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The relative contribution of prepregnancy overweight and obesity, gestational weight gain, and IADPSG-defined gestational diabetes mellitus to fetal overgrowth.

Black MH, Sacks DA, Xiang AH, Lawrence JM - Diabetes Care (2012)

Bottom Line: The prevalence of large-for-gestational-age (LGA) infants was significantly higher for overweight and obese women without GDM compared with their normal-weight counterparts.Increasing gestational weight gain was associated with a higher prevalence of LGA in all groups.Prepregnancy overweight and obesity account for a high proportion of LGA, even in the absence of GDM.

View Article: PubMed Central - PubMed

Affiliation: Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA, USA. maryhelen.x.black@kp.org

ABSTRACT

Objective: The International Association of Diabetes in Pregnancy Study Groups (IADPSG) criteria for diagnosis of gestational diabetes mellitus (GDM) identifies women and infants at risk for adverse outcomes, which are also strongly associated with maternal overweight, obesity, and excess gestational weight gain.

Research design and methods: We conducted a retrospective study of 9,835 women who delivered at ≥20 weeks' gestation; had a prenatal, 2-h, 75-g oral glucose tolerance test; and were not treated with diet, exercise, or antidiabetic medications during pregnancy. Women were classified as having GDM based on IADPSG criteria and were categorized into six mutually exclusive prepregnancy BMI/GDM groups: normal weight ± GDM, overweight ± GDM, and obese ± GDM.

Results: Overall, 5,851 (59.5%) women were overweight or obese and 1,892 (19.2%) had GDM. Of those with GDM, 1,443 (76.3%) were overweight or obese. The prevalence of large-for-gestational-age (LGA) infants was significantly higher for overweight and obese women without GDM compared with their normal-weight counterparts. Among women without GDM, 21.6% of LGA infants were attributable to maternal overweight and obesity, and the combination of being overweight or obese and having GDM accounted for 23.3% of LGA infants. Increasing gestational weight gain was associated with a higher prevalence of LGA in all groups.

Conclusions: Prepregnancy overweight and obesity account for a high proportion of LGA, even in the absence of GDM. Interventions that focus on maternal overweight/obesity and gestational weight gain, regardless of GDM status, have the potential to reach far more women at risk for having an LGA infant.

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Prevalence of LGA infants for each prepregnancy BMI/GDM group. White bars, no GDM; black bars, GDM.
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Figure 1: Prevalence of LGA infants for each prepregnancy BMI/GDM group. White bars, no GDM; black bars, GDM.

Mentions: The prevalence of most adverse obstetrical and neonatal outcomes tended to increase with increasing BMI among women with and without GDM (Supplementary Table 1). Among women without GDM, the proportion of LGA infants born to overweight women was significantly higher than the proportion born to those of normal weight (P < 0.001) (Fig. 1). Likewise, the prevalence of LGA was higher in infants born to obese women without GDM than to their overweight (P = 0.050) or normal-weight (P < 0.001) counterparts (Fig. 1). A similar trend in increasing prevalence of LGA by increasing prepregnancy BMI was observed for women with GDM, with obese GDM women having a significantly higher proportion of LGA infants than either overweight (P = 0.005) or normal-weight (P < 0.001) women with GDM (Fig. 1). A similar relationship between increasing prepregnancy BMI and increasing mean ponderal index, for women with and without GDM, was also observed (Supplementary Fig. 1).


The relative contribution of prepregnancy overweight and obesity, gestational weight gain, and IADPSG-defined gestational diabetes mellitus to fetal overgrowth.

Black MH, Sacks DA, Xiang AH, Lawrence JM - Diabetes Care (2012)

Prevalence of LGA infants for each prepregnancy BMI/GDM group. White bars, no GDM; black bars, GDM.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3526206&req=5

Figure 1: Prevalence of LGA infants for each prepregnancy BMI/GDM group. White bars, no GDM; black bars, GDM.
Mentions: The prevalence of most adverse obstetrical and neonatal outcomes tended to increase with increasing BMI among women with and without GDM (Supplementary Table 1). Among women without GDM, the proportion of LGA infants born to overweight women was significantly higher than the proportion born to those of normal weight (P < 0.001) (Fig. 1). Likewise, the prevalence of LGA was higher in infants born to obese women without GDM than to their overweight (P = 0.050) or normal-weight (P < 0.001) counterparts (Fig. 1). A similar trend in increasing prevalence of LGA by increasing prepregnancy BMI was observed for women with GDM, with obese GDM women having a significantly higher proportion of LGA infants than either overweight (P = 0.005) or normal-weight (P < 0.001) women with GDM (Fig. 1). A similar relationship between increasing prepregnancy BMI and increasing mean ponderal index, for women with and without GDM, was also observed (Supplementary Fig. 1).

Bottom Line: The prevalence of large-for-gestational-age (LGA) infants was significantly higher for overweight and obese women without GDM compared with their normal-weight counterparts.Increasing gestational weight gain was associated with a higher prevalence of LGA in all groups.Prepregnancy overweight and obesity account for a high proportion of LGA, even in the absence of GDM.

View Article: PubMed Central - PubMed

Affiliation: Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA, USA. maryhelen.x.black@kp.org

ABSTRACT

Objective: The International Association of Diabetes in Pregnancy Study Groups (IADPSG) criteria for diagnosis of gestational diabetes mellitus (GDM) identifies women and infants at risk for adverse outcomes, which are also strongly associated with maternal overweight, obesity, and excess gestational weight gain.

Research design and methods: We conducted a retrospective study of 9,835 women who delivered at ≥20 weeks' gestation; had a prenatal, 2-h, 75-g oral glucose tolerance test; and were not treated with diet, exercise, or antidiabetic medications during pregnancy. Women were classified as having GDM based on IADPSG criteria and were categorized into six mutually exclusive prepregnancy BMI/GDM groups: normal weight ± GDM, overweight ± GDM, and obese ± GDM.

Results: Overall, 5,851 (59.5%) women were overweight or obese and 1,892 (19.2%) had GDM. Of those with GDM, 1,443 (76.3%) were overweight or obese. The prevalence of large-for-gestational-age (LGA) infants was significantly higher for overweight and obese women without GDM compared with their normal-weight counterparts. Among women without GDM, 21.6% of LGA infants were attributable to maternal overweight and obesity, and the combination of being overweight or obese and having GDM accounted for 23.3% of LGA infants. Increasing gestational weight gain was associated with a higher prevalence of LGA in all groups.

Conclusions: Prepregnancy overweight and obesity account for a high proportion of LGA, even in the absence of GDM. Interventions that focus on maternal overweight/obesity and gestational weight gain, regardless of GDM status, have the potential to reach far more women at risk for having an LGA infant.

Show MeSH
Related in: MedlinePlus