Download PDF
Am J Perinatol 2014; 31(03): 249-256
DOI: 10.1055/s-0033-1347363
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

The Effect of Maternal Body Mass Index on Perinatal Outcomes in Women with Diabetes

Nicole E. Marshall
1   Department of Obstetrics and Gynecology, Oregon Health and Science University, Portland, Oregon
,
Camelia Guild
2   Department of Pediatrics, Saint Louis University, St. Louis, Missouri
,
Yvonne W. Cheng
3   Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, San Francisco, California
,
Aaron B. Caughey
1   Department of Obstetrics and Gynecology, Oregon Health and Science University, Portland, Oregon
*   Donna R. Halloran and Aaron B. Caughey served as co–senior authors.
,
Donna R. Halloran
2   Department of Pediatrics, Saint Louis University, St. Louis, Missouri
*   Donna R. Halloran and Aaron B. Caughey served as co–senior authors.
› Author Affiliations
Further Information

Publication History

29 November 2012

11 April 2013

Publication Date:
21 May 2013 (online)

    Permissions and Reprints

Abstract

Objective To determine the effect of increasing maternal obesity, including superobesity (body mass index [BMI] ≥ 50 kg/m2), on perinatal outcomes in women with diabetes.

Study Design Retrospective cohort study of birth records for all live-born nonanomalous singleton infants ≥ 37 weeks' gestation born to Missouri residents with diabetes from 2000 to 2006. Women with either pregestational or gestational diabetes were included.

Results There were 14,595 births to women with diabetes meeting study criteria, including 7,082 women with a BMI > 30 kg/m2 (48.5%). Compared with normal-weight women with diabetes, increasing BMI category, especially superobesity, was associated with a significantly increased risk for preeclampsia (adjusted relative risk [aRR] 3.6, 95% confidence interval [CI] 2.5, 5.2) and macrosomia (aRR 3.0, 95% CI 1.8, 5.40). The majority of nulliparous obese women with diabetes delivered via cesarean including 50.5% of obese, 61.4% of morbidly obese, and 69.8% of superobese women. The incidence of primary elective cesarean among nulliparous women with diabetes increased significantly with increasing maternal BMI with over 33% of morbidly obese and 39% of superobese women with diabetes delivering electively by cesarean.

Conclusion Increasing maternal obesity in women with diabetes is significantly associated with higher risks of perinatal complications, especially cesarean delivery.

Keywords

cesarean - diabetes - obesity - superobesity
 

  • References

  • 1 Hossain P, Kawar B, El Nahas M. Obesity and diabetes in the developing world—a growing challenge. N Engl J Med 2007; 356: 213-215
    CrossrefPubMedGoogle Scholar
  • 2 Baci Y, Üstüner I, Keskin HL, Ersoy R, Avşar AF. Effect of maternal obesity and weight gain on gestational diabetes mellitus. Gynecol Endocrinol 2013; 29: 133-136
    CrossrefPubMedGoogle Scholar
  • 3 Flegal KM, Carroll MD, Ogden CL, Curtin LR. Prevalence and trends in obesity among US adults, 1999–2008. JAMA 2010; 303: 235-241
    CrossrefPubMedGoogle Scholar
  • 4 American College of Obstetricians and Gynecologists. ACOG practice bulletin no. 105: bariatric surgery and pregnancy. Obstet Gynecol 2009; 113: 1405-1413
    CrossrefPubMedGoogle Scholar
  • 5 Yang J, Cummings EA, O'connell C, Jangaard K. Fetal and neonatal outcomes of diabetic pregnancies. Obstet Gynecol 2006; 108 (3 Pt 1) 644-650
    CrossrefPubMedGoogle Scholar
  • 6 Casey BM, Lucas MJ, Mcintire DD, Leveno KJ. Pregnancy outcomes in women with gestational diabetes compared with the general obstetric population. Obstet Gynecol 1997; 90: 869-873
    CrossrefPubMedGoogle Scholar
  • 7 Knight KM, Pressman EK, Hackney DN, Thornburg LL. Perinatal outcomes in type 2 diabetic patients compared with non-diabetic patients matched by body mass index. J Matern Fetal Neonatal Med 2012; 25: 611-615
    CrossrefPubMedGoogle Scholar
  • 8 Roberts JM, Gammill H. Insulin resistance in preeclampsia. Hypertension 2006; 47: 341-342
    CrossrefPubMedGoogle Scholar
  • 9 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
    CrossrefPubMedGoogle Scholar
  • 10 Ray JG, Vermeulen MJ, Shapiro JL, Kenshole AB. Diabetes Endocrine Pregnancy Outcome Study in Toronto. Maternal and neonatal outcomes in pregestational and gestational diabetes mellitus, and the influence of maternal obesity and weight gain: the DEPOSIT study. QJM 2001; 94: 347-356
    CrossrefPubMedGoogle Scholar
  • 11 Langer O, Yogev Y, Xenakis EM, Brustman L. Overweight and obese in gestational diabetes: the impact on pregnancy outcome. Am J Obstet Gynecol 2005; 192: 1768-1776
    CrossrefPubMedGoogle Scholar
  • 12 Yogev Y, Langer O. Pregnancy outcome in obese andmorbidly obese gestational diabetic women. Eur J Obstet Gynecol Reprod Biol 2008; 137: 21-26
    CrossrefPubMedGoogle Scholar
  • 13 Brockert J. Recommended standard medical definitions for the U.S. standard certificate of live birth and the U.S. standard report of fetal death. Presented at the 1990 annual meeting of the AVRHS, Traverse City, MI; 1989 revision. June 25-27
    PubMedGoogle Scholar
  • 14 Land G, Vaughan W. Birth certificate completion procedures and the accuracy of Missouri birth certificate data. J Am Med Rec Assoc 1984; 55: 31-34
    PubMedGoogle Scholar
  • 15 World Health Organization. Obesity and overweight fact sheet. Available from: http://www.who.int/mediacentre/factsheets/fs311/en . Accessed May 14, 2013
    PubMedGoogle Scholar
  • 16 Institute of Medicine (US) and National Research Council. (US) Committee to Reexamine IOM Pregnancy Weight Guidelines. National Academics Press, Washington DC 2009
    PubMedGoogle Scholar
  • 17 Mason EE, Doherty C, Maher JW, Scott DH, Rodriguez EM, Blommers TJ. Super obesity and gastric reduction procedures. Gastroenterol Clin North Am 1987; 16: 495-502
    PubMedGoogle Scholar
  • 18 DiGiuseppe DL, Aron DC, Ranbom L, Harper DL, Rosenthal GE. Reliability of birth certificate data: a multi-hospital comparison to medical records information. Matern Child Health J 2002; 6: 169-179
    CrossrefPubMedGoogle Scholar
  • 19 Kahn EB, Berg CJ, Callaghan WM. Cesarean delivery among women with low-risk pregnancies: a comparison of birth certificates and hospital discharge data. Obstet Gynecol 2009; 113: 33-40
    PubMedGoogle Scholar
  • 20 Petersen DJ, Alexander GR. Seasonal variation in adolescent conceptions, induced abortions, and late initiation of prenatal care. Public Health Rep 1992; 107: 701-706
    PubMedGoogle Scholar
  • 21 Alexander GR, Cornely DA. Prenatal care utilization: its measurement and relationship to pregnancy outcome. Am J Prev Med 1987; 3: 243-253
    PubMedGoogle Scholar
  • 22 Wispelwey BP, Sheiner E. Cesarean delivery in obese women: a comprehensive review. J Matern Fetal Neonatal Med 2013; 26: 547-551
    CrossrefPubMedGoogle Scholar
  • 23 Naylor CD, Sermer M, Chen E, Sykora K. Cesarean delivery in relation to birth weight and gestational glucose tolerance: pathophysiology or practice style? Toronto Trihospital Gestational Diabetes Investigators. JAMA 1996; 275: 1165-1170
    CrossrefPubMedGoogle Scholar
  • 24 Blackwell SC, Hassan SS, Wolfe HW, Michaelson J, Berry SM, Sorokin Y. Why are cesarean delivery rates so high in diabetic pregnancies?. J Perinat Med 2000; 28: 316-320
    PubMedGoogle Scholar
  • 25 Saravanakumar K, Rao SG, Cooper GM. The challenges of obesity and obstetric anaesthesia. Curr Opin Obstet Gynecol 2006; 18: 631-635
    CrossrefPubMedGoogle Scholar
  • 26 Gunatilake RP, Perlow JH. Obesity and pregnancy: clinical management of the obese gravida. Am J Obstet Gynecol 2011; 204: 106-119
    CrossrefPubMedGoogle Scholar
  • 27 Heit JA, Kobbervig CE, James AH, Petterson TM, Bailey KR, Melton III LJ. Trends in the incidence of venous thromboembolism during pregnancy or postpartum: a 30-year population-based study. Ann Intern Med 2005; 143: 697-706
    CrossrefPubMedGoogle Scholar
  • 28 O'Brien TE, Ray JG, Chan WS. Maternal body mass index and the risk of preeclampsia: a systematic overview. Epidemiology 2003; 14: 368-374
    CrossrefPubMedGoogle Scholar
  • 29 Joffe GM, Esterlitz JR, Levine RJ , et al; Calcium for Preeclampsia Prevention (CPEP) Study Group. The relationship between abnormal glucose tolerance and hypertensive disorders of pregnancy in healthy nulliparous women. Am J Obstet Gynecol 1998; 179: 1032-1037
    CrossrefPubMedGoogle Scholar
  • 30 Schmidt MI, Duncan BB, Reichelt AJ , et al; Brazilian Gestational Diabetes Study Group. Gestational diabetes mellitus diagnosed with a 2-h 75-g oral glucose tolerance test and adverse pregnancy outcomes. Diabetes Care 2001; 24: 1151-1155
    CrossrefPubMedGoogle Scholar
  • 31 Carr DB, Newton KM, Utzschneider KM , et al. Gestational diabetes or lesser degrees of glucose intolerance and risk of preeclampsia. Hypertens Pregnancy 2011; 30: 153-163
    CrossrefPubMedGoogle Scholar
  • 32 Yogev C Chen, Hod, et al; Hyperglycemia and Adverse Pregnancy Outcome (HAPO) Study Cooperative Research Group. Hyperglycemia and adverse pregnancy outcome (HAPO) study: Preeclampsia. Am J Obstet Gynecol 2010; 202: e1-e7
    PubMedGoogle Scholar
  • 33 Seely EW, Solomon CG. Insulin resistance and its potential role in pregnancy-induced hypertension. J Clin Endocrinol Metab 2003; 88: 2393-2398
    CrossrefPubMedGoogle Scholar
  • 34 Lorentzen B, Birkeland KI, Endresen MJ, Henriksen T. Glucose intolerance in women with preeclampsia. Acta Obstet Gynecol Scand 1998; 77: 22-27
    CrossrefPubMedGoogle Scholar
  • 35 Hauth JC, Clifton RG, Roberts JM , et al; Eunice Kennedy Shriver National Institute of Child Health and Human Development Maternal-Fetal Medicine Units Network. Maternal insulin resistance and preeclampsia. Am J Obstet Gynecol 2011; 204: e1-e6
    PubMedGoogle Scholar
  • 36 Parretti E, Lapolla A, Dalfrà M , et al. Preeclampsia in lean normotensive normotolerant pregnant women can be predicted by simple insulin sensitivity indexes. Hypertension 2006; 47: 449-453
    CrossrefPubMedGoogle Scholar
  • 37 Kim C, Newton KM, Knopp RH. Gestational diabetes and the incidence of type 2 diabetes: a systematic review. Diabetes Care 2002; 25: 1862-1868
    CrossrefPubMedGoogle Scholar
  • 38 Boney CM, Verma A, Tucker R, Vohr BR. Metabolic syndrome in childhood: association with birth weight, maternal obesity, and gestational diabetes mellitus. Pediatrics 2005; 115: e290-e296
    CrossrefPubMedGoogle Scholar
  • 39 American Diabetes Association. Standards of medical care in diabetes—2011. Diabetes Care 2011; 34 (Suppl. 01) S11-S61
    CrossrefPubMedGoogle Scholar
  • 40 Sacks DA, Chen W, Greenspoon JS, Wolde-Tsadik G. Should the same glucose values be targeted for type 1 as for type 2 diabetics in pregnancy?. Am J Obstet Gynecol 1997; 177: 1113-1119
    CrossrefPubMedGoogle Scholar
  • 41 Sacks DA, Liu AI, Wolde-Tsadik G, Amini SB, Huston-Presley L, Catalano PM. What proportion of birth weight is attributable to maternal glucose among infants of diabetic women?. Am J Obstet Gynecol 2006; 194: 501-507
    CrossrefPubMedGoogle Scholar