Abstract
There is a strong epidemiological association between maternal obesity and gestational diabetes mellitus (GDM). Since the publication of the Hyperglycemia and Adverse Pregnancy Outcome (HAPO) study on women with mild hyperglycemia in 2008, new criteria have been introduced in maternity services internationally for the diagnosis of GDM. As a result, the diagnosis of GDM may be made in one-third of obese women (n=68). The aim of this review was to examine the interplay between maternal obesity and GDM in light of the HAPO study and the subsequent revised diagnostic criteria. Obesity and GDM are important obstetric risk factors because they both are potentially modifiable. However, the new international criteria for the diagnosis of GDM have serious resource implications for maternity services provided to the large number of women attending for care in developed countries. Further consideration needs to be given as to whether obese women with mild hyperglycemia need to be referred to a multidisciplinary team antenatally if they do not require insulin treatment.
References
[1] Chu SY, Lau J, Callaghan WM, England LJ, Kim SY, Dietz PM, et al. Maternal obesity and risk of gestational diabetes mellitus. Diabetes Care. 2007;30:2070–6.10.2337/dc06-2559aSearch in Google Scholar PubMed
[2] Sathyapalan T, Mellor D, Atkin SL. Obesity and gestational diabetes. Semin Fetal Neonatal Med. 2010;15:89–93.10.1016/j.siny.2009.09.002Search in Google Scholar PubMed
[3] Hartling L, Dryden DM, Guthrie A, Muise M, Vandermeer B, Donovan L. Benefits and harms of treating gestational diabetes mellitus: a systematic review and meta-analysis for the U.S. Preventive Services Task Force and the National Institute Office of Medical Applications of Research. Ann Int Med. 2013;159:123–30.10.7326/0003-4819-159-2-201307160-00661Search in Google Scholar PubMed
[4] O Higgins AC, Dunne F, Lee B, Smith D, Turner MJ. A national survey of the implementation of guidelines for gestational diabetes mellitus. Ir Med J. 2014;107:231–3.Search in Google Scholar
[5] Metzger BE, Coustan DR. Proceedings of the Fourth International Workshop Conference on Gestational Diabetes Mellitus. Diabetes Care. 1998;21:B1–167.Search in Google Scholar
[6] National Collaborating Centre for Women’s and Children’s Health (UK). NICE Guideline March 2008. Diabetes in pregnancy management of diabetes and its complications from preconception to the postnatal period. London: RCOG Press; 2008.Search in Google Scholar
[7] O’Sullivan J, Mahan C. Criteria for the oral glucose tolerance test in pregnancy. Diabetes. 1964;13:278–85.Search in Google Scholar
[8] American Diabetes Association (ADA). Diagnosis and classification of diabetes mellitus. Diabetes Care. 2014;37:S81–90.10.2337/dc14-S081Search in Google Scholar PubMed
[9] American College of Obstetrics and Gynecology (ACOG). Practice Bulletin No. 137. Gestational Diabetes Mellitus. Obstet Gynecol. 2013;122:406–16.10.1097/01.AOG.0000433006.09219.f1Search in Google Scholar PubMed
[10] World Health Organization (WHO). Diagnostic criteria and classification of hyperglycaemia first detected in pregnancy. WHO/NMH/MND/13.2;2013.Search in Google Scholar
[11] Falavigna M, Prestes I, Schmidt MI, Duncan BB, Colagiuri S, Roglic G. Impact of gestational diabetes mellitus screening strategies on perinatal outcomes: a simulation study. Diabetes Res Clin Pract. 2013;99:358–65.10.1016/j.diabres.2012.12.009Search in Google Scholar PubMed
[12] Catalano PM, McIntyre HD, Cruickshank JK, Mc Cance 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;35:780–6.10.2337/dc11-1790Search in Google Scholar PubMed PubMed Central
[13] Almario CV, Ecker T, Moroz LA, Bucovetsky L, Berghella V, Baxter JK. Obstetricians seldom provide postpartum diabetes screening for women with gestational diabetes. Am J Obstet Gynecol. 2008;198:528.10.1016/j.ajog.2007.11.001Search in Google Scholar PubMed
[14] International Association of Diabetes and Pregnancy Study Groups Consensus Panel. International Association of Diabetes and Pregnancy Study Groups recommendations on the diagnosis and classification of hyperglycemia in pregnancy. Diabetes Care. 2010;33:676–82.10.2337/dc09-1848Search in Google Scholar PubMed PubMed Central
[15] The HAPO Study Cooperative Research Group. Hyperglycemia and adverse pregnancy outcomes. N Engl J Med. 2008;358:1991–2002.10.1056/NEJMoa0707943Search in Google Scholar PubMed
[16] Lowe LP, Metzger BE, Lowe WL, Dyer AR, McDade TW, Mc Intyre HD. Inflammatory mediators and glucose in pregnancy: results from a subset of the Hyperglycemia and Pregnancy Outcome (HAPO) study. J Clin Endocinol Metab. 2010;95:5427–34.10.1210/jc.2010-1662Search in Google Scholar PubMed PubMed Central
[17] Jones AG, Hattersley AT. The clinical utility of C-peptide measurement in the care of patients with diabetes. Diabet Med. 2013;30:803–17.10.1111/dme.12159Search in Google Scholar PubMed PubMed Central
[18] HAPO Study Cooperative Research Group. Hyperglycemia and Adverse Pregnancy Outcome (HAPO) Study: associations with neonatal anthropometrics. Diabetes. 2009;58:453–9.10.2337/db08-1112Search in Google Scholar PubMed PubMed Central
[19] Langer O, Umans JG, Miodovnik M. Perspectives on the proposed gestational diabetes mellitus diagnostic criteria. Obstet Gynecol. 2013;121:177–82.10.1097/AOG.0b013e31827711e5Search in Google Scholar PubMed
[20] O’Dwyer V, Farah N, Hogan J, O’Connor N, Kennelly MM, Turner MJ. Timing of screening for gestational diabetes mellitus in women with moderate and severe obesity. Acta Obstet Gynecol Scand. 2012;91:447–51.10.1111/j.1600-0412.2011.01324.xSearch in Google Scholar PubMed
[21] Wolf M, Sandler L, Hsu K, Vossen-Smirnakis K, Ecker J, Thandhani R. First trimester C-reactive protein and subsequent gestational diabetes. Diabetes Care. 2003;26:819–24.10.2337/diacare.26.3.819Search in Google Scholar PubMed
[22] Farren M, Turner MJ. Can fetal macrosomia be predicted or prevented? Textbook of diabetes and pregnancy, 3rd ed. London, UK: CRC Press, Forthcoming 2016.Search in Google Scholar
[23] Heslehurst N, Simpson H, Ells JH, Rankin J, Wilkinson J, Lang R, et al. The impact of maternal BMI status on pregnancy outcomes with immediate short-term obstetric resource implications: a meta-analysis. Obes Rev. 2008;9:635–83.10.1111/j.1467-789X.2008.00511.xSearch in Google Scholar PubMed
[24] O’Dwyer V, O’Toole F, Darcy S, Farah N, Kennelly MM, Turner MJ. Maternal obesity and gestational weight gain. J Obstet Gynaecol. 2013;33:671–4.10.3109/01443615.2013.821461Search in Google Scholar PubMed
[25] Turner MJ. The measurement of maternal obesity: can we do better? Clin Obes. 2011;1:127–9.10.1111/j.1758-8111.2011.00024.xSearch in Google Scholar PubMed
[26] Farah N, Murphy M, Ramphul M, O’Connor N, Kennelly MM, Turner MJ. Comparison in maternal body composition between Caucasian Irish and Indian women. J Obstet Gynaecol. 2011;31:483–5.10.3109/01443615.2011.581316Search in Google Scholar PubMed
[27] Fattah C, Farah N, O’Toole F, Barry S, Stuart B, Turner MJ. Body mass index (BMI) in women booking for antenatal care: comparison between self-reported and digital measurements. Eur J Obstet Gynecol Reprod Biol. 2009;144:32–4.10.1016/j.ejogrb.2009.01.015Search in Google Scholar
[28] Shields M, Connor Gorber S, Tremblay MS. Associations between obesity and morbidity: effects of measurement methods. Obes Rev. 2008;9:501–2.10.1111/j.1467-789X.2008.00496.xSearch in Google Scholar
[29] RCPI guidelines: Guideline No. 11 Guideline for the management of pre-gestational and gestational diabetes mellitus from pre-conception to the postnatal period.Search in Google Scholar
[30] Kim SY, England LJ, Wilson HG, Bish C, Satten GA, Dietz PM. Percentage of gestational diabetes mellitus: attributable to overweight and obesity. Am J Public Health. 2010;100:1047–52.10.2105/AJPH.2009.172890Search in Google Scholar
[31] Farah N, Mc Goldrick A, Fattah C, O’Connor C, Kennelly MM, Turner MJ. Body mass index (BMI) and glucose intolerance during pregnancy in white European women. J Reprod Infertil. 2012;13:95–9.Search in Google Scholar
[32] Leary J, Pettitt DJ, Jovanovic L. Gestational diabetes guidelines in a HAPO world. Best Pract Res Clin Endocrinol Metabol. 2010;24:673–85.10.1016/j.beem.2010.05.009Search in Google Scholar
[33] Hillier T, Vesco K, Pedula K, Beil T, Whitlock E, Pettitt D. Screening for gestational diabetes mellitus: a systematic review for the U.S. Preventive Services Task Force. Ann Intern Med. 2008;148:766–75.10.7326/0003-4819-148-10-200805200-00009Search in Google Scholar
[34] Landon MB, Gabbe SG. Gestational diabetes mellitus. Obstet Gynecol. 2011;118:1379–93.10.1097/AOG.0b013e31823974e2Search in Google Scholar
[35] Mission JF, Ohno MS, Cheng YW, Caughey AB. Gestational diabetes screening with the new IADPSG guidelines: a cost-effectiveness analysis. Am J Obstet Gynecol. 2012;207:326.10.1016/j.ajog.2012.06.048Search in Google Scholar
[36] Reece EA, Leguizamon G, Wiznitzer A. Gestational diabetes: the need for a common ground. Lancet. 2009;373:1789–97.10.1016/S0140-6736(09)60515-8Search in Google Scholar
[37] O’Dwyer V, Farah N, Fattah C, O’Connor N, Kennelly MM, Turner MJ. The risk of caesarean section in obese women analysed by parity. Eur J Obstet Gynecol Reprod Biol. 2011;158:28–32.10.1016/j.ejogrb.2011.04.007Search in Google Scholar
[38] Bellamy L, Casa JP, Hingorani AD, Williams D. Type 2 diabetes mellitus after gestational diabetes: a systematic review and meta-analysis. Lancet. 2009;373:1773–9.10.1016/S0140-6736(09)60731-5Search in Google Scholar
The authors stated that there are no conflicts of interest regarding the publication of this article.
©2015 by De Gruyter
