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Am J Perinatol 2014; 31(05): 383-388
DOI: 10.1055/s-0033-1350057
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Impact of Obesity on Maternal and Neonatal Outcomes in Insulin-Resistant Pregnancy

Lorie M. Harper
1   Department of Obstetrics and Gynecology, The University of Alabama at Birmingham, Birmingham, Alabama
,
Allyson Renth
2   Department of Obstetrics and Gynecology, Washington University in St. Louis, St. Louis, Missouri
,
W. Todd Cade
2   Department of Obstetrics and Gynecology, Washington University in St. Louis, St. Louis, Missouri
,
Ryan Colvin
2   Department of Obstetrics and Gynecology, Washington University in St. Louis, St. Louis, Missouri
,
George A. Macones
2   Department of Obstetrics and Gynecology, Washington University in St. Louis, St. Louis, Missouri
,
Alison G. Cahill
2   Department of Obstetrics and Gynecology, Washington University in St. Louis, St. Louis, Missouri
› Author Affiliations
Further Information

Publication History

04 March 2013

07 June 2013

Publication Date:
22 July 2013 (online)

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Abstract

Objective To determine the impact of obesity on pregnancies complicated by insulin resistance.

Study Design Secondary analysis of prospective cohort of women with gestational diabetes mellitus (GDM) and type 2 diabetes mellitus (DM). The exclusion criteria were type 1 DM, multiple gestation, fetal anomalies, unknown prepregnancy, and body mass index (BMI). Primary maternal outcome was a composite of any of the following: severe preeclampsia, eclampsia, third- to fourth-degree laceration, readmission, wound infection, or antepartum hospitalization. Primary neonatal outcome was a composite of any of the following: hypoglycemia, preterm delivery, admission to level 3 nursery, oxygen requirement > 6 hours after birth, shoulder dystocia, 5-minute Apgar ≤3, cord pH < 7.0, and cord base excess < –12 mmol/L. Obese women (BMI ≥30.0 kg/m2) were compared with nonobese women (BMI < 30.0 kg/m2).

Results Of 356 subjects with DM, 233 (66%) were obese. Obese women were not at further increased risk of the composite maternal outcome (adjusted odds ratio [AOR] = 0.68, 95% confidence interval [CI] = 0.43–1.09), the composite neonatal outcome (AOR = 0.76, 95% CI = 0.48–1.21), or cesarean (58.8 vs. 52.9%, p = 0.28, AOR = 1.47, 95% CI = 0.91–2.39).

Conclusion We did not find evidence that obesity worsened pregnancy outcomes in women with GDM and type 2 DM, suggesting that obese women may not require more stringent antepartum treatment strategies.

Keywords

obesity - pregestational diabetes - gestational diabetes - type 2 diabetes

Presentations

This abstract was presented at the Society for Maternal Fetal Medicine, February 11–16, 2013, San Francisco, CA.


This study was conducted at Washington University in St. Louis Medical Center, St. Louis, Missouri.


 

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