{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,15]],"date-time":"2026-07-15T04:08:06Z","timestamp":1784088486323,"version":"3.55.0"},"reference-count":25,"publisher":"MDPI AG","issue":"3","license":[{"start":{"date-parts":[[2026,7,15]],"date-time":"2026-07-15T00:00:00Z","timestamp":1784073600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Coimbra Group Scholarship Programme for Young Professors and Researchers from Latin American Universities"},{"name":"Tess Research Foundation (TRF, USA) Early-Career Investigator Research Grant"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Pathophysiology"],"abstract":"<jats:p>Background\/Objectives: Hypertensive disorders of pregnancy, particularly preeclampsia and eclampsia, are associated with high maternal and fetal morbidity and mortality, with maternal obesity representing a major, modifiable risk factor. This study aimed to estimate the association between obesity and preeclampsia\/eclampsia (PEC) in obstetric hospitalizations in the state of S\u00e3o Paulo, Brazil, and to examine risk trends across maternal age groups and between two distinct temporal cohorts. Methods: This population-based observational study analyzed 2,338,934 obstetric hospitalizations using data from the Hospital Information System of the Unified Health System (SIH\/SUS). PEC and obesity diagnoses were coded according to the International Classification of Diseases, 10th Revision (ICD-10). Logistic regression models were applied to estimate associations adjusted for maternal age, complemented by adjusted marginal predictions. Results: PEC occurred more than twice as often among women with obesity than without (5.4% vs. 2.2%; OR 2.13, 95% CI 1.84\u20132.47) and was associated with longer hospital stays (3.52 vs. 2.70 days) and higher costs (R$797.91 vs. R$602.69). The absolute risk difference between obese and non-obese women declined from 24.7% to 13.6% at age 20 between the 2017\u20132019 and 2023\u20132025 cohorts, while the relative risk gradient remained stable across all ages. Conclusions: Obesity is strongly associated with increased PEC risk, longer hospitalization, and higher costs. The observed attenuation in absolute risk differences in the most recent cohort reinforces the need for preventive interventions, nutritional surveillance, and public health policies aimed at reducing hypertensive complications during pregnancy for both obese and non-obese women.<\/jats:p>","DOI":"10.3390\/pathophysiology33030051","type":"journal-article","created":{"date-parts":[[2026,7,15]],"date-time":"2026-07-15T03:06:52Z","timestamp":1784084812000},"page":"51","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Maternal Obesity Doubles the Risk of Preeclampsia and Eclampsia: Post-COVID Changes in a Brazilian Cohort of 2.3 Million Hospitalizations"],"prefix":"10.3390","volume":"33","author":[{"given":"Priscilla Vogt Fernandes","family":"de Souza","sequence":"first","affiliation":[{"name":"Health Informatics Laboratory (LabInfoS), Department of Integrated Medical Sciences, Faculty of Medical Sciences, State University of Rio de Janeiro, Rio de Janeiro 28905-320, RJ, Brazil"},{"name":"School of Health Sciences, IBMR University Center, Barra da Tijuca, Rio de Janeiro 22631-002, RJ, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria Clara","family":"Salgado-Ramos","sequence":"additional","affiliation":[{"name":"Health Informatics Laboratory (LabInfoS), Department of Integrated Medical Sciences, Faculty of Medical Sciences, State University of Rio de Janeiro, Rio de Janeiro 28905-320, RJ, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0039-7285","authenticated-orcid":false,"given":"Jhenifer de Paiva","family":"Quadros","sequence":"additional","affiliation":[{"name":"Health Informatics Laboratory (LabInfoS), Department of Integrated Medical Sciences, Faculty of Medical Sciences, State University of Rio de Janeiro, Rio de Janeiro 28905-320, RJ, Brazil"},{"name":"School of Health Sciences, IBMR University Center, Barra da Tijuca, Rio de Janeiro 22631-002, RJ, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Juliana Cardoso","family":"Moraes","sequence":"additional","affiliation":[{"name":"School of Health Sciences, IBMR University Center, Barra da Tijuca, Rio de Janeiro 22631-002, RJ, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-1482-0875","authenticated-orcid":false,"given":"Daniel Luiz","family":"Santos da Silva","sequence":"additional","affiliation":[{"name":"School of Health Sciences, IBMR University Center, Barra da Tijuca, Rio de Janeiro 22631-002, RJ, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9832-7014","authenticated-orcid":false,"given":"Alex Oliveira","family":"da Camara","sequence":"additional","affiliation":[{"name":"Health Informatics Laboratory (LabInfoS), Department of Integrated Medical Sciences, Faculty of Medical Sciences, State University of Rio de Janeiro, Rio de Janeiro 28905-320, RJ, Brazil"},{"name":"School of Health Sciences, IBMR University Center, Barra da Tijuca, Rio de Janeiro 22631-002, RJ, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2447-5361","authenticated-orcid":false,"given":"Rafaella de Carvalho","family":"Cardoso","sequence":"additional","affiliation":[{"name":"School of Health Sciences, IBMR University Center, Barra da Tijuca, Rio de Janeiro 22631-002, RJ, Brazil"},{"name":"Laboratory of Neuropharmacogenetics, Department of Pharmacology and Psychobiology, Roberto Alc\u00e2ntara Gomes Institute of Biology, State University of Rio de Janeiro, Vila Isabel, Rio de Janeiro 20551-030, RJ, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1584-9157","authenticated-orcid":false,"given":"H\u00e9rcules Rezende","family":"Freitas","sequence":"additional","affiliation":[{"name":"Health Informatics Laboratory (LabInfoS), Department of Integrated Medical Sciences, Faculty of Medical Sciences, State University of Rio de Janeiro, Rio de Janeiro 28905-320, RJ, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,7,15]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","unstructured":"Bilano, V.L., Ota, E., Ganchimeg, T., Mori, R., and Souza, J.P. (2014). Risk Factors of Pre-Eclampsia\/Eclampsia and Its Adverse Outcomes in Low- and Middle-Income Countries: A WHO Secondary Analysis. PLoS ONE, 9.","DOI":"10.1371\/journal.pone.0091198"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"101693","DOI":"10.1016\/j.ajogmf.2025.101693","article-title":"Diagnosis of Hypertensive Disorders in Pregnancy","volume":"7","author":"Horgan","year":"2025","journal-title":"Am. J. Obstet. Gynecol. MFM"},{"key":"ref_3","first-page":"2401","article-title":"Global Trends in Prevalence of Maternal Overweight and Obesity: A Systematic Review and Meta-Analysis of Routinely Collected Data Retrospective Cohorts","volume":"9","author":"Kent","year":"2024","journal-title":"Int. J. Popul. Data Sci."},{"key":"ref_4","doi-asserted-by":"crossref","unstructured":"Louren\u00e7o, J., and Guedes-Martins, L. (2025). Pathophysiology of Maternal Obesity and Hypertension in Pregnancy. J. Cardiovasc. Dev. Dis., 12.","DOI":"10.3390\/jcdd12030091"},{"key":"ref_5","doi-asserted-by":"crossref","unstructured":"Nikolova, Z., Sandeva, M., Uchikova, E., Kirkova-Bogdanova, A., Taneva, D., Vladimirova, M., and Georgieva, L. (2025). Impact of Maternal Overweight and Obesity on Pregnancy Outcomes Following Cesarean Delivery: A Retrospective Cohort Study. Healthcare, 13.","DOI":"10.20944\/preprints202506.0509.v1"},{"key":"ref_6","doi-asserted-by":"crossref","unstructured":"Xiang, C., Sui, L., Ding, X., Cao, M., Li, G., and Du, Z. (2024). Maternal Adiposity Measures and Hypertensive Disorders of Pregnancy: A Meta-Analysis. BMC Pregnancy Childbirth, 24.","DOI":"10.1186\/s12884-024-06788-2"},{"key":"ref_7","doi-asserted-by":"crossref","unstructured":"Abraham, T., and Romani, A.M.P. (2022). The Relationship between Obesity and Pre-Eclampsia: Incidental Risks and Identification of Potential Biomarkers for Pre-Eclampsia. Cells, 11.","DOI":"10.3390\/cells11091548"},{"key":"ref_8","doi-asserted-by":"crossref","unstructured":"Zhang, Y., Lu, M., Yi, Y., Xia, L., Zhang, R., Li, C., and Liu, P. (2024). Influence of Maternal Body Mass Index on Pregnancy Complications and Outcomes: A Systematic Review and Meta-Analysis. Front. Endocrinol., 15.","DOI":"10.3389\/fendo.2024.1280692"},{"key":"ref_9","doi-asserted-by":"crossref","unstructured":"Lopez-Jaramillo, P., Barajas, J., Rueda-Quijano, S.M., Lopez-Lopez, C., and Felix, C. (2018). Obesity and Preeclampsia: Common Pathophysiological Mechanisms. Front. Physiol., 9.","DOI":"10.3389\/fphys.2018.01838"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"1025","DOI":"10.1016\/S2213-8587(16)30217-0","article-title":"Preconceptional and Maternal Obesity: Epidemiology and Health Consequences","volume":"4","author":"Poston","year":"2016","journal-title":"Lancet Diabetes Endocrinol."},{"key":"ref_11","doi-asserted-by":"crossref","unstructured":"Saldiva, S.R.D.M., De Arruda Neta, A.d.C.P., Teixeira, J.A., Peres, S.V., Marchioni, D.M.L., Carvalho, M.A., Vieira, S.E., and Francisco, R.P.V. (2022). Dietary Pattern Influences Gestational Weight Gain: Results from the ProcriAr Cohort Study-S\u00e3o Paulo, Brazil. Nutrients, 14.","DOI":"10.3390\/nu14204428"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"104","DOI":"10.1055\/s-0043-1766109","article-title":"Guidelines on How to Monitor Gestational Weight Gain during Antenatal Care","volume":"45","author":"Surita","year":"2023","journal-title":"Rev. Bras. Ginecol. Obstet."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"797","DOI":"10.1590\/S1413-81232011000700010","article-title":"A import\u00e2ncia na inser\u00e7\u00e3o do nutricionista na Estrat\u00e9gia Sa\u00fade da Fam\u00edlia","volume":"16","author":"Geus","year":"2011","journal-title":"Ci\u00eanc. Sa\u00fade Coletiva"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"e237149","DOI":"10.1001\/jamanetworkopen.2023.7149","article-title":"Severe Maternal Morbidity and Mortality of Pregnant Patients With COVID-19 Infection During the Early Pandemic Period in the US","volume":"6","author":"Matsuo","year":"2023","journal-title":"JAMA Netw. Open"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"103395","DOI":"10.1016\/j.eclinm.2025.103395","article-title":"The Effect of Maternal Pre-Pregnancy Body Mass Index on Hypertensive Disorders of Pregnancy (HDP): A Systematic Review and Dose-Response Meta-Analysis of Cohort Studies Involving 50 Million Pregnancies","volume":"86","author":"Xiong","year":"2025","journal-title":"EClinicalMedicine"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"e2226531","DOI":"10.1001\/jamanetworkopen.2022.26531","article-title":"Comparison of Pregnancy and Birth Outcomes Before vs During the COVID-19 Pandemic","volume":"5","author":"Molina","year":"2022","journal-title":"JAMA Netw. Open"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"e2324011","DOI":"10.1001\/jamanetworkopen.2023.24011","article-title":"Prenatal Health Care Outcomes Before and During the COVID-19 Pandemic Among Pregnant Individuals and Their Newborns in an Integrated US Health System","volume":"6","author":"Ferrara","year":"2023","journal-title":"JAMA Netw. Open"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"e17481","DOI":"10.7717\/peerj.17481","article-title":"Preeclampsia in Pregnant Women with COVID-19: A Prospective Cohort Study from Two Tertiary Hospitals in Southern Brazil","volume":"12","author":"Sobieray","year":"2024","journal-title":"PeerJ"},{"key":"ref_19","doi-asserted-by":"crossref","unstructured":"Iannaccone, A., Gellhaus, A., Reisch, B., Dzietko, M., Schmidt, B., Mavarani, L., Kraft, K., Andresen, K., Kimmig, R., and Pecks, U. (2024). The Importance of Vaccination, Variants and Time Point of SARS-CoV-2 Infection in Pregnancy for Stillbirth and Preterm Birth Risk: An Analysis of the CRONOS Register Study. J. Clin. Med., 13.","DOI":"10.3390\/jcm13061522"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"e00032419","DOI":"10.1590\/0102-311x00032419","article-title":"Microdatasus: Pacote para download e pr\u00e9-processamento de microdados do Departamento de Inform\u00e1tica do SUS (DATASUS)","volume":"35","author":"Saldanha","year":"2019","journal-title":"Cad. Sa\u00fade P\u00fablica"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"725","DOI":"10.1161\/CIRCRESAHA.123.322762","article-title":"Body Mass Index, Adverse Pregnancy Outcomes, and Cardiovascular Disease Risk","volume":"133","author":"Khan","year":"2023","journal-title":"Circ. Res."},{"key":"ref_22","doi-asserted-by":"crossref","unstructured":"Xie, J., Yan, Y., Ye, Z., Wu, Y., Yu, Y., Sun, Y., Rong, S., Santillan, D.A., Ryckman, K., and Snetselaar, L.G. (2025). Racial\/Ethnic Disparities in the Association of Maternal Diabetes and Obesity with Risk of Preterm Birth among 17 Million Mother-Infant Pairs in the United States: A Population-Based Cohort Study. BMC Pregnancy Childbirth, 25.","DOI":"10.1186\/s12884-025-07352-2"},{"key":"ref_23","first-page":"6","article-title":"The Role of Obesity in Preeclampsia","volume":"1","author":"Roberts","year":"2011","journal-title":"Pregnancy Hypertens. Int. J. Women\u2019s Cardiovasc. Health"},{"key":"ref_24","doi-asserted-by":"crossref","unstructured":"Carrilho, I., Mariana, M., and Cairrao, E. (2025). Adiponectin as a Biomarker of Preeclampsia: A Systematic Review. Reprod. Med., 6.","DOI":"10.3390\/reprodmed6040029"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"395","DOI":"10.1002\/oby.24206","article-title":"Racial Disparities in Gestational Weight Gain and Adverse Pregnancy Outcomes among Black and White Pregnant People with Obesity","volume":"33","author":"Kracht","year":"2025","journal-title":"Obesity"}],"container-title":["Pathophysiology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1873-149X\/33\/3\/51\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,15]],"date-time":"2026-07-15T03:42:23Z","timestamp":1784086943000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1873-149X\/33\/3\/51"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7,15]]},"references-count":25,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2026,9]]}},"alternative-id":["pathophysiology33030051"],"URL":"https:\/\/doi.org\/10.3390\/pathophysiology33030051","relation":{},"ISSN":["1873-149X"],"issn-type":[{"value":"1873-149X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7,15]]}}}