio (AOR) from a multivariable conditional logistic regression model assessing the total effect of body mass index on preeclampsia risk was compared with the AOR from the same model after results were controlled for C-reactive protein, triglycerides, and confounding factors (direct-effects model). The percentage of the total effect that was mediated through inflammation and triglycerides was calculated as 100 – [ln(direct-effects AOR)/ln(total-effects AOR)]. In the total-effects model, 4- and 8-unit increases in body mass index were associated with 1.7-fold (95% confidence interval (CI): 1.3, 2.3) and 2.9-fold (95% CI: 1.6, 5.2) increases in preeclampsia risk, whereas in the direct-effects model, these AORs were 1.4 (95% CI: 1.0, 1.9) and 2.0 (95% CI: 1.0, 3.8), respectively. Inflammation was a more important mediator than triglycerides. These findings suggest that approximately one third of the total effect of body mass index on preeclampsia risk is mediated through inflammation and triglyceride levels.
body mass index; C-reactive protein; inflammation; obesity; pre-eclampsia; pregnancy; triglycerides
Abbreviations: AOR, adjusted odds ratio; BMI, body mass index; CRP, C-reactive protein
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