The hyperglycemia and adverse pregnancy outcome study: associations of GDM and obesity with pregnancy outcomes

Patrick M Catalano, H David McIntyre, J Kennedy Cruickshank, David R McCance, Alan R Dyer, Boyd E Metzger, Lynn P Lowe, Elisabeth R Trimble, Donald R Coustan, David R Hadden, Bengt Persson, Moshe Hod, Jeremy J N Oats, HAPO Study Cooperative Research Group, Patrick M Catalano, H David McIntyre, J Kennedy Cruickshank, David R McCance, Alan R Dyer, Boyd E Metzger, Lynn P Lowe, Elisabeth R Trimble, Donald R Coustan, David R Hadden, Bengt Persson, Moshe Hod, Jeremy J N Oats, HAPO Study Cooperative Research Group

Abstract

Objective: To determine associations of gestational diabetes mellitus (GDM) and obesity with adverse pregnancy outcomes in the Hyperglycemia and Adverse Pregnancy Outcome (HAPO) Study.

Research design and methods: Participants underwent a 75-g oral glucose tolerance test (OGTT) between 24 and 32 weeks. GDM was diagnosed post hoc using International Association of Diabetes and Pregnancy Study Groups criteria. Neonatal anthropometrics and cord serum C-peptide were measured. Adverse pregnancy outcomes included birth weight, newborn percent body fat, and cord C-peptide >90th percentiles, primary cesarean delivery, preeclampsia, and shoulder dystocia/birth injury. BMI was determined at the OGTT. Multiple logistic regression was used to examine associations of GDM and obesity with outcomes.

Results: Mean maternal BMI was 27.7, 13.7% were obese (BMI ≥33.0 kg/m(2)), and GDM was diagnosed in 16.1%. Relative to non-GDM and nonobese women, odds ratio for birth weight >90th percentile for GDM alone was 2.19 (1.93-2.47), for obesity alone 1.73 (1.50-2.00), and for both GDM and obesity 3.62 (3.04-4.32). Results for primary cesarean delivery and preeclampsia and for cord C-peptide and newborn percent body fat >90th percentiles were similar. Odds for birth weight >90th percentile were progressively greater with both higher OGTT glucose and higher maternal BMI. There was a 339-g difference in birth weight for babies of obese GDM women, compared with babies of normal/underweight women (64.2% of all women) with normal glucose based on a composite OGTT measure of fasting plasma glucose and 1- and 2-h plasma glucose values (61.8% of all women).

Conclusions: Both maternal GDM and obesity are independently associated with adverse pregnancy outcomes. Their combination has a greater impact than either one alone.

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Source: PubMed

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