Article Text
Abstract
Background Obesity and gestational diabetes mellitus (GDM) increase the morbidity of the mother and newborn, which could increase further should they coexist. We aimed to determine the risk of adverse pregnancy and neonatal outcomes associated with excess weight (EW), and within this group identify potential differences between those with and without GDM.
Methods We carried out a post-hoc analysis of the St. Carlos Gestational Study which included 3312 pregnant women, arranged in 3 groups: normal-weight women (NWw) (2398/72.4%), overweight women (OWw) (649/19.6%) and obese women (OBw) (265/8%). OWw and OBw were grouped as EW women (EWw). We analyzed variables related to adverse pregnancy and neonatal outcomes.
Results The relative risk (95% CI) for GDM was 1.82 (1.47 to 2.25; p<0.0001) for OWw, and 3.26 (2.45 to 4.35; p<0.0001) in OBw. Univariate analysis showed associations of EW to higher rates of prematurity, birth weight >90th centile, newborns admitted to neonatal intensive care unit (NICU), instrumental delivery and cesarean delivery (all p<0.005). Multivariate analysis, adjusted for parity and ethnicity, showed that EW increased the risk of prematurity, admission to NICU, cesarean and instrumental delivery, especially in EWw without GDM. NWw with GDM had a significantly lower risk of admission to NICU and cesarean delivery, compared with NWw without GDM.
Conclusions EW is detrimental for pregnancy and neonatal outcomes, and treatment of GDM contributes to lowering the risk in EWw and NWw. Applying the same lifestyle changes to all pregnant women, independent of their weight or GDM condition, could improve these outcomes.
- Gestational Diabetes Mellitus
- Obesity
- Overweight
- Clinical Care
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Footnotes
Contributors CA-B, TR, CF and ALC-P wrote the manuscript and research data. ALC-P, MAR, MAH, NI, NP and AD contributed to the study concept and design, acquisition of data, analysis and interpretation of data. EB, AO, IC, LdV, IR, NGdlT, CM and MJT take responsibility for universal screening, researched data and drafting of the manuscript. All authors were involved in the critical revision of the manuscript for important intellectual content, material support and study supervision. All authors have seen and agree with the content of the previous version of the manuscript.
Funding This research was supported by grants from Fundación para Estudios Endocrinometabolicos, and IdISSC Hospital Clinico San Carlos, Madrid, and the Instituto de Salud Carlos III of Spain (PI14/01563) and Fondo Europeo de Desarrollo Regional (FEDER). LdV was supported by a grant from the IdISSC and the Fundación para Estudios Endocrinometabólicos. CA-B was supported by a grant from the Fundación para Estudios Endocrinometabólicos.
Disclaimer The design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, and approval of the manuscript; and decision to submit the manuscript for publication are the responsibilities of the authors alone and independent of the funders.
Competing interests None declared.
Patient consent Obtained.
Ethics approval The study protocol was reviewed and approved by the Ethics Committee of the St. Carlos Hospital.
Provenance and peer review Not commissioned; externally peer reviewed.
Data sharing statement No additional data are available.