Journal Article

The Hyperglycemia and Adverse Pregnancy Outcome Study: Associations of GDM and obesity with pregnancy outcomes

COUSTAN, Donald R, CATALANO, Patrick M, HOD, Moshe, METZGER, Boyd E, DYER, Alan R, OATS, Jeremy J. N, KENNEDY CRUICKSHANK, J, TRIMBLE, Elisabeth R, DAVID MCINTYRE, H, MCCANCE, David R, PERSSON, Bengt, LOWE, Lynn P, HADDEN, David R

2012

Overview

To determine associations of gestational diabetes mellitus (GDM) and obesity with adverse pregnancy outcomes in the Hyperglycemia and Adverse Pregnancy Outcome (HAPO) Study. Participants underwent a 75-g oral glucose tolerance test (OGTT) between 24 and 32 weeks. GDM was diagnosed post hoc using International Association of Diabetes and Pregnancy Study Groups criteria. Neonatal anthropometrics and cord serum C-peptide were measured. Adverse pregnancy outcomes included birth weight, newborn percent body fat, and cord C-peptide >90th percentiles, primary cesarean delivery, preeclampsia, and shoulder dystocia/birth injury. BMI was determined at the OGTT. Multiple logistic regression was used to examine associations of GDM and obesity with outcomes. Mean maternal BMI was 27.7, 13.7% were obese (BMI ≥33.0 kg/m(2)), and GDM was diagnosed in 16.1%. Relative to non-GDM and nonobese women, odds ratio for birth weight >90th percentile for GDM alone was 2.19 (1.93-2.47), for obesity alone 1.73 (1.50-2.00), and for both GDM and obesity 3.62 (3.04-4.32). Results for primary cesarean delivery and preeclampsia and for cord C-peptide and newborn percent body fat >90th percentiles were similar. Odds for birth weight >90th percentile were progressively greater with both higher OGTT glucose and higher maternal BMI. There was a 339-g difference in birth weight for babies of obese GDM women, compared with babies of normal/underweight women (64.2% of all women) with normal glucose based on a composite OGTT measure of fasting plasma glucose and 1- and 2-h plasma glucose values (61.8% of all women). Both maternal GDM and obesity are independently associated with adverse pregnancy outcomes. Their combination has a greater impact than either one alone.

• Publisher: American Diabetes Association
• Subject: Adult / analysis / Biological and medical sciences / birth weight / Birth Weight - physiology / blood / blood glucose / Blood Glucose - analysis / Blood Glucose - metabolism / blood serum / body fat / Body Mass Index / c-peptide / complications / Complications and side effects / Diabetes / Diabetes in pregnancy / Diabetes, Gestational / Diabetes, Gestational - blood / Diabetes, Gestational - epidemiology / Diabetes. Impaired glucose tolerance / dystocia / Endocrine pancreas. Apud cells (diseases) / Endocrinopathies / epidemiology / etiology / fasting / Female / gestational diabetes / glucose / glucose tolerance / Glucose Tolerance Test / Humans / Hyperglycemia / Hyperglycemia - blood / Hyperglycemia - complications / Hyperglycemia - epidemiology / Infant, Newborn / Male / Medical sciences / Metabolic diseases / metabolism / Miscellaneous / neonates / Obesity / Obesity - complications / Obesity - epidemiology / Obstetric Labor Complications / Obstetric Labor Complications - blood / Obstetric Labor Complications - epidemiology / Obstetric Labor Complications - etiology / odds ratio / Original Research / physiology / pre-eclampsia / Pregnancy / Pregnancy Complications / Pregnancy Complications - blood / Pregnancy Complications - epidemiology / Pregnancy Complications - etiology / pregnancy outcome / Pregnancy Outcome - epidemiology / Pregnancy, Complications of / Public health. Hygiene / Public health. Hygiene-occupational medicine / regression analysis / Risk factors / underweight / women / Womens health / Young Adult