Maternal BMI, glucose tolerance, and adverse pregnancy outcomes

doi:10.1016/j.ajog.2012.04.035

American Journal of Obstetrics and Gynecology

Volume 207, Issue 1, July 2012, Pages 62.e1-62.e7

Presented, as preliminary results, at the 31st annual meeting of the Society for Maternal-Fetal Medicine, San Francisco, CA, Feb. 7-12, 2011.

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https://doi.org/10.1016/j.ajog.2012.04.035 Get rights and content

Objective

The purpose of this study was to estimate the association of pregravid body mass index (BMI), independent of 3-hour oral glucose tolerance test (OGTT) results, with pregnancy outcome.

Study Design

In this secondary analysis of a cohort of women with untreated mild gestational glucose intolerance, which was defined as a 50-g glucose loading test between 135 and 199 mg/dL and fasting glucose level of <95 mg/dL, we modeled the association between pregravid BMI, OGTT results, and both pregnancy complications and neonatal adiposity.

Results

Among 1250 participants, both pregravid BMI and glucose at hour 3 of the OGTT were associated with increased risk of gestational hypertension. Maternal pregravid BMI also was associated positively with large-for-gestational-age infants; both maternal BMI and fasting glucose were associated with birthweight z-score and neonatal fat mass.

Conclusion

Among women with untreated mild gestational glucose intolerance, pregravid BMI is associated with increased gestational hypertension, birthweight, and neonatal fat mass, independent of OGTT values.

Section snippets

Materials and Methods

We performed a secondary analysis of women with untreated mild gestational glucose intolerance. Participants were women who were assigned randomly to no treatment in the previously reported Eunice Kennedy Shriver National Institute of Child Health and Human Development Maternal-Fetal Medicine Units Network multicenter randomized trial of treatment for mild GDM and women in the associated observational cohort, which comprised women with a 50-g glucose screen of ≥135 mg/dL who did not meet

Results

Of the 1250 women who were eligible for inclusion in our analysis, most were Hispanic (54.2%). The mean maternal age was 27.9 years, and 34% of the women were nulliparous (Table 1).

Maternal pregravid BMI correlated with fasting 3-hour OGTT results (r = 0.16; P < .001). BMI was also associated with the 1-hour value on the 3-hour OGTT and inversely associated with 3-hour value. We found correlations among all 4 3-hour OGTT parameters (all P ≤ .005), with the strongest correlations among post-load

Comment

In a secondary analysis of a cohort of women with 50-g glucose loading test screen between 135 and 199 mg/dL and a normal fasting glucose level, we found that elevated maternal pregravid BMI was associated with hypertensive complications, infant birthweight z-score, and fat mass, independent of 3-hour OGTT results. These findings suggest that elevated maternal pregravid BMI is an independent risk factor for adverse birth outcomes and neonatal adiposity, with the caveat that our cohort was

Acknowledgments

We thank the following MFMU Network members who participated in protocol development and coordination between clinical research centers (Francee Johnson, RN, MSN, and Jo-Ann Tillinghast, RN, MSN), protocol/data management and statistical analysis (Elizabeth Thom, PhD), and protocol development and oversight (John M. Thorp Jr, MD).

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: Supported by the following grants from the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD): nos. HD27915, HD34116, HD40485, HD34208, HD27869, HD40500, HD40560, HD34136, HD40544, HD27860, HD40545, HD53097, HD21410, HD27917, HD40512, HD53118, and HD36801; General Clinical Research Centers grant no. M01-RR00034; and National Center for Research Resources grant nos. UL1-RR024989, M01-RR00080, UL1-RR025764, and C06-RR11234. A.M.S. receives support from the Women's Reproductive Health Research Career Development Center at the University of North Carolina (grant no. 5K12HD050113-04).

: This work does not necessarily represent the official views of the National Institute of Child Health and Human Development or the National Institutes of Health.

: The authors report no conflict of interest.

: The other members of the Eunice Kennedy Shriver National Institute of Child Health and Human Development Maternal–Fetal Medicine Units Network are listed in the Appendix.

: Cite this article as: Stuebe AM, Landon MB, Lai Y, et al. Maternal BMI, glucose tolerance, and adverse pregnancy outcomes. Am J Obstet Gynecol 2012;207:62.e1-7.

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ResearchObstetricsMaternal BMI, glucose tolerance, and adverse pregnancy outcomes

Objective

Study Design

Results

Conclusion

Section snippets

Materials and Methods

Results

Comment

Acknowledgments

Am J Obstet Gynecol

Diabetes Metab

Am J Obstet Gynecol

Am J Obstet Gynecol

Diabetes Metab

Am J Clin Nutr

Effect of body mass index on pregnancy outcomes in nulliparous women delivering singleton babies

BMC Public Health

The prevalence and impact of overweight and obesity in an Australian obstetric population

Med J Aust

Prepregnancy body mass index and adverse pregnancy outcomes

Arch Gynecol Obstet

The effects of maternal body mass index on pregnancy outcome

Eur J Epidemiol

Maternal obesity and pregnancy outcome: a study of 287,213 pregnancies in London

Int J Obes Relat Metab Disord

ACOG practice bulletin no. 30: gestational diabetes

Obstet Gynecol

Maternal metabolism and obesity: modifiable determinants of pregnancy outcome

Hum Reprod Update

Childhood obesity and metabolic imprinting: the ongoing effects of maternal hyperglycemia

Diabetes Care

A multicenter, randomized trial of treatment for mild gestational diabetes

N Engl J Med

Effect of treatment of gestational diabetes mellitus on pregnancy outcomes

N Engl J Med

1994-1996 US singleton birthweight percentiles for gestational age by race, Hispanic origin, and gender

Matern Child Health J

Research
Obstetrics
Maternal BMI, glucose tolerance, and adverse pregnancy outcomes