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American Journal of Epidemiology Advance Access originally published online on August 27, 2009
American Journal of Epidemiology 2009 170(7):829-836; doi:10.1093/aje/kwp211
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American Journal of Epidemiology © The Author 2009. Published by the Johns Hopkins Bloomberg School of Public Health. All rights reserved. For permissions, please e-mail: journals.permissions@oxfordjournals.org.

ORIGINAL CONTRIBUTIONS

Metabolic Syndrome in Early Pregnancy and Risk of Preterm Birth

Leda Chatzi, Estel Plana, Vasiliki Daraki, Polyxeni Karakosta, Dimitris Alegkakis, Christos Tsatsanis, Antonis Kafatos, Antonis Koutis and Manolis Kogevinas

Correspondence to Dr. Leda Chatzi, Department of Social Medicine, Faculty of Medicine, University of Crete, P.O. Box 2208, Heraklion 71003, Crete, Greece (e-mail: lchatzi{at}med.uoc.gr).

Received for publication March 3, 2009. Accepted for publication June 19, 2009.

The authors determined the association between metabolic syndrome in early pregnancy (mean, 11.96 weeks) and the risk of preterm birth in the mother-child cohort study ("Rhea" Study) in Crete, Greece, 2007–2009. Maternal fasting serum samples were collected, and blood pressure was measured at the time of the first major ultrasound examination (n = 625). Multivariable log-binomial regression models were used. Women with metabolic syndrome were at high risk for preterm birth (relative risk (RR) = 2.93, 95% confidence interval (CI): 1.53, 5.58), with the highest risk observed for medically indicated preterm births (RR = 5.13, 95% CI: 1.97, 13.38). Among the components of metabolic syndrome, the most significant risk factor was hypertension (RR = 2.32, 95% CI: 1.28, 4.20). An elevation of 10 mm Hg in diastolic blood pressure increased the relative risk for preterm birth by 29% (RR = 1.29, 95% CI: 1.08, 1.53), while a per unit increase in the low density lipoprotein/high density lipoprotein cholesterol ratio increased this risk by 19% (RR = 1.19, 95% CI: 1.02, 1.39). Fetal weight growth restriction was associated with elevated levels of insulin (RR = 1.14, 95% CI: 1.08, 1.20) and diastolic blood pressure (RR = 1.27, 95% CI: 1.00, 1.61) in early pregnancy. These findings suggest that women with metabolic syndrome in early pregnancy had higher risk for preterm birth.

fetal growth retardation; metabolic syndrome X; premature birth

Abbreviations: CI, confidence interval; HDL, high density lipoprotein; LDL, low density lipoprotein; RR, relative risk


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