Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

Keynote webinar | Spotlight on medication adherence

LIVE: Thursday 27th June 2024, 18:00-19:30 (CEST)
Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.
ADVANCED SEARCH
Log in
Top
BMC Pregnancy and Childbirth
Published in: BMC Pregnancy and Childbirth 1/2020

01-12-2020 | Gestational Diabetes | Research article

Women with a predisposition for diabetes have an increased risk of pregnancy complications, especially in combination with pregestational overweight

Authors: Ulrika Moll, Håkan Olsson, Mona Landin-Olsson

Published in: BMC Pregnancy and Childbirth | Issue 1/2020

Login to get access

Abstract

Background

Overweight and gestational diabetes are risk factors for pregnancy complications. We hypothesized that the metabolic impact of overweight on pregnancy outcome, would be different if it was combined with a predisposition for diabetes. The aim of this study was to compare the outcome of pregnancies in women with diabetes diagnosed later in life, to the outcome of pregnancies of women who did not develop diabetes.

Methods

Women in a population-based cohort who also were registered in the Swedish Medical Birth Registry (n = 4738) were included. A predisposition for diabetes (GDM or diabetes after pregnancy) was found in 455 pregnancies. The number of pregnancies with maternal BMI ≥ 25 kg/m2 and without diabetes were 2466, and in 10,405 pregnancies the mother had a BMI < 25 kg/m2 without diabetes at any time. Maternal BMI, gestational length, gestational weight gain, frequency of caesarean section, infant birth weight, frequency of large for gestational age (LGA) and Apgar score were retrospectively compared.

Results

Pregnancies with normal maternal BMI ≤25 kg/m2, with predisposition for diabetes had a higher frequency of LGA (11.6% vs. 2.9%; p < 0.001), a higher frequency of macrosomia (28.6% vs. 17.6%; p < 0.001), and a shorter gestational length (39.7 vs. 40 weeks; p = 0.08) when compared to pregnancies in women without a predisposition for diabetes. In addition, pregnancies with both maternal predisposition for diabetes and BMI ≥ 25 kg/m2 there was a higher frequency of LGA (23.3% vs. 7.1%; p < 0.001), caesarean section (24.0% vs. 14.9%, p = 0.031) compared to pregnancies in women who were only overweight. A predisposition for diabetes significantly increases the risk of macrosomia (OR1.5; 95% CI 1.07–2.15; p = 0.02).

Conclusions

In pregnancy, there is an increased frequency of LGA, macrosomia and caesarean section if the woman has a predisposition for diabetes. The frequency of overweight young women is increasing, and it is urgent to identify pregnant women with a predisposition to diabetes. How to distinguish the women with the highest risk for adverse pregnancy outcome and the highest risk of future disease, remains to be studied.
Literature
1.
Athukorala C, Rumbold AR, Willson KJ, Crowther CA. The risk of adverse pregnancy outcomes in women who are overweight or obese. BMC Pregnancy Childbirth. 2010;10:56.CrossRefPubMedPubMedCentral
2.
Owens LA, O'Sullivan EP, Kirwan B, Avalos G, Gaffney G, Dunne F. ATLANTIC DIP: the impact of obesity on pregnancy outcome in glucose-tolerant women. Diabetes Care. 2010;33(3):577–9.CrossRefPubMedPubMedCentral
3.
Dennedy MC, Avalos G, O'Reilly MW, O'Sullivan EP, Gaffney G, Dunne F. ATLANTIC-DIP: raised maternal body mass index (BMI) adversely affects maternal and fetal outcomes in glucose-tolerant women according to International Association of Diabetes and Pregnancy Study Groups (IADPSG) criteria. J Clin Endocrinol Metab. 2012;97(4):E608–12.CrossRefPubMed
4.
Ehrenberg HM, Durnwald CP, Catalano P, Mercer BM. The influence of obesity and diabetes on the risk of cesarean delivery. Am J Obstet Gynecol. 2004;191(3):969–74.CrossRefPubMed
5.
Ehrenberg HM, Mercer BM, Catalano PM. The influence of obesity and diabetes on the prevalence of macrosomia. Am J Obstet Gynecol. 2004;191(3):964–8.CrossRefPubMed
6.
Nohr EA, Vaeth M, Baker JL, Sorensen T, Olsen J, Rasmussen KM. Combined associations of prepregnancy body mass index and gestational weight gain with the outcome of pregnancy. Am J Clin Nutr. 2008;87(6):1750–9.CrossRefPubMed
7.
Johansson K, Linne Y, Rossner S, Neovius M. Maternal predictors of birthweight: the importance of weight gain during pregnancy. Obes Res Clin Pract. 2007;1(4):243–52.CrossRef
8.
Linne Y. Effects of obesity on women's reproduction and complications during pregnancy. Obesity Rev. 2004;5(3):137–43.CrossRef
9.
Villamor E, Cnattingius S. Interpregnancy weight change and risk of adverse pregnancy outcomes: a population-based study. Lancet (British edition). 2006;368(9542):1164–70.
10.
Cedergren M. Effects of gestational weight gain and body mass index on obstetric outcome in Sweden. Int J Gynaecol Obstet. 2006;93(3):269–74.CrossRefPubMed
11.
Institute of M, National Research Council Committee to Reexamine IOMPWG. The National Academies Collection: Reports funded by National Institutes of Health. In: Rasmussen KM, Yaktine AL, editors. Weight Gain During Pregnancy: Reexamining the Guidelines. Washington (DC): National Academies Press (US). National Academy of Sciences; 2009.
12.
13.
Catalano PM, McIntyre HD, Cruickshank JK, McCance DR, Dyer AR, Metzger BE, et al. The hyperglycemia and adverse pregnancy outcome study: associations of GDM and obesity with pregnancy outcomes. Diabetes Care. 2012;35(4):780–6.CrossRefPubMedPubMedCentral
14.
Landon MB, Mele L, Spong CY, Carpenter MW, Ramin SM, Casey B, et al. The relationship between maternal glycemia and perinatal outcome. Obstet Gynecol. 2011;117(2 Pt 1):218–24.CrossRefPubMedPubMedCentral
15.
Wood SL, Jick H, Sauve R. The risk of stillbirth in pregnancies before and after the onset of diabetes. Diabetic Med. 2003;20(9):703–7.CrossRefPubMed
16.
Metzger BE, Lowe LP, Dyer AR, Trimble ER, Sheridan B, Hod M, et al. Hyperglycemia and Adverse Pregnancy Outcome (HAPO) Study: Associations with Neonatal Anthropometrics. Diabetes. 2008.
17.
Metzger BE, Lowe LP, Dyer AR, Trimble ER, Chaovarindr U, Coustan DR, et al. Hyperglycemia and adverse pregnancy outcomes. N Engl J Med. 2008;358(19):1991–2002.CrossRefPubMed
18.
Jensen DM, Korsholm L, Ovesen P, Beck-Nielsen H, Molsted-Pedersen L, Damm P. Adverse pregnancy outcome in women with mild glucose intolerance: is there a clinically meaningful threshold value for glucose? Acta Obstet Gynecol Scand. 2008;87(1):59–62.CrossRefPubMed
19.
Hilden K, Hanson U, Persson M, Fadl H. Overweight and obesity: a remaining problem in women treated for severe gestational diabetes. Diabetic Med. 2016;33:1045–51.
20.
Heude B, Thiebaugeorges O, Goua V, Forhan A, Kaminski M, Foliguet B, et al. Pre-pregnancy body mass index and weight gain during pregnancy: relations with gestational diabetes and hypertension, and birth outcomes. Matern Child Health J. 2012;16(2):355–63.CrossRefPubMedPubMedCentral
21.
Black MH, Sacks DA, Xiang AH, Lawrence JM. The relative contribution of prepregnancy overweight and obesity, gestational weight gain, and IADPSG-defined gestational diabetes mellitus to fetal overgrowth. Diabetes Care. 2013;36(1):56–62.CrossRefPubMed
22.
Sovio U, Murphy HR, Smith GC. Accelerated fetal growth prior to diagnosis of gestational diabetes mellitus: a prospective cohort study of nulliparous women. Diabetes Care. 2016;39(6):982–7.CrossRefPubMed
23.
Lindqvist PG, Epstein E, Landin-Olsson M, Ingvar C, Nielsen K, Stenbeck M, et al. Avoidance of sun exposure is a risk factor for all-cause mortality: results from the melanoma in southern Sweden cohort. J Intern Med. 2014;276(1):77–86.CrossRefPubMed
24.
25.
Robinson WR, Kershaw KN, Mezuk B, Rafferty J, Lee H, Johnson-Lawrence V, et al. Coming unmoored: disproportionate increases in obesity prevalence among young, disadvantaged white women. Obesity (Silver Spring, Md). 2015;23(1):213–9.CrossRef
26.
Weedn AE, Hale JJ, Thompson DM, Darden PM. Trends in obesity prevalence and disparities among low-income children in Oklahoma, 2005-2010. Childhood Obesity (Print). 2014;10(4):318–25.CrossRef
27.
Ignell C, Claesson R, Anderberg E, Berntorp K. Trends in the prevalence of gestational diabetes mellitus in southern Sweden, 2003-2012. Acta Obstet Gynecol Scand. 2014;93(4):420–4.CrossRefPubMed
28.
Aberg AE, Jonsson EK, Eskilsson I, Landin-Olsson M, Frid AH. Predictive factors of developing diabetes mellitus in women with gestational diabetes. Acta Obstet Gynecol Scand. 2002;81(1):11–6.CrossRefPubMed
29.
Almahmeed B, Shah BR, Mukerji G, Ling V, Booth GL, Feig DS. Effect of multiparity and ethnicity on the risk of development of diabetes: a large population-based cohort study. Diabetic Med. 2017;34(11):1637–45.CrossRefPubMed
30.
Burke N, Burke G, Breathnach F, McAuliffe F, Morrison JJ, Turner M, et al. Prediction of cesarean delivery in the term nulliparous woman: results from the prospective, multicenter Genesis study. Am J Obstet Gynecol. 2017;216(6):598.e1–e11.CrossRef
31.
Kiel DW, Dodson EA, Artal R, Boehmer TK, Leet TL. Gestational weight gain and pregnancy outcomes in obese women: how much is enough? Obstet Gynecol. 2007;110(4):752–8.CrossRefPubMed
32.
Boriboonhirunsarn D, Waiyanikorn R. Emergency cesarean section rate between women with gestational diabetes and normal pregnant women. Taiwanese J Obstet Gynecol. 2016;55(1):64–7.CrossRefPubMed
33.
Thorsell M, Lyrenas S, Andolf E, Kaijser M. Induction of labor and the risk for emergency cesarean section in nulliparous and multiparous women. Acta Obstet Gynecol Scand. 2011;90(10):1094–9.CrossRefPubMed
34.
Chu SY, Callaghan WM, Bish CL, D'Angelo D. Gestational weight gain by body mass index among US women delivering live births, 2004-2005: fueling future obesity. Am J Obstet Gynecol. 2009;200:271.e1–271.e7.
35.
Faucher MA, Barger MK. Gestational weight gain in obese women by class of obesity and select maternal/newborn outcomes: a systematic review. Women Birth. 2015;28(3):e70–9.CrossRefPubMed
36.
Johansson K, Hutcheon JA, Stephansson O, Cnattingius S. Pregnancy weight gain by gestational age and BMI in Sweden: a population-based cohort study. Am J Clin Nutr. 2016;103(5):1278–84.CrossRefPubMed
37.
Simas TA, Waring ME, Liao X, Garrison A, Sullivan GM, Howard AE, et al. Prepregnancy weight, gestational weight gain, and risk of growth affected neonates. J Womens Health (2002). 2012;21(4):410–7.CrossRef
38.
Power ML, Lott ML, Mackeen AD, DiBari J, Schulkin J. A retrospective study of gestational weight gain in relation to the Institute of Medicine's recommendations by maternal body mass index in rural Pennsylvania from 2006 to 2015. BMC Pregnancy Childbirth. 2018;18(1):239.CrossRefPubMedPubMedCentral
39.
Amorim AR, Rossner S, Neovius M, Lourenco PM, Linne Y. Does excess pregnancy weight gain constitute a major risk for increasing long-term BMI? Obesity (Silver Spring, Md). 2007;15(5):1278–86.CrossRef
40.
Rode L, Kjaergaard H, Ottesen B, Damm P, Hegaard HK. Association between gestational weight gain according to body mass index and postpartum weight in a large cohort of Danish women. Matern Child Health J. 2012;16(2):406–13.CrossRefPubMed
41.
Haugen M, Brantsaeter AL, Winkvist A, Lissner L, Alexander J, Oftedal B, et al. Associations of pre-pregnancy body mass index and gestational weight gain with pregnancy outcome and postpartum weight retention: a prospective observational cohort study. BMC Pregnancy Childbirth. 2014;14:201.CrossRefPubMedPubMedCentral
42.
Linne Y, Dye L, Barkeling B, Rossner S. Long-term weight development in women: a 15-year follow-up of the effects of pregnancy. Obes Res. 2004;12(7):1166–78.CrossRefPubMed
43.
Arendas K, Qiu Q, Gruslin A. Obesity in pregnancy: pre-conceptional to postpartum consequences. Journal of obstetrics and gynaecology Canada : JOGC =. J Obstet Gynaecol Can. 2008;30(6):477–88.CrossRefPubMed
44.
HAPO Study Cooperative Research Group H. Hyperglycaemia and Adverse Pregnancy Outcome (HAPO) Study: associations with maternal body mass index. BJOG. 2010;117(5):575–84.
45.
Lynch CM, Sexton DJ, Hession M, Morrison JJ. Obesity and mode of delivery in primigravid and multigravid women. Am J Perinatol. 2008;25(3):163–7.CrossRefPubMed
46.
Poobalan AS, Aucott LS, Gurung T, Smith WC, Bhattacharya S. Obesity as an independent risk factor for elective and emergency caesarean delivery in nulliparous women - systematic review and meta-analysis of cohort studies. Obesity Rev. 2008;10(1):28–35.
47.
Magriples U, Kershaw TS, Rising SS, Westdahl C, Ickovics JR. The effects of obesity and weight gain in young women on obstetric outcomes. Am J Perinatol. 2009;26(5):365–71.CrossRefPubMed
48.
Anandaraj AA, Almutairi KM. Association of selected Adipocytokines and inflammatory markers on body mass index in type 2 diabetes patients in Saudi Arabia and as risk factors to cardiovascular disease. Curr Diabetes Rev. 2016;13(3):330–5.
49.
Kranendonk ME, de Kleijn DP, Kalkhoven E, Kanhai DA, Uiterwaal CS, van der Graaf Y, et al. Extracellular vesicle markers in relation to obesity and metabolic complications in patients with manifest cardiovascular disease. Cardiovasc Diabetol. 2014;13:37.CrossRefPubMedPubMedCentral
50.
Katra P, Dereke J, Nilsson C, Hillman M. Plasma levels of the Interleukin-1-receptor antagonist are lower in women with gestational diabetes mellitus and are particularly associated with postpartum development of type 2 diabetes. PLoS One. 2016;11(5):e0155701.CrossRefPubMedPubMedCentral
Metadata
Title
Women with a predisposition for diabetes have an increased risk of pregnancy complications, especially in combination with pregestational overweight
Authors
Ulrika Moll
Håkan Olsson
Mona Landin-Olsson
Publication date
01-12-2020
Publisher
BioMed Central
Published in
BMC Pregnancy and Childbirth / Issue 1/2020
Electronic ISSN: 1471-2393
DOI
https://doi.org/10.1186/s12884-020-2741-5

Other articles of this Issue 1/2020

BMC Pregnancy and Childbirth 1/2020 Go to the issue

Study protocol

Endometrial scratch vs no intervention in egg donation cycles: the ENDOSCRATCH trial protocol

Research article

“The midwife helped me ... otherwise I could have died”: women’s experience of professional midwifery services in rural Afghanistan - a qualitative study in the provinces Kunar and Laghman

Research article

Effect of HELLP syndrome on acute kidney injury in pregnancy and pregnancy outcomes: a systematic review and meta-analysis

Research article

Knowledge deficit on health promotion activities during pregnancy: the case for adolescent pregnant women at Chiladzulu District, Malawi

Research article

Prevalence of and socioeconomic gradient in low birth weight in Ethiopia: further analysis of the 2016 demographic and health survey data

Research article

Perinatal outcomes of babies delivered by second-stage Caesarean section versus vacuum extraction in a resource-poor setting, Nigeria – a retrospective analysis