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The hyperglycemia and adverse pregnancy outcome study: associations of GDM and obesity with pregnancy outcomes.

AbstractOBJECTIVE:
To determine associations of gestational diabetes mellitus (GDM) and obesity with adverse pregnancy outcomes in the Hyperglycemia and Adverse Pregnancy Outcome (HAPO) Study.
RESEARCH DESIGN AND METHODS:
Participants underwent a 75-g oral glucose tolerance test (OGTT) between 24 and 32 weeks. GDM was diagnosed post hoc using International Association of Diabetes and Pregnancy Study Groups criteria. Neonatal anthropometrics and cord serum C-peptide were measured. Adverse pregnancy outcomes included birth weight, newborn percent body fat, and cord C-peptide >90th percentiles, primary cesarean delivery, preeclampsia, and shoulder dystocia/birth injury. BMI was determined at the OGTT. Multiple logistic regression was used to examine associations of GDM and obesity with outcomes.
RESULTS:
Mean maternal BMI was 27.7, 13.7% were obese (BMI ≥33.0 kg/m(2)), and GDM was diagnosed in 16.1%. Relative to non-GDM and nonobese women, odds ratio for birth weight >90th percentile for GDM alone was 2.19 (1.93-2.47), for obesity alone 1.73 (1.50-2.00), and for both GDM and obesity 3.62 (3.04-4.32). Results for primary cesarean delivery and preeclampsia and for cord C-peptide and newborn percent body fat >90th percentiles were similar. Odds for birth weight >90th percentile were progressively greater with both higher OGTT glucose and higher maternal BMI. There was a 339-g difference in birth weight for babies of obese GDM women, compared with babies of normal/underweight women (64.2% of all women) with normal glucose based on a composite OGTT measure of fasting plasma glucose and 1- and 2-h plasma glucose values (61.8% of all women).
CONCLUSIONS:
Both maternal GDM and obesity are independently associated with adverse pregnancy outcomes. Their combination has a greater impact than either one alone.
AuthorsPatrick M Catalano, H David McIntyre, J Kennedy Cruickshank, David R McCance, Alan R Dyer, Boyd E Metzger, Lynn P Lowe, Elisabeth R Trimble, Donald R Coustan, David R Hadden, Bengt Persson, Moshe Hod, Jeremy J N Oats, HAPO Study Cooperative Research Group
JournalDiabetes care (Diabetes Care) Vol. 35 Issue 4 Pg. 780-6 (Apr 2012) ISSN: 1935-5548 [Electronic] United States
PMID22357187 (Publication Type: Journal Article, Multicenter Study, Research Support, N.I.H., Extramural, Research Support, Non-U.S. Gov't)
Chemical References
  • Blood Glucose
Topics
  • Adult
  • Birth Weight (physiology)
  • Blood Glucose (analysis, metabolism)
  • Body Mass Index
  • Diabetes, Gestational (blood, epidemiology)
  • Female
  • Glucose Tolerance Test
  • Humans
  • Hyperglycemia (blood, complications, epidemiology)
  • Infant, Newborn
  • Male
  • Obesity (complications, epidemiology)
  • Obstetric Labor Complications (blood, epidemiology, etiology)
  • Pregnancy
  • Pregnancy Complications (blood, epidemiology, etiology)
  • Pregnancy Outcome (epidemiology)
  • Young Adult

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