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

Ijäs, Hilkka; Koivunen, Sanna; Raudaskoski, Tytti; Kajantie, Eero; Gissler, Mika; Vääräsmäki, Marja

doi:10.1371/journal.pone.0221549

Cited by 39 publications

(79 citation statements)

References 25 publications

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“…Several studies have reported maternal obesity as an independent risk factor for newborn macrosomia (17,(23)(24)(25). Pre-gestational BMI is a documented factor that affects fetal growth (26)(27)(28).…”

Section: Discussionmentioning

confidence: 99%

Excessive Maternal Weight and Diabetes Are Risk Factors for Macrosomia: A Cross-Sectional Study of 42,663 Pregnancies in Uruguay

2020

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Objective: To evaluate the risk of macrosomia in newborns from women with gestational diabetes, pregestational diabetes, overweight, and obesity in Uruguay in 2012, as well as its association with prolonged pregnancy, maternal age, multiparity, and excessive gestational weight gain (EGWG). Methods: We performed a cross-sectional study of 42,663 pregnant women. The risk of macrosomia was studied using logistic regression. Results: Mean maternal age was 26.7 ± 6.8 years. Pregestational overweight and obesity was present in 20.9% and 10.7% of women, respectively. There were 28.1% and 19.8% of women overweight and obese at the end of the pregnancy, respectively. Furthermore, 0.5% had pregestational diabetes and 8.5% were multiparous. Twenty two percent developed gestational diabetes and 44.9% had EGWG. The prevalence of macrosomia was 7.9%, significantly more prevalent in males (10.0% vs. 5.5%, p<0.005). Univariate analysis showed that obesity and overweight pre-pregnancy, obesity and overweight at the end of pregnancy, EGWG, pregestational diabetes, gestational diabetes, multiparity, prolonged pregnancy, and male newborn were strongly associated with macrosomia (p<0.0001). Maternal age >35 years did not increase the risk of macrosomia. After multiple logistic regression macrosomia was more likely in pre-gestational obese women (OR 1.24;

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Section: Discussionmentioning

confidence: 99%

Excessive Maternal Weight and Diabetes Are Risk Factors for Macrosomia: A Cross-Sectional Study of 42,663 Pregnancies in Uruguay

2020

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“…Supporting this, studies in Pima Indians, a population with a high prevalence of T2DM, have revealed sibling discrepancies, with a higher incidence of diabetes among siblings born after maternal diagnosis of diabetes when compared to siblings born before the maternal diagnosis of diabetes [48]. Nevertheless, caution should be taken, as women with diabetes during pregnancy are more likely to be overweight or obese, and obesity per se has adverse effects on the offspring [49]. In order to determine the specific role of the hyperglycemia per se in the adverse outcomes of the progeny, the HAPO (Hyperglycemia and Adverse Pregnancy Outcome) study, analyzing a multiethnic cohort of 25,505 pregnant women with glucose levels below GDM threshold at 15 centers in 9 countries, demonstrated that maternal glucose levels during pregnancy were associated with birth weight and newborn adiposity [50].…”

Section: Adverse Outcomes Of Gdmmentioning

confidence: 99%

Molecular Modelling of Islet β-Cell Adaptation to Inflammation in Pregnancy and Gestational Diabetes Mellitus

Lorenzo

Martín-Montalvo

Vuilleumier

et al. 2019

IJMS

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Gestational diabetes mellitus (GDM), a metabolic disease that develops with the increase in insulin resistance during late pregnancy, is currently one of the most common complications affecting pregnancy. The polygenic nature of GDM, together with the interplay between different genetic variants with nutritional and environmental factors has hindered the full understanding of the etiology of this disease. However, an important genetic overlap has been found with type 2 diabetes mellitus (T2DM) and, as in the case of T2DM, most of the identified loci are associated with β-cell function. Early detection of GDM and adequate interventions to control the maternal glycemia are necessary to avoid the adverse outcomes for both the mother and the offspring. The in utero exposure to the diabetic milieu predispose these children for future diseases, among them T2DM, originating a vicious circle implicated in the increased prevalence of both GDM and T2DM. The involvement of inflammatory processes in the development of GDM highlights the importance of pancreatic β-cell factors able to favor the adaptation processes required during gestation, concomitantly with the protection of the islets from an inflammatory milieu. In this regard, two members of the Pax family of transcription factors, PAX4 and PAX8, together with the chromatin remodeler factor HMG20A, have gained great relevance due to their involvement in β-cell mass adaptation together with their anti-inflammatory properties. Mutations in these factors have been associated with GDM, highlighting these as novel candidates for genetic screening analysis in the identification of women at risk of developing GDM.

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“…O sobrepeso e a obesidade são fatores de risco para doenças crônicas e degenerativas, e quando associada à gestação, elevam o risco para complicações maternas, fetais e neonatais (Ijas et al, 2019). Complicações maternas, ocorridas durante o trabalho de parto/parto/puerpério, como pré-eclâmpsia, diabetes mellitus gestacional, teste de tolerância à glicose diminuída, ruptura prematura de membranas, placenta prévia, anemia, oligodrâminio, taxas de cesarianas, laceração vaginal e perineal e hemorragias pós-parto foram associadas à obesidade.…”

Section: Introductionunclassified

Avaliação do perfil nutricional materno no acompanhamento pré-natal

Vasconcelos

Antunes

Freitas

et al. 2020

RSD

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Objetivo: Avaliar o perfil nutricional pré-gestacional e gestacional materno a partir do acompanhamento pré-natal. Método: Trata-se de um estudo transversal, desenvolvido em uma maternidade de referência em gestação de alto risco do estado do Amazonas, no período de maio a novembro de 2019, com uma amostra não probabilística de 108 puérperas. A coleta de dados deu-se por meio da aplicação de um instrumento pré-elaborado e consulta às informações dos cartões de pré-natal. Resultados: Foram avaliadas 108 puérperas, sendo mais frequente mulheres de 20 a 34 anos (70,4%), ensino médio completo (37,0%), união consensual (50,9%), cor parda (85,2%), renda familiar até três salários-mínimos (98,1%), não fumantes (94,4%) e não etilistas (84,3%). Referente aos registros no cartão de pré-natal, observou-se a ausência da avaliação nutricional (curva de Atalah), nos três trimestres de gestação (90,4%, 91,8% e 89,1%), respectivamente. A avaliação realizada pela equipe da pesquisa, identificou maior frequência para o perfil eutrófico tanto no período pré-gestacional (51,9%), como no primeiro (43,2%), segundo (39,6%) e terceiro trimestres de gestação (36,7%). Porém, também foi observado variações para baixo peso, sobrepeso e obesidade, evidenciando alterações no comportamento do perfil nutricional durante o período gestacional, e não identificado na assistência pré-natal. Conclusão: Apesar da maioria apresentar perfil eutrófico, nos períodos pré e gestacional, a ausência de registros e avaliações nos cartões de pré-natal, consistem em um obstáculo para a detecção precoce de alterações do perfil nutricional, resultando em desfechos desfavoráveis relacionados a morbidades maternas.

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

Cited by 39 publications

References 25 publications

Excessive Maternal Weight and Diabetes Are Risk Factors for Macrosomia: A Cross-Sectional Study of 42,663 Pregnancies in Uruguay

Excessive Maternal Weight and Diabetes Are Risk Factors for Macrosomia: A Cross-Sectional Study of 42,663 Pregnancies in Uruguay

Molecular Modelling of Islet β-Cell Adaptation to Inflammation in Pregnancy and Gestational Diabetes Mellitus

Avaliação do perfil nutricional materno no acompanhamento pré-natal

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