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Am J Perinatol 2016; 33(13): 1300-1305
DOI: 10.1055/s-0036-1586506
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Prepregnancy Weight in Women with Type I Diabetes Mellitus: Effect on Pregnancy Outcomes

T. Kawakita
1   Department of Obstetrics and Gynecology, MedStar Washington Hospital Center, Washington, District of Columbia
,
K. Bowers
2   Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
,
E. Coviello
1   Department of Obstetrics and Gynecology, MedStar Washington Hospital Center, Washington, District of Columbia
,
M. Miodovnik
3   Pregnancy and Perinatology Branch, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institute of Health, Bethesda, Maryland
,
S. Ehrlich
2   Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
,
B. Rosenn
4   Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Mount Sinai West Hospital, New York, New York
,
J. C. Khoury
2   Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
5   Division of Endocrinology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
› Author Affiliations
Further Information

Publication History

01 March 2016

18 June 2016

Publication Date:
03 August 2016 (online)

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Abstract

Objective This study aims to evaluate the association between prepregnancy body mass index (BMI) and adverse pregnancy outcomes in women with type 1 diabetes mellitus (DM).

Methods This is a secondary analysis of a cohort of 426 pregnancies in women with type 1 DM recruited before 20 weeks gestation. Women were categorized according to prepregnancy BMI: low BMI (< 20 kg/m2), normal BMI (20 to < 25 kg/m2), and high BMI (≥ 25 kg/m2). The outcomes of interest were: spontaneous abortion (delivery < 20 weeks gestation); preeclampsia; emergent delivery for maternal indications (hypertension or placental abruption); and preterm delivery (< 37 weeks gestation). Analyses included proportional hazards and multiple logistic regression models with covariates: age, age at diagnosis of type 1 DM, previous spontaneous abortion, microvascular disease (nephropathy or retinopathy), and glycohemoglobin A1 concentrations.

Results Low BMI was associated with preterm delivery. High BMI was associated with emergent delivery for maternal indications. Glycemic control as measured by glycohemoglobin A1 was associated with increased risk of spontaneous abortion, attenuating the association with low prepregnancy weight.

Conclusion Prepregnancy BMI is a risk factor to be considered when caring for women with type 1 DM, in particular for preterm delivery (low BMI) and emergent delivery for maternal indications (high BMI).

Keywords

prepregnancy weight - preterm delivery - spontaneous abortion - type 1 diabetes - low BMI - high BMI
 

  • References

  • 1 National Center for Health Statistics. National Vital Statistics Reports. Available at: http://www.cdc.gov/nchs/data/factsheets/factsheet_obesity.pdf . Accessed February 16, 2016
    PubMedGoogle Scholar
  • 2 Ovesen P, Rasmussen S, Kesmodel U. Effect of prepregnancy maternal overweight and obesity on pregnancy outcome. Obstet Gynecol 2011; 118 (2 Pt 1): 305-312
    CrossrefPubMedGoogle Scholar
  • 3 Cedergren MI. Maternal morbid obesity and the risk of adverse pregnancy outcome. Obstet Gynecol 2004; 103 (2) 219-224
    CrossrefPubMedGoogle Scholar
  • 4 Lashen H, Fear K, Sturdee DW. Obesity is associated with increased risk of first trimester and recurrent miscarriage: matched case-control study. Hum Reprod 2004; 19 (7) 1644-1646
    CrossrefPubMedGoogle Scholar
  • 5 Schieve LA, Cogswell ME, Scanlon KS , et al; The NMIHS Collaborative Study Group. Prepregnancy body mass index and pregnancy weight gain: associations with preterm delivery. Obstet Gynecol 2000; 96 (2) 194-200
    CrossrefPubMedGoogle Scholar
  • 6 Sebire NJ, Jolly M, Harris J, Regan L, Robinson S. Is maternal underweight really a risk factor for adverse pregnancy outcome? A population-based study in London. BJOG 2001; 108 (1) 61-66
    PubMedGoogle Scholar
  • 7 Ronnenberg AG, Wang X, Xing H , et al. Low preconception body mass index is associated with birth outcome in a prospective cohort of Chinese women. J Nutr 2003; 133 (11) 3449-3455
    PubMedGoogle Scholar
  • 8 Vargas R, Repke JT, Ural SH. Type 1 diabetes mellitus and pregnancy. Rev Obstet Gynecol 2010; 3 (3) 92-100
    PubMedGoogle Scholar
  • 9 Garner P. Type I diabetes mellitus and pregnancy. Lancet 1995; 346 (8968) 157-161
    CrossrefPubMedGoogle Scholar
  • 10 Persson M, Pasupathy D, Hanson U, Norman M. Birth size distribution in 3,705 infants born to mothers with type 1 diabetes: a population-based study. Diabetes Care 2011; 34 (5) 1145-1149
    CrossrefPubMedGoogle Scholar
  • 11 Scifres CM, Feghali MN, Althouse AD, Caritis SN, Catov JM. Effect of excess gestational weight gain on pregnancy outcomes in women with type 1 diabetes. Obstet Gynecol 2014; 123 (6) 1295-1302
    CrossrefPubMedGoogle Scholar
  • 12 Reece EA, Sivan E, Francis G, Homko CJ. Pregnancy outcomes among women with and without diabetic microvascular disease (White's classes B to FR) versus non-diabetic controls. Am J Perinatol 1998; 15 (9) 549-555
    Article in Thieme ConnectPubMedGoogle Scholar
  • 13 Gordon M, Landon MB, Samuels P, Hissrich S, Gabbe SG. Perinatal outcome and long-term follow-up associated with modern management of diabetic nephropathy. Obstet Gynecol 1996; 87 (3) 401-409
    CrossrefPubMedGoogle Scholar
  • 14 Miodovnik M, Rosenn BM, Khoury JC, Grigsby JL, Siddiqi TA. Does pregnancy increase the risk for development and progression of diabetic nephropathy?. Am J Obstet Gynecol 1996; 174 (4) 1180-1189 , discussion 1189–1191
    CrossrefPubMedGoogle Scholar
  • 15 Hanson U, Persson B. Outcome of pregnancies complicated by type 1 insulin-dependent diabetes in Sweden: acute pregnancy complications, neonatal mortality and morbidity. Am J Perinatol 1993; 10 (4) 330-333
    Article in Thieme ConnectPubMedGoogle Scholar
  • 16 Chillarón JJ, Benaiges D, Mañé L, Pedro-Botet J, Flores Le-Roux JA. Obesity and type 1 diabetes mellitus management. Minerva Endocrinol 2015; 40 (1) 53-60
    PubMedGoogle Scholar
  • 17 McElvy SS, Miodovnik M, Rosenn B , et al. A focused preconceptional and early pregnancy program in women with type 1 diabetes reduces perinatal mortality and malformation rates to general population levels. J Matern Fetal Med 2000; 9 (1) 14-20
    CrossrefPubMedGoogle Scholar
  • 18 Kaplan LA, Cline D, Gartside P, Burstein S, Sperling M, Stein EA. Hemoglobin A1 in hemolysates from healthy and insulin-dependent diabetic children, as determined with a temperature-controlled minicolumn assay. Clin Chem 1982; 28 (1) 13-18
    PubMedGoogle Scholar
  • 19 Zhong Y, Cahill AG, Macones GA, Zhu F, Odibo AO. The association between prepregnancy maternal body mass index and preterm delivery. Am J Perinatol 2010; 27 (4) 293-298
    Article in Thieme ConnectPubMedGoogle Scholar
  • 20 Wang T, Zhang J, Lu X, Xi W, Li Z. Maternal early pregnancy body mass index and risk of preterm birth. Arch Gynecol Obstet 2011; 284 (4) 813-819
    CrossrefPubMedGoogle Scholar
  • 21 Salihu HM, Mbah AK, Alio AP, Clayton HB, Lynch O. Low pre-pregnancy body mass index and risk of medically indicated versus spontaneous preterm singleton birth. Eur J Obstet Gynecol Reprod Biol 2009; 144 (2) 119-123
    CrossrefPubMedGoogle Scholar
  • 22 Han Z, Mulla S, Beyene J, Liao G, McDonald SD ; Knowledge Synthesis Group. Maternal underweight and the risk of preterm birth and low birth weight: a systematic review and meta-analyses. Int J Epidemiol 2011; 40 (1) 65-101
    CrossrefPubMedGoogle Scholar
  • 23 Peacock I. Glycosylated haemoglobin: measurement and clinical use. J Clin Pathol 1984; 37 (8) 841-851
    CrossrefPubMedGoogle Scholar