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Impact of maternal body mass index above 30 kg/m2 on adverse pregnancy outcomes in women with and without gestational diabetes mellitus in southeastern Sweden

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Názov: Impact of maternal body mass index above 30 kg/m2 on adverse pregnancy outcomes in women with and without gestational diabetes mellitus in southeastern Sweden
Autori: Stogianni, Anna, Jönsson, Annika, Penna, Malin, Lendahls, Lena, Alvarsson, Michael, Landin-Olsson, Mona, Wanby, Pär, Thunander, Maria
Zdroj: Acta Obstetricia et Gynecologica Scandinavica. 104(11):2093-2101
Predmety: apgar, cesarean section, ethnicity, gestational diabetes, gestational weight gain, large-for-gestational-age, obesity, preeclampsia, Health and Caring Sciences, Hälsovetenskap
Popis: Introduction: Our objective was to evaluate the association of early-pregnancy body mass index (BMI) in women with gestational diabetes mellitus (GDM) with maternal, delivery, and child outcomes, and compare with pregnancies without diabetes in southeastern Sweden, including after a surge of non-European immigration.Material and Methods: A retrospective population-based observational study of all 401 singleton pregnancies with GDM in the Kronoberg and southern Kalmar regions, 2013-2018, and 377 pregnancies without diabetes, matched by date of delivery. Data were collected by chart review. Women with early-pregnancy BMI <30 kg/m(2)/>= 30 kg/m(2) were compared. Main outcomes were gestational weight gain (GWG), continuous and dichotomized <8 kg/>= 8 kg, preeclampsia, cesarean section (CS), and large-for-gestational-age (LGA). Maternal age, ethnicity, parity, smoking, physical activity, delivery type and week, birthweight, and the APGAR(5min) score were also registered.Results: Obese women with GDM had lower mean GWG (9.2 +/- 6.8 vs. 11.7 +/- 6.1 kg); fewer reached >= 8 kg (54% vs. 75%), more had preeclampsia (13% vs. 2.6%), and infants weighed 200 g less than those of nonobese women with GDM all p < 0.001 and those of obese women without GDM (11.2 +/- 5.8 kg, p < 0.001; 68%, p = 0.05, 3.1%, p = 0.03). APGAR(5min) scores were high in all groups, 9.4-9.8. All women with GDM had a higher prevalence of LGA infants than controls without diabetes; obese 24% versus 12% (p = 0.03) and nonobese 11% versus 6% (p = 0.05). Obese women with GDM delivered more LGA infants than nonobese women with GDM, p = 0.001. The combination of GDM and obesity increased risk of LGA, OR 5.3 (2.76-10.1); preeclampsia OR 4.3 (1.83-10.23); and CS OR 1.9 (1.26-2.97) and decreased odds of GWG >= 8 kg, OR 0.25 (0.16-0.38), compared to the reference group of nonobese women without GDM. All results remained unchanged in a sensitivity analysis using the BMI obesity limit >= 27.5 kg/m(2) for Asians, who were overrepresented in the group of women with GDM.Conclusions: Women with GDM and obesity, especially in combination, had a greater risk for preeclampsia, CS, and delivering LGA infants; their lower GWG and high APGAR(5min) scores in all groups, compared to earlier studies, suggested successful care interventions. Efforts to lower the levels of early-pregnancy obesity and strict glucose control in women with GDM are recommended to reduce adverse outcomes.
Popis súboru: electronic
Prístupová URL adresa: https://urn.kb.se/resolve?urn=urn:nbn:se:lnu:diva-141356
https://doi.org/10.1111/aogs.70040
Databáza: SwePub
Popis
Abstrakt:<strong>Introduction:</strong> Our objective was to evaluate the association of early-pregnancy body mass index (BMI) in women with gestational diabetes mellitus (GDM) with maternal, delivery, and child outcomes, and compare with pregnancies without diabetes in southeastern Sweden, including after a surge of non-European immigration.<strong>Material and Methods:</strong> A retrospective population-based observational study of all 401 singleton pregnancies with GDM in the Kronoberg and southern Kalmar regions, 2013-2018, and 377 pregnancies without diabetes, matched by date of delivery. Data were collected by chart review. Women with early-pregnancy BMI <30 kg/m(2)/>= 30 kg/m(2) were compared. Main outcomes were gestational weight gain (GWG), continuous and dichotomized <8 kg/>= 8 kg, preeclampsia, cesarean section (CS), and large-for-gestational-age (LGA). Maternal age, ethnicity, parity, smoking, physical activity, delivery type and week, birthweight, and the APGAR(5min) score were also registered.<strong>Results:</strong> Obese women with GDM had lower mean GWG (9.2 +/- 6.8 vs. 11.7 +/- 6.1 kg); fewer reached >= 8 kg (54% vs. 75%), more had preeclampsia (13% vs. 2.6%), and infants weighed 200 g less than those of nonobese women with GDM all p < 0.001 and those of obese women without GDM (11.2 +/- 5.8 kg, p < 0.001; 68%, p = 0.05, 3.1%, p = 0.03). APGAR(5min) scores were high in all groups, 9.4-9.8. All women with GDM had a higher prevalence of LGA infants than controls without diabetes; obese 24% versus 12% (p = 0.03) and nonobese 11% versus 6% (p = 0.05). Obese women with GDM delivered more LGA infants than nonobese women with GDM, p = 0.001. The combination of GDM and obesity increased risk of LGA, OR 5.3 (2.76-10.1); preeclampsia OR 4.3 (1.83-10.23); and CS OR 1.9 (1.26-2.97) and decreased odds of GWG >= 8 kg, OR 0.25 (0.16-0.38), compared to the reference group of nonobese women without GDM. All results remained unchanged in a sensitivity analysis using the BMI obesity limit >= 27.5 kg/m(2) for Asians, who were overrepresented in the group of women with GDM.<strong>Conclusions:</strong> Women with GDM and obesity, especially in combination, had a greater risk for preeclampsia, CS, and delivering LGA infants; their lower GWG and high APGAR(5min) scores in all groups, compared to earlier studies, suggested successful care interventions. Efforts to lower the levels of early-pregnancy obesity and strict glucose control in women with GDM are recommended to reduce adverse outcomes.
ISSN:00016349
16000412
DOI:10.1111/aogs.70040