Overweight and obesity: a remaining problem in women treated for severe gestational diabetes

Abstract

AimTo analyse the impact of overweight and obesity on the risk of adverse maternal outcomes and fetal macrosomia in pregnancies of women treated for severe gestational diabetes.MethodsThis was a population‐based cohort study including all singleton pregnancies in Sweden without pre‐existing diabetes in the period 1998–2012. Only mothers with an early‐ pregnancy BMI of ≥ 18.5 kg/m² were included. Logistic regression analysis was used to determine odds ratios with 95% CIs for maternal outcomes and fetal growth. Analyses were stratified by maternal gestational diabetes/non‐gestational diabetes to investigate the impact of overweight/obesity in each group.ResultsOf 1 249 908 singleton births, 13 057 were diagnosed with gestational diabetes (1.0%). Overweight/obesity had the same impact on the risks of caesarean section and fetal macrosomia in pregnancies with and without gestational diabetes, but the impact of maternal BMI on the risk of preeclampsia was less pronounced in women with gestational diabetes. Normal‐weight women with gestational diabetes had an increased risk of caesarean section [odds ratio 1.26 (95% CI 1.16–1.37)], preeclampsia [odds ratio 2.03 (95% CI 1.71–2.41)] and large‐for‐gestational‐age infants [odds ratio 2.25 (95% CI 2.06–2.46)]. Risks were similar in the overweight group without gestational diabetes, caesarean section [odds ratio 1.34 (1.33–1.36)], preeclampsia odds ratio [1.76 (95% CI 1.72–1.81)], large‐for‐gestational‐age [odds ratio 1.76 (95% CI 1.74–1.79)].ConclusionsMaternal overweight and obesity is associated with similar increments in risks of adverse maternal outcomes and delivery of large‐for‐gestational‐age infants in women with and without gestational diabetes. Obese women with gestational diabetes are defined as a high‐risk group. Normal‐weight women with gestational diabetes have similar risks of adverse outcomes to overweight women without gestational diabetes.

Gestational diabetes and adiposity are independent risk factors for perinatal outcomes: a population based cohort study in Sweden

“…We also confirm that overweight and obesity are associated with increased rates of severe adverse perinatal outcomes independent of GDM. The same independent association has been reported for maternal outcomes and large for gestational age .…”

Macronutrient Preload effect on Glycaemic Control and Pregnancy Outcome in Gestational Diabetes Mellitus

“…There is a great need to find safe and effective procedures to treat gestational diabetes and this is the case not only from the maternal point of view but also from the short and long term perspective of the offspring. Uncontrolled hyperglycemia during pregnancy increases the incidence of fetal macrosomia [19,20,21], which in turn increases the risk of offspring's obesity, the impact of which could continue until adulthood [22,23]. Bodyweight is a controllable factor and active gestational body mass control is important for prevention of fetal macrosomia.…”

Reflections on changing paradigms

“…The contribution of obesity and hyperglycaemia to pregnancy outcomes is reported by Hildén et al . . Maternal overweight and obesity increased the risks of adverse outcomes to a similar degree in women with and without gestational diabetes.…”