Influence of Pre-Pregnancy Underweight Body Mass Index on Fetal Abdominal Circumference, Estimated Weight, and Pregnancy Outcomes in Gestational Diabetes Mellitus

Kim, Minji; Hur, Kyu-Yeon; Choi, Suk‐Joo; Oh, Soo‐Young; Roh, Cheong‐Rae

doi:10.4093/dmj.2021.0059

Cited by 5 publications

(5 citation statements)

References 17 publications

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“… 41 Moreover, recent data from our institute revealed that about 10% of GDM women are underweight (BMI < 18.5 kg/m 2 ), and these women have a rather significantly higher risk of SGA. 32 Meanwhile, our data also showed that, incidence-wise, obesity is more prevalent than GDM (13.03% vs. 10.20%). Together with the finding that obese women without GDM have higher risks for adverse maternal and neonatal outcomes than supervised GDM women and non-obese women, our study implicates that we need to develop systematic management protocols targeting maternal obesity to be included in current GDM education, instead of worrying too much about well-supervised non-obese diabetes patients.…”

Section: Discussionsupporting

confidence: 57%

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Obesity Is Associated With Higher Risk of Adverse Maternal and Neonatal Outcomes Than Supervised Gestational Diabetes

et al. 2023

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Background Unlike gestational diabetic mellitus (GDM), which is strictly managed by most patients and physicians, obesity does not have proper management guidelines, and the importance of its management during pregnancy is often ignored. The aim of this study was to compare maternal and neonatal outcomes according to obesity and GDM, alone or in combination. Methods This was a retrospective cohort study of 3,078 consecutive pregnant women who experienced prenatal care and delivery of a live singleton neonate between January 2016 and December 2020 at our institution. Study participants were categorized into 4 mutually exclusive groups, as follows: group 1, no GDM without obesity; group 2, GDM without obesity; group 3, no GDM with obesity; and group 4, GDM with obesity. Results Compared to group 2, group 3 had higher rates of pre-eclampsia, cesarean section including emergent cesarean section rate. Also, neonates in group 3 were heavier and had lower glucose levels compared to those in group 2. Of note, there was no significant difference in maternal or neonatal outcomes except the rate of large-for-gestational-age (LGA) between group 1 and group 2. Among the GDM groups, group 4 had higher risks for pre-eclampsia, cesarean section, and LGA infant status than group 2. Conclusion Our data showed that obese women without GDM face higher risk of adverse pregnancy outcomes than women with supervised GDM and non-obese women. We also confirmed that adverse pregnancy outcomes associated with GDM were mainly attributable to obesity among women receiving GDM education.

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Section: Discussionsupporting

confidence: 57%

“… 31 Also, according to another Korean research, in GDM women, gestational weight gain was less in the group with high pre-pregnancy BMI. 32 As such, obese women may gain less weigh during pregnancy. Of note, relative weight gain based on the women’s pre-pregnancy BMI is more important than absolute weight gain.…”

Section: Discussionmentioning

confidence: 99%

Obesity Is Associated With Higher Risk of Adverse Maternal and Neonatal Outcomes Than Supervised Gestational Diabetes

et al. 2023

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“…Given the unique clinical, epidemiological, and pathophysiological features of lean DM, the current treatment guidelines for overweight/obese women with GDM may not be helpful (or even potentially harmful) to lean women with GDM. For example, while large-for-gestational-age neonates are considered to be the most common adverse outcome in women with GDM, lean women with GDM are five times more likely to have small-for-gestational-age (SGA) neonates than normal or overweight women with GDM ( 34 ). Intrauterine protein deficiency has been clearly established to contribute to low birth weight and other neonatal development issues, as has been confirmed by many studies in animals ( 35 ).…”

Section: Discussionmentioning

confidence: 99%

Is gestational diabetes mellitus in lean women a distinct entity warranting a modified management approach?

Wadivkar,

Hawkins

2024

Front. Clin. Diabetes Healthc.

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During pregnancy, insulin resistance and impaired insulin secretion may lead to the development of Gestational Diabetes Mellitus (GDM). Although a higher Body Mass Index (BMI) is often cited as a risk factor for the development of GDM, lean pregnant women are also at risk of developing GDM based on evidence from several studies. It is proposed that insulin deficiency (more than insulin resistance) leads to the development of GDM in women with low BMI (BMI <18.5 kg/m2). Neonates of these women are more at risk of preterm birth and small-for-gestational-age. Given this unique pathophysiology and phenotype, this entity needs a modified management approach. This article aims to raise awareness of GDM in lean women to encourage more research on this topic and create a modified management approach.

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“…Hence, it is of vital significance to explore the pregnancy outcomes of GDM women with different thyroid hormone sensitivity and pBMI levels, which may deepen our understanding of GDM pathogenesis and add further guides for individualized GDM management. For example, previous study has indicated that GDM patients with underweight BMI encountered lower risk of preeclampsia and macrosomia and required a relaxed maternal glycemic target [ 54 ].…”

Section: Discussionmentioning

confidence: 99%

Maternal pre-pregnancy obesity modifies the association between first-trimester thyroid hormone sensitivity and gestational Diabetes Mellitus: a retrospective study from Northern China

Sun,

Zhou,

Liu

et al. 2023

Diabetol Metab Syndr

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Background Contradictory relationships have been observed between thyroid function and gestational diabetes mellitus (GDM). Previous studies have indicated that pre-pregnancy BMI (pBMI) could modify their relationships. Few studies have illustrated the role of thyroid hormone sensitivity on GDM. We aimed to explore the effect of pre-pregnancy obesity on the association between early pregnancy thyroid hormone sensitivity and GDM in euthyroid pregnant women. Methods This study included 1310 women with singleton gestation. Subjects were classified into pre-pregnancy obese and non-obese subgroups by pBMI levels with a cutoff of 25 kg/m2. Sensitivity to thyroid hormone was evaluated by Thyroid Feedback Quartile-Based Index (TFQI), Chinese-referenced parametric TFQI (PTFQI), TSH Index (TSHI) and Thyrotrophic T4 Resistance Index (TT4RI). The associations between these composite indices and GDM were analyzed using multivariate regression models in the two subgroups, respectively. Results In pre-pregnancy non-obese group, early pregnancy TFQI, PTFQI, TSHI and TT4RI levels were higher in subjects with incident GDM compared to those without GDM (all P < 0.05). By contrast, obese women with GDM exhibited lower levels of those indices (all P < 0.05). The occurrence of GDM were increased with rising TFQI, PTFQI, TSHI and TT4RI quartiles in non-obese women ( all P for trend < 0.05), while exhibited decreased trend across quartiles of those indices in obese women (all P for trend < 0.05). Further logistic analysis indicated contrary relationships between thyroid hormone sensitivity and the occurrence of GDM in the two groups, respectively. The OR of the fourth versus the first quartile of TFQI for GDM was 1.981 (95% CI 1.224, 3.207) in pre-pregnancy non-obese group, while was 0.131 (95% CI 0.036, 0.472) in pre-pregnancy obese group. PTFQI and TSHI yielded similar results. Conclusions The association between maternal sensitivity to thyroid hormones during early gestation and the occurrence of GDM was modified by pre-pregnancy obesity.

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Influence of Pre-Pregnancy Underweight Body Mass Index on Fetal Abdominal Circumference, Estimated Weight, and Pregnancy Outcomes in Gestational Diabetes Mellitus

Cited by 5 publications

References 17 publications

Obesity Is Associated With Higher Risk of Adverse Maternal and Neonatal Outcomes Than Supervised Gestational Diabetes

Obesity Is Associated With Higher Risk of Adverse Maternal and Neonatal Outcomes Than Supervised Gestational Diabetes

Is gestational diabetes mellitus in lean women a distinct entity warranting a modified management approach?

Maternal pre-pregnancy obesity modifies the association between first-trimester thyroid hormone sensitivity and gestational Diabetes Mellitus: a retrospective study from Northern China

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