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  • Gestational diabetes mellitus treatment reduces obesity-induced adverse pregnancy and neonatal outcomes: the St. Carlos gestational study

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Clinical care/education/nutrition/psychosocial research
Gestational diabetes mellitus treatment reduces obesity-induced adverse pregnancy and neonatal outcomes: the St. Carlos gestational study
  1. Carla Assaf-Balut1,
  2. Cristina Familiar1,
  3. Nuria García de la Torre1,
  4. Miguel A Rubio1,2,
  5. Elena Bordiú1,2,
  6. Laura del Valle1,
  7. Miriam Lara1,
  8. Teresa Ruiz1,
  9. Ana Ortolá1,
  10. Irene Crespo1,
  11. Alejandra Duran1,2,
  12. Miguel A Herraiz2,3,
  13. Nuria Izquierdo2,3,
  14. Noelia Perez2,3,
  15. Maria J Torrejon1,4,
  16. Isabelle Runkle1,2,
  17. Carmen Montañez1,
  18. Alfonso L Calle-Pascual1,2
  1. 1Endocrinology and Nutrition Department, Hospital Clínico San Carlos, Madrid, Spain
  2. 2Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain
  3. 3Gynecology and Obstetrics Department, Madrid, Spain
  4. 4Clinical Laboratory Department, Madrid, Spain
  5. Hospital Clínico San Carlos-IdISSC, Madrid, Spain
  1. Correspondence to Dr Alfonso L Calle-Pascual; acallepascual{at}hotmail.com

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

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/

https://doi.org/10.1136/bmjdrc-2016-000314

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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.