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Gestational diabetes, obesity increase risk for adverse maternal, neonatal outcomes
Pregnant women with gestational diabetes and obesity have a greater risk for cesarean section, preeclampsia and delivering a baby that is large for gestational age vs. women of normal weight without gestational diabetes, but overweight and obesity increase these risks in women with and without gestational diabetes, recent study findings show.
Karin Hilden, of the department of obstetrics and gynecology at the School of Health and Medical Sciences at Örebro University, Sweden, and colleagues analyzed data from 1,249,908 women with a BMI of at least 18.5 kg/m² and a singleton pregnancy recorded in the Swedish Medical Birth Register between 1998 and 2012. Women with type 1 or type 2 diabetes were excluded. Information in the register included maternal demographic data, reproductive history and complications during pregnancy, delivery and the neonatal period. Gestational diabetes was identified by 75 g oral glucose tolerance test.
Within the cohort, 13,057 women (1%) were diagnosed with gestational diabetes; 38.1% of those women had obesity.
For all adverse outcomes, researchers found the highest risks were observed in women with both gestational diabetes and obesity (BMI of at least 30 kg/m²); after adjustment for maternal age, smoking, hypertensive disease, parity and country of birth, the OR for cesarean section was 2.68 (95% CI, 2.52-2.85); OR for preeclampsia was 6.45 (95% CI, 5.82-7.14); OR for delivering of a baby large for gestational age was 6.5 (95% CI, 6.1-6.92).
Normal-weight women with gestational diabetes had an increased risk for cesarean section (OR = 1.26; 95% CI, 1.16-1.37)], preeclampsia (OR = 2.03; 95% CI, 1.71-2.41) and large-for-gestational-age infants (OR = 2.25; 95% CI, 2.06-2.46). Women with overweight but without gestational diabetes had similar increased risk for caesarean section (OR = 1.34; 95% CI, 1.33-1.36), preeclampsia (OR = 1.76; 95% CI, 1.72-1.81) and delivering a large-for-gestational-age infant (OR = 1.76; 95% CI, 1.74-1.79).
“The present nationwide study shows that overweight and obesity are associated with similar increments in risks of cesarean section, preeclampsia and delivery of [a large-for-gestational-age] infant in women with and without gestational diabetes,” the researchers wrote. “The combination of gestational diabetes and obesity conveys the greatest risks, with an independent and additive effect on risk of the adverse outcomes. In women without gestational diabetes, overweight is associated with similar risks, and obesity with higher risks, than those observed in normal-weight women with gestational diabetes.” – by Regina Schaffer
Disclosure: The researchers report no relevant financial disclosures.