Pre-pregnancy obesity, gestational diabetes or gestational weight gain: Which is the strongest predictor of pregnancy outcomes?

Diabetes Res Clin Pract. 2018 Oct:144:286-293. doi: 10.1016/j.diabres.2018.08.019. Epub 2018 Sep 4.

Abstract

Aims: Both obesity and gestational diabetes (GDM) are risk factors for adverse pregnancy outcomes. The aim of our study is to ascertain the independent role of prepregnancy BMI (pp-BMI), gestational weight gain (GWG), and GDM on pregnancy outcomes.

Methods: We analyzed data of 1198 pregnant women, who underwent selective screening for GDM. Data on pregnancy outcomes was collected from hospital discharge records.

Results: Cesarean section (CS) was comparable in GDM and NGT women. Prevalence of fetal macrosomia was 5.9%, with no difference between GDM and normal glucose tolerance (NGT), neonatal hyperbilirubinemia were more frequent in newborns of GDM women (63.3% vs. 52.2%; p < 0.01). Offspring of women with excessive GWG weighed more than those of women with regular GWG (3405 ± 510 g vs. 3287 ± 524 g; p < 0.01). On a logistic regression analysis, GWG was an independent risk factor for macrosomia (OR 1.08, 95% CI 1.02-1.13; p < 0.01) and delivery at a gestational age <37 weeks (OR 0.29, 95% CI 0.16-0.53; p < 0.0001). GDM and pp-BMI were not independent risk factors for adverse outcomes in this cohort.

Conclusions: GWG rather than GDM is associated with adverse pregnancy outcomes. These findings call for an early education and implementation of a healthy lifestyle in women planning a pregnancy.

Keywords: Gestational diabetes; Gestational weight gain; Pre-pregnancy BMI; Pregnancy; Pregnancy outcomes.

MeSH terms

  • Adult
  • Body Mass Index
  • Diabetes, Gestational / physiopathology*
  • Female
  • Fetal Macrosomia / epidemiology*
  • Gestational Age
  • Humans
  • Infant, Newborn
  • Italy / epidemiology
  • Male
  • Obesity / physiopathology*
  • Pregnancy
  • Pregnancy Outcome
  • Prevalence
  • Retrospective Studies
  • Risk Factors
  • Weight Gain*
  • Young Adult