Maternal pre-pregnancy body mass index and the risk for gestational diabetes mellitus in women with twin pregnancy in South Korea

ObjectiveTo investigate the association between maternal pre-pregnancy body mass index (BMI) and the risk for gestational diabetes mellitus (GDM) in women with twin pregnancy in South Korea.Materials and methodsWe performed a single-center, retrospective cohort study involving 1028 women with twin pregnancy from January 2006 to December 2018 in South Korea. Pregnancies with monoamnionic twins, twin–twin transfusion syndrome, fetal death in utero before 24 weeks, pre-gestational diabetes mellitus, and unknown BMI or GDM status were excluded. Subjects were grouped into four groups based on pre-pregnancy BMI: underweight (<18.5 kg/m²), normal (18.5–22.9 kg/m²), overweight (23.0–24.9 kg/m²), and obese (≥25.0 kg/m²).ResultsAmong 1028 women who were included in the analysis, 169 (16.4%), 655 (63.7%), 111 (10.8%), and 93 (9.0%) women were underweight, normal, overweight, and obese, respectively, before pregnancy. The incidence of GDM was 8.9% in the total study population: 4.7%, 8.2%, 11.7%, and 17.2% in the underweight, normal, overweight, and obese group, respectively (p = 0.005). The incidence of GDM significantly increased according to the increase in pre-pregnancy BMI (p < 0.001). Women in the obese group were more likely to be affected by GDM compared to the normal group (adjusted odds ratio = 2.20, 95% confidence interval = 1.19–4.08) after controlling for maternal age, parity, type of conception, and chorionicity.ConclusionIn twin pregnancies in South Korea, the risk of GDM increased as maternal pre-pregnancy BMI increased and obese women before pregnancy were more likely to be affected by GDM.     

The effect of low body mass index on the development of gestational hypertension and preeclampsia

Objectives.?To evaluate the relationship between low maternal body mass index (BMI) as calculated in the first trimester and the risk of preeclampsia and gestational hypertension.

Methods.?Patients enrolled in the First And Second Trimester Evaluation of Risk for aneuploidy (FASTER) trial were grouped into three weight categories: low BMI (BMI <19.8 kg/m²), normal BMI (BMI 19.8 – 26 kg/m²), and overweight BMI (26.1 – 29 kg/m²). The incidences of gestational hypertension and preeclampsia were ascertained for each group. Tests for differences in crude incidence proportions were performed using Chi-square tests. Multiple logistic regression was used to adjust for maternal age, race, parity, obesity, use of assisted reproductive technology (ART), in vitro fertilization (IVF), gestational diabetes, pre-gestational diabetes, cocaine use, and smoking.

Results.?The proportion of patients having gestational hypertension in the low BMI group was 2.0% compared to 3.2% for normal BMI and 6.0% for overweight BMI (p < 0.0001). Women with low BMI were also less likely to develop preeclampsia, 1.1% vs. 1.9% for normal BMI and 2.8% for overweight BMI (p < 0.0001).

Conclusions.?We found that women with low BMI in the first trimester were significantly less likely to develop gestational hypertension or preeclampsia than women with a normal BMI.     

妊娠期糖尿病孕妇体重指数变化与围产结局的关系

目的探讨妊娠期糖尿病(GDM)孕妇妊娠前体重指数(BMI)及妊娠期体重指数增幅与围产结局的关系。方法2006年1月至2007年12月间在浙江大学医学院附属妇产科医院产科门诊行常规检查并确诊为GDM的238例患者,按妊娠前体重指数分为正常组(18.5≤BMI<23)、超重组(23≤BMI<25)、肥胖组(BMI≥25),按早孕至终止妊娠前BMI的总增幅,分为A组(BMI总增幅<4),B组(4≤BMI总增幅≤6),C组(BMI总增幅>6),比较分析各组间围产结局的差异。结果肥胖组子痫前期、早产发生率均(26.0%,32.7%)显著高于正常组(11.9%,8.3%)及超重组(10.8%,13.7%),差异均有统计学意义(P<0.05)。正常组孕妇胎儿窘迫发生率(8.3%)显著低于超重组(23.5%)和肥胖组(23.1%),差异有统计学意义(P<0.05)。B组子痫前期(10.4%)、羊水过多(10.4%)、胎膜早破(10.4%)、胎儿窘迫(11.3%)和早产(8.0%)的发生率均明显低于C组(22.2%,23.8%,25.3%,30.2%,30.2%),差异均有统计学意义(P均<0.05)。C组胎膜早破发生率明显高...     

The relationship between antenatal body attitudes,pre-pregnancy body mass index,and gestational weight gain

Objectivesan estimated 50% of women experience excessive gestational weight gain (GWG). Maternal body attitudes are associated with GWG, however this relationship is complex and may differ based on pre-pregnancy body mass index (BMI) or gestational age. The aim of this study was to explore the moderating role of maternal pre-pregnancy BMI on the relationship between body attitudes in early-to-mid and late pregnancy and GWG.Design/Participantspregnant women less than 18 weeks gestation were recruited for a postal questionnaire study via Australian pregnancy online forums, pregnancy and parenting magazines, and antenatal clinics. In early-mid pregnancy (Time 1; mean (M) = 16.81 weeks gestation, standard deviation (SD) = 1.18), participants reported demographics, pre-pregnancy weight, height, and body attitudes (salience of weight and shape, attractiveness, strength and fitness and feeling fat). In late pregnancy, body attitudes (Time 2; M = 32.65 weeks gestation, SD = 0.91) and weight (Time 3; M = 37.15 weeks gestation, SD = 1.55) were reported. Pre-pregnancy BMI and total GWG were calculated. Moderation analyses were conducted.Findingsin early-mid pregnancy, pre-pregnancy BMI moderated the relationship between feeling fat and GWG. Pre-pregnancy BMI did not moderate the relationship between body attitudes and GWG for salience of weight and shape, attractiveness or strength and fitness in early-mid pregnancy. In late pregnancy, pre-pregnancy BMI moderated the relationship between all four body attitude facets (salience of weight and shape, attractiveness, feeling fat and strength and fitness) and GWG.Conclusion/Implications for practicethe relationship between body attitudes and GWG was moderated by pre-pregnancy BMI, particularly in late pregnancy. It is recommended that antenatal health care providers monitor women's body attitudes throughout pregnancy to aid in the management of healthy GWG and promote positive maternal and infant health outcomes. This is particularly important for women entering pregnancy with an underweight/normal weight BMI.     

Maternal and neonatal outcomes in women with twin pregnancies with excessive gestational weight gain

Objective: To determine if an excessive rate of gestational weight gain (GWG) in twin pregnancies is associated with adverse obstetric outcomes.

Methods: Retrospective cohort study of twin pregnancies delivered at the University of California, San Diego 2001–2014. Women were included if they had adequate or excessive rates of GWG as determined by Institute of Medicine guidelines. Demographic and outcome variables were collected by chart review.

Results: Four hundred and eighty-nine twin pregnancies met inclusion criteria. Of which, 40.5% had adequate rates of GWG and 41.5% had excessive rates of GWG. The rates of preterm birth and gestational diabetes were similar between the two groups. Gestational hypertension and preeclampsia were more common in women with excessive GWG (37.9% versus 19.7%; p?<?0.01). This finding persisted in multivariate analysis. The mean birth weight percentiles were higher in the excessive GWG group and these women were also less likely to have an infant with a birth weight <10th percentile (21.4% versus 35.9%, p?<?0.01).

Conclusions: Excessive GWG is associated with a higher risk for gestational hypertension and preeclampsia, but no other adverse perinatal outcomes. Infants born to mothers with excessive GWG are less likely to be small for gestational age than those born to women with adequate GWG.     

孕前体重指数和孕期增重对妊娠结局的影响

目的 探讨孕前体重指数(body mass index,BMI)和孕期增重对妊娠结局的影响,为制定孕期体重分级管理方案提供依据. 方法 研究对象为2009年1月至2010年4月在南京大学医学院附属鼓楼医院产科定期产前检查的健康单胎妊娠孕妇2409例.根据孕前BMI分为孕前体重过低(BMI＜ 18.5)、体重正常(BMI 18.5～)、超重和肥胖(BMI≥24.0)3组.孕期增重计算方法为分娩前最高体重减去孕前体重.将孕前体重过低和体重正常的孕产妇,分别按孕期增重＜10 kg、10 kg～、≥15 kg分为3个亚组;孕前超重和肥胖的孕产妇,按孕期增重＜5 kg、5 kg～、10 kg～、≥15 kg分为4个亚组.记录分娩孕周、分娩方式、新生儿出生体重和Apgar评分,以及妊娠期高血压疾病、妊娠期糖尿病、巨大儿、胎儿生长受限及早产的发生率.统计学分析采用t检验、方差分析、Student-Newman-Keuls检验、x2检验或Fisher精确概率法. 结果 (1)2409例孕妇中,孕前体重过低、体重正常、超重和肥胖组的构成比分别为18.5％(445例)、69.9％(1685例)和11.6％(279例).孕前超重和肥胖组HDP、GDM和巨大儿发生率、剖宫产率分别为12.9％(36例)、17.9％(50例)、13.6％(38例)和52.3％(146例),均高于孕前体重过低组[3.4％(15例)、4.3％(19例)、3.8％(17例)和25.8％(115例),x2分别为23.8、37.1、23.5和50.2,P＜0.05]和体重正常组[5.5％(92例)、7.8％(132例)、7.8％(132例)和31.6％(532例),x2分别为21.8、29.0、10.1和3.4,P＜0.05].(2)孕前体重正常者,孕期增重＜10 kg亚组FGR发生率和早产率分别为3.5％(4/115)和8.7％(10/115),高于增重10 kg～亚组[0.7％(4/548)和3.3％(18/548),x2分别为6.0和6.9,P＜0.05]和≥15 kg亚组[0.8％(8/1022)和3.6％(37/1022),x2分别为7.2和6.7,P＜0.05].增重≥15 kg亚组巨大儿发生率和剖宫产率分别为10.7％(109/1022)和34.5％(353/1022),高于增重＜10 kg亚组[3.5％(4/115)和32.2％(37/115),x2分别为6.0和63.0,P＜0.05]和10 kg～亚组[3.5％(19/548)和25.9％(142/548),x2分别为24.7和31.0,P＜0.05].(3)孕前超重和肥胖者,孕期增重不同的4个亚组妊娠并发症和妊娠结局比较,差异均无统计学意义(P＞0.05). 结论 孕前超重或肥胖者妊娠并发症和剖宫产的风险增加.孕前体重正常者如果孕期增重过高或过低,也可能增加妊娠并发症风险,孕期增重控制在10～15 kg较为适宜.     

The mutual effect of pregestational body mass index,maternal hyperglycemia and gestational weight gain on adverse pregnancy outcomes

Objective: To investigate the mutual effect of obesity, gestational diabetes (GDM) and gestational weight gain (GWG) on adverse pregnancy outcomes.

Methods: Charts of patients who delivered in our hospital between June 2001 and June 2006 singleton, live births >24 weeks gestation were reviewed. Univariate and multivariate logistic regression were used to assess pregnancy outcomes defined as large for gestational age (LGA), primary cesarean section (PCS) and a composite outcome of LGA and/or PCS.

Results: A total of 8595 women were included. Frequency of composite outcome increased with increasing body mass index (BMI), increasing hyperglycemia and above-recommended GWG. In the multivariate logistic regression analysis compared to women with normal BMI, odds ratio (OR) for composite outcome was 1.23 (95% confidence interval [CI] 1.06–1.44) in overweight women, OR?=?1.86 (1.51–2.31) in obese women and in severe obesity OR?=?2.97 (2.15–4.11).

Compared to normoglycemic women, odds for composite outcome in women with abnormal glucose challenge test OR?=?1.46 (1.20–1.79), impaired glucose tolerance OR?=?1.65 (1.14–2.4) and GDM OR?=?1.56 (1.16–2.10). Women with GWG above recommended had OR?=?1.58, (1.37–1.81) for composite outcome.

Conclusions: Higher pregestational BMI, maternal hyperglycemia and above-recommended GWG independently contribute to adverse pregnancy outcomes. Furthermore, there is mutual effect between these three factors and adverse outcomes. Appropriate pregestational weight and adequate GWG might reduce risk of adverse pregnancy outcomes.     

The effect of prepregnancy body mass index on birth weight,preterm birth,cesarean section,and preeclampsia in pregnant women

Objective: The objective of this study is to determine the impact of maternal prepregnancy BMI on birth weight, preterm birth, cesarean section, and preeclampsia among pregnant women delivering singleton life birth.

Methods: A cross-sectional study of 4397 women who gave singleton birth in Tehran, Iran from 6 to 21 July 2015, was conducted. Women were categorized into four groups: underweight (BMI?2), normal (BMI 18.5–25?kg/m²), overweight (BMI 25–30?kg/m²) and obese (BMI >30?kg/m²), and their obstetric and infant outcomes were analyzed using both univariate and multivariate logistic regression.

Results: Prepregnancy BMI of women classified 198 women as underweight (4.5%), 2293 normal (52.1%), 1434 overweight (32.6%), and 472 as obese (10.7%). In comparison with women of normal weight, women who were overweight or obese were at increased risk of preeclampsia (odds ratio (OR)?=?1.47, 95% CI?=?1.06–2.02; OR?=?3.67, 95% CI?=?2.57–5.24, respectively) and cesarean section (OR?=?1.21, 95% CI?=?1.04–1.41; OR?=?1.35, 95% CI?=?1.06–1.72, respectively). Infants of obese women were more likely to be macrosomic (OR?=?2.43, 95% CI?=?1.55–3.82).

Conclusion: Prepregnancy obesity is a risk factor for macrosomia, preeclampsia, and cesarean section and need for resuscitation.     

Effects of gestational weight gain and body mass index on obstetric outcome in Sweden.

OBJECTIVE: The objective of this study was to estimate the effects of low and high gestational weight gain, in different maternal Body Mass Index (BMI) classes, on obstetric and neonatal outcomes. METHOD: A prospective population-based cohort study of 245,526 singleton term pregnancies. Women were grouped in five categories of BMI and in three gestational weight gain categories; < 8 kg (low weight gain), 8-16 kg and >16 kg (high weight gain). Obstetric and neonatal outcomes were evaluated after adjustments for maternal age, parity, smoking, year of birth. RESULT: Obese women with low gestational weight gain had a decreased risk for the following outcomes (adjusted odds ratio; 95% confidence interval): preeclampsia (0.52; 0.42-0.62), cesarean section (0.81; 0.73-0.90), instrumental delivery (0.75; 0.63-0.88), and LGA births (0.66; 0.59-0.75). There was a 2-fold increased risk for preeclampsia and LGA infants among average and overweight women with excessive weight gain. High gestational weight gain increased the risk for cesarean delivery in all maternal BMI classes. CONCLUSION: The effects of high or low gestational weight gain differ depending on maternal BMI and the outcome variable studied. Obese women may benefit from a low weight gain during pregnancy.     

Serum chemerin level during the first trimester of pregnancy and the risk of gestational diabetes mellitus

Objective: To investigate the association between chemerin level in the first trimester of pregnancy and the risk of gestational diabetes mellitus.

Methods: The blood samples of 212 women at 8–12?weeks of gestation were collected. After screening for gestational diabetes mellitus (GDM), 19 women with GDM and 20 women randomly selected from 144 women with normal glucose tolerance (NGT) were included in the study. Blood samples were collected from these women. Triglycerides, glucose, total cholesterol, and HDL cholesterol, LDL cholesterol, insulin and chemerin were measured. Gestational weight gain and body mass index was assessed.

Results: Serum levels of chemerin were significantly elevated during late gestation, and the risk of GDM was positively associated with maternal serum chemerin in the first trimester.

Conclusion: Serum chemerin level during the first trimester of pregnancy has the potential to predict risk of GDM.     

The impact of pre-pregnancy body mass index on the risk of gestational diabetes

Objective: To evaluate the effect of pre-pregnancy body mass index (BMI) on the risk of developing gestational diabetes mellitus (GDM) in a large unselected population. Methods: We performed a case control study using data collected in The Consortium on Safe Labor database. The association between BMI and GDM was evaluated both using BMI weight categories adopted by the National Institute of Health, and separately using BMI as a continuous variable. Multiple logistic regression analyses were used to evaluate the effects of BMI, age, ethnicity, parity, chronic hypertension and antenatal steroid use on the risk of GDM. Odds ratios (ORs) and 95% confidence intervals (CIs) were calculated to approximate relative risks of GDM. A p value of <0.05 was considered significant. Results: After controlling for other factors, the risk of GDM increased with an increasing BMI across all weight categories. For each 1?kg/m² increase of BMI the OR of developing GDM was 1.08 (95% CI 1.08–1.09) and for each 5?kg/m² increase, the OR was 1.48 (95% CI 1.45–1.51). Conclusions: GDM is a multifactorial disorder and pre-pregnancy BMI plays an important role in that risk. Modest changes in pre-pregnancy BMI may decrease the risk of GDM substantially.     

The association between body mass index and preeclampsia: a meta-analysis

Background: Several observational studies have reported a positive association between elevated body mass index (BMI) and preeclampsia, but no meta-analysis has been conducted yet. This meta-analysis was conducted to estimate the overall association between overweight or obesity and preeclampsia.

Methods: Major electronic databases, including PubMed, Web of Science, and Scopus were searched until August 2015. The reference lists of included studies were screened as well. Epidemiological studies addressing the association between BMI and preeclampsia were enrolled. The heterogeneity across studies was explored by Q-test and I² statistic. The possibility of publication bias was assessed using Begg's and Egger's tests. The results were reported using odds ratio (OR) estimate with its 95% confidence intervals (CI) using a random-effects model.

Results: We identified a total of 1298 references and included 23 studies with 1 387 599 participants. Preeclampsia was associated with overweight (OR?=?1.73; 95% CI: 1.59, 1.87; 21 studies; I^2?=^?62.3%) and obesity (OR?=?3.15; 95% CI: 2.96, 3.35; 22 studies; I^2?=^?36.0%). There was no evidence of publication bias.

Conclusions: There is sufficient evidence that excess body mass index is significantly associated with an increased risk of preeclampsia. Therefore, overweight and obesity can be considered as a predictor of preeclampsia.     

Predictors for antenatal insulin requirement in gestational diabetes

The purpose of this study was to identify pre-gestational and gestational factors predicting subsequent insulin requirement in patients with gestational diabetes mellitus (GDM). Maternal parameters were compared between mothers achieving glycemic control with or without the addition of antenatal insulin therapy (AIT). Insulin was required only in 8/83 (10%) patients for glycemic control. Those who needed insulin had a stronger family history of diabetes and higher first hour plasma glucose along with multiple (>1) abnormal values during oral glucose tolerance test (OGTT) in univariate analysis (p?相似文献   

Low gestational weight gain improves infant and maternal pregnancy outcomes in overweight and obese Korean women with gestational diabetes mellitus

Objective.?The aim of the study was to retrospectively assess what was the optimal gestational weight gain to have better maternal and neonatal outcomes in overweight and obese Korean women with gestational diabetes mellitus (GDM) who maintained normoglycemia throughout pregnancy by dietary modification, exercise, and/or insulin treatment.

Study design.?We performed a hospital-based study of 215 GDM women with prepregnancy BMI?≥?25 kg/m². Body weight, glucose homeostasis, lipid profiles, insulin treatment, and maternal outcomes were collected as predictors of neonatal birth weight. We divided the subjects into three groups according to modified Institute of Medicine (IOM) guidelines for weight gain during pregnancy: inadequate (n?=?42), normal (n?=?96), and excessive (n?=?77) groups.

Results.?Excessive weight gain resulted in increased macrosomia, HbA_1c at delivery, and postprandial blood glucose levels, but fasting blood glucose levels were not significantly different among the groups. The inadequate weight gain group (2.4?kg weight gain during pregnancy) had better neonatal outcomes and better maternal glycemic control with fewer requiring insulin treatment.

Conclusion.?Minimal weight gain, well below IOM recommendations, and tight control of blood glucose levels during pregnancy with proper medical management and dietary modification may eliminate most of the adverse pregnancy outcomes experienced by obese GDM Asian women.