Impact of diabetes, obesity and hypertension on preterm birth: Population-based study

Abstract

Objective To determine the impact of pre-pregnancy diabetes mellitus (D), obesity (O) and chronic hypertension (H) on preterm birth (PTB). Methods Retrospective population-based cohort study in Ontario, Canada between 2012-2016. Women who had a singleton livebirth or stillbirth at > 20 weeks gestation were included in the cohort. Exposures of interest were D, O and H, individually, and in various combinations. The primary outcome was PTB at 24 1/7 to 36 6/7 weeks. PTB was further analyzed by spontaneous or provider-initiated, early (< 34 weeks) or late (34-37 weeks), and the co-presence of preeclampsia, large for gestational age (LGA), and small for gestational age (SGA). Multivariable Poisson regression models with robust error variance were used to generate relative risks (RR), further adjusted for maternal age and parity (aRR). Population attributable fractions (PAF) were calculated for each of the outcomes by exposure state. Results 506,483 women were eligible for analysis. 30,139 pregnancies (6.0%) were complicated by PTB < 37 weeks, of which 7375 (24.5%) had D or O or H. Relative to women without D or O or H, the aRR for PTB < 37 weeks was higher for D (3.51; 95% CI 3.26-3.78) and H (3.81; 95% CI 3.55-4.10) than O (1.14; 95% CI 1.10-1.17). The combined state of DH was associated with a significantly higher aRR of PTB < 37 weeks (6.34; 95% CI 5.14-7.80) and < 34 weeks (aRR 10.33, 95% CI 6.96-15.33) than D alone. The risk of provider initiated PTB was generally higher than that for spontaneous PTB. Pre-pregnancy hypertension was

Population-based study on birth outcomes among women with hypertensive disorders of pregnancy and gestational diabetes mellitus

“…This is an exceptional finding has not been reported previously 22 , 42 , 44 , 45 . A recent study evaluating 30,139 pregnancies in Ontario, Canada, also associated pre-pregnancy diabetes with increased risk of LGA with an adjusted relative risk of 28.9 in preterm births 46 . However, the absolute rate of LGA was smaller in our study than in the Ontario study (2.7% versus 6.4%).…”

Diabetes during Pregnancy: A Maternal Disease Complicating the Course of Pregnancy with Long-Term Deleterious Effects on the Offspring. A Clinical Review

“…Berger et al evaluated 30,139 pregnancies complicated by prematurity, of which 7375 had diabetes or diabetes complicated by hypertension or obesity. The relative risk for prematurity was 3.51, 95% CI 3.26–3.78 for diabetes, 6.34, 95% CI 5.14–7.80 for diabetes complicated by hypertension, and 3.09, 95% CI 2.80–3.40 for diabetes complicated by obesity [ 184 ]. The highest risk was seen in women with diabetes complicated by both hypertension and obesity—11.26, 95% CI 9.40–13.49 [ 184 ].…”

“…The relative risk for prematurity was 3.51, 95% CI 3.26–3.78 for diabetes, 6.34, 95% CI 5.14–7.80 for diabetes complicated by hypertension, and 3.09, 95% CI 2.80–3.40 for diabetes complicated by obesity [ 184 ]. The highest risk was seen in women with diabetes complicated by both hypertension and obesity—11.26, 95% CI 9.40–13.49 [ 184 ]. Riskin et al evaluated 526 diabetic pregnancies and showed that prematurity was more common in pregnancy with PGDM (31.9%), compared to GDM (11.3%), and among controls only 4.9% ( p = 0.001) [ 185 ].…”

Systematic review with meta-analysis: Non-alcoholic fatty liver disease and the association with pregnancy outcomes

“…Multiple co-variates showed significant associations such as certain ethnic backgrounds and the interesting link with parity are all specific risk factors for NAFLD in the pregnancy state; this is a major strength of the analysis. The higher occurrence of pre-term birth in NAFLD patients is possibly translated through the higher occurrence of DM and HTN in its various severities, which are known risk factors for prematurity [48]. The higher occurrence of past miscarriage or abortion is also related to obesity which is a stronger risk factor for miscarriage than diabetes mellitus [49].…”