Impact Of Prepregnancy Overweight And Obesity On Treatment Modality And Pregnancy Outcome In Women With Gestational Diabetes Mellitus

Abstract

BackgroundWe aim to evaluate the impact of prepregnancy overweight on treatment modalities of Gestational Diabetes Mellitus (GDM). We assessed the association of increased pregravid Body Mass Index (BMI) with dosing of basal and rapid acting insulin as well as pregnancy outcome.MethodsWe included 509 gestational diabetic women (normal weight: 200, overweight: 157, obese: 152), attending the pregnancy outpatient clinic at the Department of Obstetrics and Gynecology, Medical University of Vienna, in this retrospective study. We used a prospectively compiled database to assess patient characteristics, treatment approaches – particularly maximum doses of basal and rapid acting insulin or metformin – and pregnancy outcome.ResultsIncreased BMI was associated with the need of glucose lowering medication (odds ratio (OR): 1.08 for the increase of 1 kg/m² BMI, 95%CI 1.05–1.11, p<0.001). Mothers with pregestational obesity received the highest amount of insulin. Metformin was more often used in patients with obesity who also required higher daily doses. Maternal BMI was associated with increased risk of cesarean section (OR 1.04, 95%CI 1.01–1.07, p<0.001) and delivering large for gestational age offspring (OR 1.09, 95%CI 1.04–1.13, p<0.001). Birthweight percentiles were highest in patients with obesity who required glucose lowering therapy.ConclusionsTreatment modalities and outcome in GDM pregnancies are closely related to the extent of maternal BMI. Patients with obesity required glucose lowering medication more often and were at higher risk of adverse pregnancy outcomes. It is crucial to further explore the underlying pathophysiologic mechanisms to optimize clinical management and individual treatment approaches.

Continuous glucose monitoring-derived glycemic metrics and adverse pregnancy outcomes among women with gestational diabetes: a prospective cohort study

“… 30 GDM combined with overweight and obesity may exaggerate the risk of developing adverse pregnancy outcomes. 31 This was in line with our present finding that the association between maternal hyperglycemia status (e.g., TAR and daytime MBG) and adverse pregnancy outcome was stronger among overweight or obese women.…”

Characteristics of the oral glucose tolerance test in women with different pre-pregnancy body mass index and the effect of gestational diabetes mellitus on twin pregnancy outcomes

“…The international diagnostic criteria for overweight and obesity are mostly recommended by the 2009 IOM (pre-pregnancy BMI of 25.0–29.9 and ≥ 30.0 kg/m 2 ). 26 27 Due to ethnicity-related differences in BMI, in China at present, most studies used modified BMI classification (pre-pregnancy BMI of 24.0–27.9 and ≥ 28 kg/m 2 as the diagnostic criteria of overweight and obese, respectively). Domestic studies and those conducted outside of China have found that GDM is related to many factors, such as the age of pregnant women and pre-pregnancy BMI.…”

New Developments, Challenges and Open Questions in Diagnosis and Treatment of Gestational Diabetes Mellitus

“…However, we failed to identify differences in obstetric outcomes such as the rate of large-for-gestational-age (LGA) offspring. In another retrospective study, Linder et al classified mothers with GDM according to their pregestational BMI as normal weight, overweight and obese patients, and observed that elevated BMI was closely associated not only with the requirement of pharmacotherapy (insulin and/or metformin), but also with an increased risk of LGA newborns and caesarean section delivery [ 15 ]. Most interestingly, the incidence of LGA was highest in obese mothers that needed glucose-lowering medications.…”