The Effect of Maternal Obesity on Pregnancy Outcomes of Women with Gestational Diabetes Controlled with Diet Only, Glyburide, or Insulin
24 October 2011
16 February 2012
29 May 2012 (eFirst)
Objective To examine the effect of obesity on maternal and neonatal outcomes in women diagnosed with gestational diabetes mellitus (GDM) and managed with diet only, glyburide, or insulin.
Study Design Women with singleton gestations enrolled for outpatient services diagnosed with GDM and without history of pregnancy-related hypertension at enrollment or in a prior pregnancy were identified in a database. Women with GDM controlled by diet only (n = 3918), glyburide (n = 873), or insulin without prior exposure to oral hypoglycemic agents (n = 2229) were included. Pregnancy outcomes were compared for obese versus nonobese women within each treatment group and also compared across treatment groups within the obese and nonobese populations.
Results Within each treatment group, obesity was associated with higher rates of cesarean delivery, pregnancy-related hypertension, macrosomia, and hyperbilirubinemia (all p < 0.05). Higher rates of pregnancy-related hypertension and hyperbilirubinemia were observed in women receiving glyburide.
Conclusion Obesity adversely affects pregnancy outcome in women with GDM. Higher rates of pregnancy-related hypertension and hyperbilirubinemia were observed in pregnant women receiving glyburide.
- 1 American Diabetes Association. Diagnosis and classification of diabetes mellitus. Diabetes Care 2010; 33 (Suppl. 01) S62-S69
- 2 Ferrara A. Increasing prevalence of gestational diabetes mellitus: a public health perspective. Diabetes Care 2007; 30 (Suppl. 02) S141-S146
- 3 Langer O, Yogev Y, Most O, Xenakis EM. Gestational diabetes: the consequences of not treating. Am J Obstet Gynecol 2005; 192: 989-997
- 4 Landon MB, Mele L, Spong CY , et al; Eunice Kennedy Shriver National Institute of Child Health, and Human Development (NICHD) Maternal–Fetal Medicine Units (MFMU) Network. The relationship between maternal glycemia and perinatal outcome. Obstet Gynecol 2011; 117 (2 Pt 1) 218-224
- 5 Metzger BE, Lowe LP, Dyer AR , et al; HAPO Study Cooperative Research Group. Hyperglycemia and adverse pregnancy outcomes. N Engl J Med 2008; 358: 1991-2002
- 6 American Diabetes Association. Standards of medical care in diabetes—2011. Diabetes Care 2011; 34 (Suppl. 01) S11-S61
- 7 Rowan JA, Hague WM, Gao W, Battin MR, Moore MP. MiG Trial Investigators. Metformin versus insulin for the treatment of gestational diabetes. N Engl J Med 2008; 358: 2003-2015
- 8 Dhulkotia JS, Ola B, Fraser R, Farrell T. Oral hypoglycemic agents vs insulin in management of gestational diabetes: a systematic review and metaanalysis. Am J Obstet Gynecol 2010; 203: 457 , e1–e9
- 9 Flegal KM, Carroll MD, Ogden CL, Curtin LR. Prevalence and trends in obesity among US adults, 1999–2008. JAMA 2010; 303: 235-241
- 10 Joy S, Istwan N, Rhea D, Desch C, Stanziano G. The impact of maternal obesity on the incidence of adverse pregnancy outcomes in high-risk term pregnancies. Am J Perinatol 2009; 26: 345-349
- 11 Roman AS, Rebarber A, Fox NS , et al. The effect of maternal obesity on pregnancy outcomes in women with gestational diabetes. J Matern Fetal Neonatal Med 2011; 24: 723-727
- 12 Jacobson GF, Ramos GA, Ching JY, Kirby RS, Ferrara A, Field DR. Comparison of glyburide and insulin for the management of gestational diabetes in a large managed care organization. Am J Obstet Gynecol 2005; 193: 118-124
- 13 Cheng YW, Chung JH, Block-Kurbisch I, Inturrisi M, Caughey AB. Treatment of gestational diabetes mellitus: glyburide compared to subcutaneous insulin therapy and associated perinatal outcomes. J Matern Fetal Neonatal Med 2011; [Epub ahead of print]
- 14 Pollex EK, Feig DS, Koren G. Oral hypoglycemic therapy: understanding the mechanisms of transplacental transfer. J Matern Fetal Neonatal Med 2010; 23: 224-228
- 15 Melamed N, Yogev Y. Can pregnant diabetics be treated with glyburide?. Womens Health (Lond Engl) 2009; 5: 649-658
- 16 Maymone AC, Baillargeon JP, Ménard J, Ardilouze JL. Oral hypoglycemic agents for gestational diabetes mellitus?. Expert Opin Drug Saf 2011; 10: 227-238