Maternal Anthropometric Indices and Gestational Diabetes

Abstract

The prevalence of gestational diabetes (GDM) has been on the rise worldwide. GDM is glucose intolerance first detected in pregnancy and heightens the risk of caesarian section, prematurity and neonatal mortality, to name a few of its consequences. Greater prepregnancy BMI is a strong risk factor for GDM with evidence that overweight doubles its risk and obesity triples it. Other anthropometric risk factors of GDM reviewed in this chapter include low birth weight, short stature or leg length, increased abdominal adiposity (by waist circumference or waist-to-hip ratio), excessive total adiposity by skinfolds, greater gestational weight gain, and postpartum weight retention. Due to the strong association between prepregnancy BMI and the risk of GDM, these other anthropometric risk factors were also evaluated for whether there is evidence that they can delineate risks apart from that related to BMI; that is, whether they have clinical relevance independent of pregravid BMI. Scarce evidence was given that measures of total adiposity by skinfolds add to discriminating participants at risk for GDM that may not have been determined by prepregnancy BMI. Measures of central adiposity by waist and hip circumferences may have added information. Difficulties in measurement may preclude their use in clinical practice as they require some technical training to obtain valid and reliable values. Short stature or leg length and low birth weight, were factors that remained associated with increased risk of GDM independent of BMI but these associations were weak. Investigations of these associations, however, support the developmental origins of human disease hypothesis and generate evidence that early life risk factors may be important for future health. Gestational weight gain has been regarded as not to be a determinant of GDM by the Institute of Medicine, and review of the studies to date supports their conclusion, although there is some evidence that it is still relevant for development of less severe forms of hyperglycemia in pregnancy. Lastly, post-partum weight retention may increase the risk of GDM in subsequent pregnancies but this is through the mechanism of BMI. In conclusion, anthropometry does play a significant role in the development of GDM and investigations of its measures may bring about greater understanding of the etiology of the disease, even if not all measures are suitable for clinical use.