Gestational diabetes and adiposity are independent risk factors for perinatal outcomes: a population based cohort study in Sweden

Hildén, Karin; Hanson, Ulf; Persson, Martina; Magnuson, Anders; Simmons, David; Fadl, Helena

doi:10.1111/dme.13843

Cited by 36 publications

(60 citation statements)

References 40 publications

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“…According to our knowledge, there is only one previous study available evaluating the interaction effects of GDM and obesity on perinatal outcomes. The study of Hildeń et al (2019) revealed no interaction effect between GDM and BMI for severe perinatal outcomes such as malformations, perinatal mortality, stillbirth, prematurity, low Apgar score, fetal distress or Erb’s palsy [28]; that study did not asses our primary outcomes. By contrast, we found that while overweight/obesity alone are associated with macrosomia, caesarean delivery, treatment at neonatal ward (obesity only), delivery induction and low Apgar score, GDM amplifies these risks.…”

Section: Discussionmentioning

confidence: 89%

Independent and concomitant associations of gestational diabetes and maternal obesity to perinatal outcome: A register-based study

et al. 2019

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Aims Gestational diabetes (GDM) is often accompanied by maternal overweight. Our aim was to evaluate the separate and concomitant effects of GDM and maternal overweight/obesity on perinatal outcomes. Methods We used the Finnish Medical Birth Register to identify all 24,577 women with a singleton pregnancy who delivered in 2009 in Finland and underwent an oral glucose tolerance test (OGTT). Women were divided into groups according to the result of OGTT (GDM/no GDM) and pre-pregnancy body mass index (BMI): normal weight (≤24.9 kg/m 2 ), overweight (25.0–29.9 kg/m 2 ), and obese (≥30.0 kg/m 2 ). Primary outcomes included macrosomia, caesarean delivery, and treatment at neonatal ward. Normal weight women without GDM constituted the reference group. Results Compared to reference group, overweight or obese women without GDM had an increased risk of macrosomia [odds ratio adjusted for age, parity, smoking and socio-economic status (aOR)1.18 (95% CI 1.09–1.28) and 1.50 (95% CI 1.19–1.88)], and caesarean delivery [aORs 1.17 (95% CI 1.07–1.28) and 1.52 (95% CI 1.37–1.69)], respectively. In normal weight GDM women the risk of macrosomia [aOR 1.17 (95% CI 0.85–1.62)] and caesarean delivery [aOR 1.10 (95% CI 0.96–1.27)] was not significantly increased as compared to normal weight women without GDM. GDM increased the risk of treatment at neonatal ward in all BMI categories and maternal obesity without GDM was also a risk factor for treatment at neonatal ward. Interaction p values between BMI and GDM on these outcomes were <0.001. Conclusions Maternal overweight and obesity without GDM increased the risk of macrosomia and caesarean delivery when compared to the reference group. These risks were amplified when overweight/obesity was accompanied by GDM. Obesity without GDM was a risk factor for treatment at neonatal ward; GDM increased this risk in all BMI categories. Our results suggest that especially maternal obesity should be considered as a risk factor for adverse pregnancy outcomes and GDM further amplifies this risk.

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Section: Discussionmentioning

confidence: 89%

Independent and concomitant associations of gestational diabetes and maternal obesity to perinatal outcome: A register-based study

et al. 2019

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“…The diagnosis of gestational diabetes implies a high risk for mothers and unborn babies, because perinatal morbidity is increased in these cases when compared to the general population of pregnant women (4) . In addition, DM represents one of the main causes of maternal morbidity and mortality in the world; around 1.0% of pregnancies are correlated with maternal and fetal complications, according to a study carried out in several countries (5) .…”

Section: Introductionmentioning

confidence: 99%

Instrument for nursing consultation to pregnant women with diabetes mellitus

Filgueiras¹,

Silva²,

Pimenta³

et al. 2019

Rev Rene

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Objective: to construct and validate an instrument to assist the nursing consultation of pregnant women with diabetes mellitus. Methods: methodological study involving the construction of an instrument and evaluation by expert judges in the area who delivered opinions on the objectives, structure, presentation, relevance and content of the instrument of each item. Results: the instrument obtained a satisfactory evaluation in the evaluated criteria, obtaining an index of validity of general content above 85.0% and index of content validity above 80.0% in most of the items. Five items were modified according to the recommendations provided by the judges. Conclusion: the content of the instrument was considered valid to guide the nursing consultation, favoring the promotion of quality of life, adoption of healthy life habits and self-care practices, and provides glimpses of emotional, psychological and social aspects that may influence the endocrine modifications during gestation.

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“…The papers by Hild en et al and Hauffe et al [1,2] together add to the evidence that maternal obesity is a significant risk factor for serious adverse outcomes, independent of glycaemia, and that high birth weight, with all its attendant potential complications, is a complex phenomenon that cannot be equated simply with glycaemic control. Diabetes, maternal obesity and excessive gestational weight gain all increase birth weight, while factors such as smoking, inadequate weight gain, hypertensive disorders and placental insufficiency may all reduce birth weight.…”

mentioning

confidence: 99%

“…In a paper in this issue of the journal, Hildén et al . try to disentangle the impact of GDM (diagnosed by fairly liberal criteria) and maternal obesity on a number of serious pregnancy outcomes in the Swedish population. As expected, the women with GDM were older, more overweight and more likely to be migrants, multiparous and to have chronic hypertension.…”

mentioning

confidence: 99%