Does maternal body mass index influence treatment effect in women with mild gestational diabetes?

Brian M Casey, Lisa Mele, Mark B Landon, Catherine Y Spong, Susan M Ramin, Ronald J Wapner, Michael W Varner, Dwight J Rouse, John M Thorp Jr, Patrick Catalano, Margaret Harper, George Saade, Yoram Sorokin, Alan M Peaceman, Eunice Kennedy Shriver National Institute of Child Health and Human Development Maternal-Fetal Medicine Units Network, Brian M Casey, Lisa Mele, Mark B Landon, Catherine Y Spong, Susan M Ramin, Ronald J Wapner, Michael W Varner, Dwight J Rouse, John M Thorp Jr, Patrick Catalano, Margaret Harper, George Saade, Yoram Sorokin, Alan M Peaceman, Eunice Kennedy Shriver National Institute of Child Health and Human Development Maternal-Fetal Medicine Units Network

Abstract

Objective: The aim of the article is to determine whether maternal body mass index (BMI) influences the beneficial effects of diabetes treatment in women with gestational diabetes mellitus (GDM).

Study design: Secondary analysis of a multicenter randomized treatment trial of women with GDM. Outcomes of interest were elevated umbilical cord c-peptide levels (> 90th percentile 1.77 ng/mL), large for gestational age (LGA) birth weight (> 90th percentile), and neonatal fat mass (g). Women were grouped into five BMI categories adapted from the World Health Organization International Classification of normal, overweight, and obese adults. Outcomes were analyzed according to treatment group assignment.

Results: A total of 958 women were enrolled (485 treated and 473 controls). Maternal BMI at enrollment was not related to umbilical cord c-peptide levels. However, treatment of women in the overweight, Class I, and Class II obese categories was associated with a reduction in both LGA birth weight and neonatal fat mass. Neither measure of excess fetal growth was reduced with treatment in normal weight (BMI < 25 kg/m(2)) or Class III (BMI ≥ 40 kg/m(2)) obese women.

Conclusion: There was a beneficial effect of treatment on fetal growth in women with mild GDM who were overweight or Class I and Class II obese. These effects were not apparent for normal weight and very obese women.

Conflict of interest statement

The authors report no conflict of interest.

Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Figures

Figure 1
Figure 1
Percent LGA according to maternal body mass index (BMI) and treatment group in women with mild gestational diabetes who were randomized to either diet therapy and glucose monitoring or routine prenatal care. The X2 or Fisher exact test was used to compare treatment groups within BMI category.
Figure 2
Figure 2
Neonatal Fat Mass (grams) according to maternal body mass index (BMI) and treatment group in women with mild gestational diabetes that were randomized to either diet therapy and glucose monitoring or routine prenatal care. The Wilcoxon rank sum test was used to compare treatment groups within BMI category.

Source: PubMed

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