Impact of obesity on maternal and neonatal outcomes in insulin-resistant pregnancy.

Abstract

OBJECTIVE:

To determine the impact of obesity on pregnancies complicated by insulin resistance.

STUDY DESIGN:

Secondary analysis of prospective cohort of women with gestational diabetes mellitus (GDM) and type 2 diabetes mellitus (DM). The exclusion criteria were type 1 DM, multiple gestation, fetal anomalies, unknown prepregnancy, and body mass index (BMI). Primary maternal outcome was a composite of any of the following: severe preeclampsia, eclampsia, third- to fourth-degree laceration, readmission, wound infection, or antepartum hospitalization. Primary neonatal outcome was a composite of any of the following: hypoglycemia, preterm delivery, admission to level 3 nursery, oxygen requirement > 6 hours after birth, shoulder dystocia, 5-minute Apgar ≤3, cord pH < 7.0, and cord base excess < -12 mmol/L. Obese women (BMI ≥30.0 kg/m(2)) were compared with nonobese women (BMI < 30.0 kg/m(2)).

RESULTS:

Of 356 subjects with DM, 233 (66%) were obese. Obese women were not at further increased risk of the composite maternal outcome (adjusted odds ratio [AOR] = 0.68, 95% confidence interval [CI] = 0.43-1.09), the composite neonatal outcome (AOR = 0.76, 95% CI = 0.48-1.21), or cesarean (58.8 vs. 52.9%, p = 0.28, AOR = 1.47, 95% CI = 0.91-2.39).

CONCLUSION:

We did not find evidence that obesity worsened pregnancy outcomes in women with GDM and type 2 DM, suggesting that obese women may not require more stringent antepartum treatment strategies.

• Authors: Lorie M Harper, Allyson Renth, W Todd Cade, Ryan Colvin, George A Macones, Alison G Cahill
• Journal: American journal of perinatology (Am J Perinatol) Vol. 31 Issue 5 Pg. 383-8 (May 2014) ISSN: 1098-8785 [Electronic] United States
• PMID: 23877768 (Publication Type: Comparative Study, Journal Article, Research Support, N.I.H., Extramural, Research Support, Non-U.S. Gov't)
• Copyright: Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Topics

• Adult
• Body Mass Index
• Cesarean Section (statistics & numerical data)
• Cohort Studies
• Diabetes Mellitus, Type 2 (epidemiology)
• Diabetes, Gestational (epidemiology)
• Dystocia (epidemiology)
• Eclampsia (epidemiology)
• Female
• Fetal Macrosomia (epidemiology)
• Humans
• Hypoglycemia (epidemiology)
• Infant, Newborn
• Insulin Resistance
• Intensive Care Units, Neonatal (statistics & numerical data)
• Lacerations (epidemiology)
• Male
• Obesity (epidemiology)
• Obstetric Labor Complications (epidemiology)
• Odds Ratio
• Pre-Eclampsia (epidemiology)
• Pregnancy
• Pregnancy Complications (epidemiology)
• Pregnancy in Diabetics (epidemiology)
• Premature Birth (epidemiology)
• Prospective Studies
• Severity of Illness Index
• Surgical Wound Infection (epidemiology)
• Young Adult