Top

Diabetes Therapy

Published in:

Open Access 01-04-2019 | Gestational Diabetes | Original Research

The Association Between Trimester-Specific Weight Gain and Severe Preeclampsia/Adverse Perinatal Outcome in Gestational Diabetes Mellitus Complicated by Preeclampsia: A Retrospective Case Study

Authors: Xueqin Zhang, Yunshan Xiao

Published in: Diabetes Therapy | Issue 2/2019

Abstract

Introduction

Gestational diabetes mellitus (GDM) and preeclampsia share many risk factors, e.g., gestational weight gain (GWG). Previous studies on the co-occurrence of these two diseases cannot powerfully clear up the effects of GWG on perinatal outcome.

Methods

A total of 329 pregnant women with GDM complicated by preeclampsia were enrolled. Clinical data of mothers and newborns were retrospectively analyzed, including baseline characteristics of pregnant women and pregnancy outcomes. We focused on the association between trimester-specific weight gain and severe preeclampsia (s-PE)/adverse perinatal outcomes in GDM complicated by preeclampsia, including cesarean section (C-sect), preterm birth, and large for gestational age birth (LGA). Regression analysis was used to adjust the impact of confounding factors, including height, age, parity, scarred uterus, and so on.

Result

By unconditional regression analysis, middle trimester excessive GWG is a risk factor for LGA [OR 6.586, 95% CI (2.254–19.242), AOR 6.481, 95% CI (2.213–18.981)]; late excessive GWG is a risk factor for s-PE and C-sect [OR 1.683, 95% CI (1.084–2.614), AOR 1.888, 95% CI (1.193–2.990); and OR 1.754, 95% CI (1.121–2.744), AOR 1.841, 95% CI (1.153–2.937)], excessive total GWG is a risk factor for LGA, and is a protective factor for the preterm [OR 5.920, 95% CI (2.479–14.139), AOR 5.602, 95% CI (2.337–13.431); and OR 0.448, 95% CI (0.248–0.841), AOR 0.429, 95% CI (0.235–0.783)].

Conclusions

The trimester-specific weight gain has a significant impact on the perinatal outcomes among pregnant women with both GDM and preeclampsia. This study is helpful for carry out risk monitoring in time, identifying early warning signs, and improving maternal and infant health.

Mirghani Dirar A, Doupis J. Gestational diabetes from A to Z. World J Diabetes. 2017;8(12):489–511. https://doi.org/10.4239/wjd.v8.i12.489.PubMedPubMedCentralCrossRef

Mosca L, Benjamin EJ, Berra K, et al. Effectiveness-based guidelines for the prevention of cardiovascular disease in women-2011 update: a guideline from the American Heart Association. J Am Coll Cardiol. 2011;57(12):1404–23.PubMedPubMedCentralCrossRef

Roberts JM, Lain KY. Recent Insights into the pathogenesis of pre-eclampsia. Placenta. 2002;23(5):359–72. https://doi.org/10.1053/plac.2002.0819.PubMedCrossRef

Jin WY, Lin SL, Hou RL, et al. Associations between maternal lipid profile and pregnancy complicatisons and perinatal outcomes: a population-based study from China. BMC Pregnancy Childbirth. 2016;16:60. https://doi.org/10.1186/s12884-016-0852-9.PubMedPubMedCentralCrossRef

Schneider S, Freerksen N, Rohrig S, Hoeft B, Maul H. Gestational diabetes and preeclampsia–similar risk factor profiles? Early Hum Dev. 2012;88(3):179–84. https://doi.org/10.1016/j.earlhumdev.2011.08.004.PubMedCrossRef

International Association of Diabetes and Pregnancy Study Groups Consensus Panel, Metzger BE, Gabbe SG, et al. International Association of Diabetes and Pregnancy Study Groups recommendations on the diagnosis and classification of hyperglycemia in pregnancy. Diabetes Care. 2010;33(3):676–82.PubMedCentralCrossRef

Wei Y, Yang H, Zhu W, et al. International Association of Diabetes and Pregnancy Study Group criteria is suitable for gestational diabetes mellitus diagnosis: further evidence from China. Chin Med J (Engl). 2014;127(20):3553–6.

Eiland E, Nzerue C, Faulkner M. Preeclampsia. J Pregnancy. 2012;2012:586578. https://doi.org/10.1155/2012/586578.PubMedPubMedCentralCrossRef

Scientific research collaborative group of neonatal development in 15 cities of China. Neonatal birth weight for gestational age and percentile in 15 cities of China. Zhonghua Er Ke Za Zh. 1989;27:316 (Chinese).

10.

Lao TT, Hui ASY, Sahota DS, Leung TY. Maternal height and risk of hypertensive disorders in pregnancy. J Matern Fetal Neonatal Med. 2017;17:1–6. https://doi.org/10.1080/14767058.2017.1410786.CrossRef

11.

Zhou B, Cooperative Meta-analysis Group of the Working Group on obesity in China. Predictive values of body mass index and waist circumference for risk factors of certain related diseases in Chinese adults–study on optimal cut-off points of body mass index and waist circumference in Chinese adults. Asia Pac J Clin Nutr. 2002;11(Suppl):S685–93.

12.

Institute of Medicine and National Research Council. Weight gain during pregnancy: reexamining the guidelines. Washington, DC: The National Academies Press; 2009.

13.

Zhu WW, Fan L, Yang HX, et al. Fasting plasma glucose at 24–28 weeks to screen for gestational diabetes mellitus: new environment from China. Diabetes Care. 2013;36:2038–40.PubMedPubMedCentralCrossRef

14.

Li B, Yang H, Zhang W, et al. Fatty acid-binding protein 4 predicts gestational hypertension and preeclampsia in women with gestational diabetes mellitus. PLoS One. 2018;13(2):e0192347. https://doi.org/10.1371/journal.pone.0192347.PubMedPubMedCentralCrossRef

15.

Stella CL, O'Brien JM, Forrester KJ, et al. The coexistence of gestational hypertension and diabetes: influence on pregnancy outcome. Am J Perinatol. 2008;25(6):325–9. https://doi.org/10.1055/s-2008-1078758.PubMedCrossRef

16.

Weissgerber TL, Mudd LM. Preeclampsia and diabetes. Curr Diab Rep. 2015;15(3):9.PubMedCrossRef

17.

Odegard RA, Vatten LJ, Nilsen ST, Salvesen KA, Austgulen R. Risk factors and clinical manifestations of pre-eclampsia. BJOG. 2000;107:1410–6.PubMedCrossRef

18.

Shin D, Song WO. Prepregnancy body mass index is an independent risk factor for gestational hypertension, gestational diabetes, preterm labor, and small- and large-for-gestational-age infants. J Matern Fetal Neonatal Med. 2015;28(14):1679–86.

19.

Kim SS, Mendola P, Zhu Y, Hwang BS, Grantz KL. Spontaneous and indicated preterm delivery risk is increased among overweight and obese women without prepregnancy chronic disease. BJOG. 2017;124(11):1708–16.PubMedPubMedCentralCrossRef

20.

Goldstein RF, Abell SK, Ranasinha S, et al. Association of gestational weight gain with maternal and infant outcomes: a systematic review and meta-analysis. JAMA. 2017;317(21):2207–25.PubMedPubMedCentralCrossRef

21.

Huang A, Ji Z, Zhao W, Hu H, Yang Q, Chen D. Rate of gestational weight gain and preterm birth in relation to prepregnancy body mass indices and trimester: a follow-up study in China. Reprod Health. 2016;13(1):93. https://doi.org/10.1186/s12978-016-0204-2 (Published 2016 Aug 12).PubMedPubMedCentralCrossRef

22.

Chmitorz A, von Kries R. Rasmussen KM, Nehring I, Ensenauer R. Do trimester-specific cutoffs predict whether women ultimately stay within the Institute of Medicine/National Research Council guidelines for gestational weight gain? Findings of a retrospective cohort study. Am J Clin Nutr. 2012;95(6):1432–7. https://doi.org/10.3945/ajcn.111.033704.PubMedCrossRef

23.

Drehmer M, Duncan BB, Kac G, Schmidt MI. Association of second and third-trimester weight gain in pregnancy with maternal and fetal outcomes. PLoS One. 2013;8(1):e54704.PubMedPubMedCentralCrossRef

24.

Marić I, Mayo JA, Druzin ML, et al. Maternal height and risk of preeclampsia among race/ethnic groups. Am J Perinatol. 2018. https://doi.org/10.1055/s-0038-1675205.PubMedCrossRef

25.

Durst JK, Tuuli MG, Stout MJ, Macones GA, Cahill AG. Degree of obesity at delivery and risk of preeclampsia with severe features. Am J Obstet Gynecol. 2016;214(5):651.e1–5. https://doi.org/10.1016/j.ajog.2015.11.024.CrossRef

26.

Graham LE, Brunner Huber LR, Thompson ME, Ersek JL. Does amount of weight gain during pregnancy modify the association between obesity and cesarean section delivery? Birth. 2014;41:93–9. https://doi.org/10.1111/birt.12095.PubMedCrossRef

27.

Oteng-Ntim E, Varma R, Croker H, Poston L, Doyle P. Lifestyle interventions for overweight and obese pregnant women to improve pregnancy outcome: systematic review and meta-analysis. BMC Med. 2012;10:47. https://doi.org/10.1186/1741-7015-10-47 (Published 2012 May 10).PubMedPubMedCentralCrossRef

28.

Broskey NT, Wang P, Li N, et al. Early pregnancy weight gain exerts the strongest effect on birth weight, posing a critical time to prevent childhood obesity. Obesity. 2017;25:1569–76. https://doi.org/10.1002/oby.21878.PubMedCrossRef

29.

Košir Pogačnik R, Trojner Bregar A, Lučovnik M, et al. The effect of interaction between parity, gestational diabetes, and pregravid obesity on the incidence of preeclampsia. J Matern Fetal Neonatal Med. 2018;19:1–4. https://doi.org/10.1080/14767058.2018.1509311.CrossRef

Title: The Association Between Trimester-Specific Weight Gain and Severe Preeclampsia/Adverse Perinatal Outcome in Gestational Diabetes Mellitus Complicated by Preeclampsia: A Retrospective Case Study
Authors: Xueqin Zhang
Yunshan Xiao
Publication date: 01-04-2019
Publisher: Springer Healthcare
Keywords: Gestational Diabetes
Premature Birth
Sectio Ceasarea
Gestational Diabetes
Pre-Eclampsia
Sectio Caesarea
Published in: Diabetes Therapy / Issue 2/2019
Print ISSN: 1869-6953
Electronic ISSN: 1869-6961
DOI: https://doi.org/10.1007/s13300-019-0589-3

ACC 2024 Congress Coverage

Heart Failure Video

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

The Association Between Trimester-Specific Weight Gain and Severe Preeclampsia/Adverse Perinatal Outcome in Gestational Diabetes Mellitus Complicated by Preeclampsia: A Retrospective Case Study

Abstract

Introduction

Methods

Result

Conclusions

ACC 2024 Congress Coverage

Year in Review: Heart failure and cardiomyopathies

Semaglutide benefits people with type 2 diabetes and obesity-related heart failure

Incentivised to exercise

New intervention for STEMI-related cardiogenic shock

» View more highlights on the ACC 2024 congress hub page

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Introduction

Methods

Result

Conclusions

Please log in to get access to this content

Other articles of this Issue 2/2019

Addition of Basal Insulin to Oral Antidiabetic Agents in Patients with Inadequately Controlled Type 2 Diabetes Leads to Improved HbA1c Levels: Metabolic Control, Frequency of Hypoglycemia, and Insulin Titration Analysis as Results of a Prospective Observational Study (BALI Study)

Improvement in Quality of Care for Patients with Type 2 Diabetes in Hungary Between 2008 and 2016: Results from Two Population-Based Representative Surveys

C-Peptide Area Under the Curve at Glucagon Stimulation Test Predicts Glucose Improvements by GLP-1 Receptor Analogue: A Retrospective Observational Study

Higher Baseline Serum Irisin Decreases Risk for Body Mass Index Increment in Chinese Populations: A 3.2-Year Cohort Study

Population Pharmacokinetics of Semaglutide for Type 2 Diabetes

Efficacy of Autologous Bone Marrow Mononuclear Cell Transplantation Therapy for Type 2 Diabetes Mellitus: An Updated Meta-Analysis

ACC 2024 Congress Coverage

Year in Review: Heart failure and cardiomyopathies

Semaglutide benefits people with type 2 diabetes and obesity-related heart failure

Incentivised to exercise

New intervention for STEMI-related cardiogenic shock

» View more highlights on the ACC 2024 congress hub page