The Influence of Maternal Obesity on Pregnancy Complications and Neonatal Outcomes in Diabetic and Nondiabetic Women

Abstract

Introduction This study aimed to investigate the influence of obesity on pregnancy complications and neonatal outcomes in diabetic and nondiabetic women.

Materials and Methods This retrospective case control study was conducted on 1193 pregnant women and their neonates at a tertiary level maternity hospital between March 2007 and 2011. The pregnant women were classified into 2 groups according to the presence of diabetes mellitus. Six hundred and seven patients with gestational diabetes or pregestational diabetes formed the diabetic group (study group) and 586 patients were in the nondiabetic group (control group). Demographic characteristics, body mass index, gestational weight gain, obstetric history, smoking status, type of delivery, gestational ages, pregnancy complications, neonatal outcomes were recorded for each patient. Multivariable logistic regression analysis was performed to evaluate the effect of obesity and diabetes on the pregnancy complications and neonatal outcomes.

Results The mean age and pre-pregnancy body mass indices of women with diabetes mellitus were significantly higher than the control groupʼs (p < 0.001). Gestational weight gain and number of smokers were similar among the groups. Multiparity and obesity were more prevalent in the diabetic group compared to controls (both p < 0.001). Although gestational age at birth was earlier in the diabetic group, birth weights were higher in this group than in the control group (both p < 0.001). Cesarean delivery rates, the incidence of macrosomia, and neonatal intensive care unit admission rates were significantly higher in the diabetes group both with normal and increased body mass index (all p < 0.001). However, adverse pregnancy outcomes were comparable between the groups (p = 0.279). Multivariable logistic regression analysis showed that obesity is a significant risk factor for pregnancy complications (OR = 1.772 [95% CI, 1.283 – 2.449], p = 0.001) but not for adverse neonatal outcomes (OR = 1.068 [95% CI, 0.683 – 1.669], p = 0.773).

Conclusion While obesity increases risk of developing a pregnancy complication, diabetes worsens neonatal outcomes.

Zusammenfassung

Einleitung Ziel dieser Studie war es, den Einfluss von mütterlicher Adipositas auf Schwangerschaftskomplikationen sowie Neugeborenen-Outcomes bei Frauen mit und ohne Diabetes zu untersuchen.

Material und Methode Diese retrospektive Fallkontrollstudie wurde an 1193 schwangeren Frauen und ihren neugeborenen Kinder durchgeführt, die zwischen März 2007 und 2011 in einer Geburtsklinik der Regelversorgung betreut wurden. Die schwangeren Frauen wurden in 2 Gruppen eingeteilt, abhängig davon, ob sie Diabetes hatten oder nicht. 607 Patientinnen mit Gestations- oder Prägestationsdiabetes bildeten die Diabetesgruppe (Untersuchungsgruppe), die 586 Patientinnen in der Gruppe ohne Diabetes fungierten als Kontrollgruppe. Demografische Merkmale, Body-Mass-Index (BMI), Gewichtszunahme während der Schwangerschaft, geburtshilfliche Anamnese, Raucherstatus, Art der Entbindung, Schwangerschaftsalter, Schwangerschaftskomplikationen und neonatales Outcome wurden für jede Patientin erfasst. Eine multivariable Regressionsanalyse wurde durchgeführt, um die Auswirkung von Adipositas und Diabetes auf Schwangerschaftskomplikationen und neonatales Outcome zu bewerten.

Ergebnisse Das Durchschnittsalter und der BMI vor der Schwangerschaft waren deutlich höher bei den Frauen mit Diabetes mellitus als in der Kontrollgruppe (p < 0,001). Die Gewichtszunahme während der Schwangerschaft und die Anzahl der Raucherinnen waren in beiden Gruppen ähnlich. Es gab mehr Frauen mit Übergewicht und mehr Mehrgebärende in der Diabetesgruppe verglichen mit der Kontrollgruppe (beide jeweils p < 0,001). Obwohl die Neugeborenen der Diabetesgruppe ein jüngeres Schwangerschaftsalter hatten bei der Geburt, war das Geburtsgewicht bei den Neugeborenen der Diabetesgruppe höher verglichen mit der Kontrollgruppe (beide jeweils p < 0,001). Die Kaiserschnittraten, die Häufigkeit von Makrosomie und die Einweisungsrate in die Neugeborenen-Intensivstation waren deutlich höher für die Diabetesgruppe, sowohl für Frauen mit normalem BMI als auch für Frauen mit hohem BMI (jeweils p < 0,001). Die unerwünschten Schwangerschaftsausgänge waren aber in beiden Gruppen vergleichbar (p = 0,279). Die multivariable Regressionsanalyse zeigte, dass Übergewicht einen wesentlichen Risikofaktor für Schwangerschaftskomplikationen darstellt (OR = 1,772 [95%-KI 1,283 – 2,449], p = 0,001), aber nicht für ungünstige neonatale Ergebnisse (OR = 1,068 [95%-KI 0,683 – 1,669], p = 0,773).

Schlussfolgerung Während Adipositas das Risiko von Schwangerschaftskomplikationen erhöht, verschlechtert Diabetes das neonatale Outcome.

Key words

gestational diabetes - body mass index - obstetric outcomes - pregestational diabetes - pregnancy outcomes

Schlüsselwörter

Gestationsdiabetes - Body-Mass-Index - geburtshilfliche Ergebnisse - Prägestationsdiabetes - Schwangerschaftsergebnisse

• References

• 1 Lu Y, Hajifathalian K, Ezzati M. et al. Global Burden of Metabolic Risk Factors for Chronic Diseases Collaboration (BMI Mediated Effects). Metabolic mediators of the effects of body-mass index, overweight, and obesity on coronary heart disease and stroke: a pooled analysis of 97 prospective cohorts with 1·8 million participants. Lancet 2014; 383: 970-983
• 2 Ng M, Fleming T, Robinson M. et al. Global, regional, and national prevalence of overweight and obesity in children and adults during 1980–2013: a systematic analysis for the Global Burden of Disease Study 2013. Lancet 2014; 384: 766-781
• 3 Satman I, Omer B, Tutuncu Y. et al. Twelve-year trends in the prevalence and risk factors of diabetes and prediabetes in Turkish adults. Eur J Epidemiol 2013; 28: 169-180
• 4 Chen Z, Du J, Shao L. et al. Prepregnancy body mass index, gestational weight gain, and pregnancy outcomes in China. Int J Gynaecol Obstet 2010; 109: 41-44
• 5 Kumar A, Chaudhary K, Prasad S. Maternal indicators and obstetric outcome in the north Indian population: a hospital-based study. J Postgrad Med 2010; 56: 192-195
• 6 Çınar M, Timur H, Aksoy RT. et al. Evaluation of maternal and perinatal outcomes among overweight women who experienced stillbirth. J Matern Fetal Neonatal Med 2017; 30: 38-42
• 7 OʼSullivan EP, Avalos G, OʼReilly M. et al. Atlantic DIP collaborators. Atlantic Diabetes in Pregnancy (DIP): the prevalence and outcomes of gestational diabetes mellitus using new diagnostic criteria. Diabetologia 2011; 54: 1670-1675
• 8 Liu X, Du J, Wang G. et al. Effect of pre-pregnancy body mass index on adverse pregnancy outcome in north of China. Arch Gynecol Obstet 2011; 283: 65-70
• 9 Nohr EA, Vaeth M, Baker JL. et al. Combined associations of prepregnancy body mass index and gestational weight gain with the outcome of pregnancy. Am J Clin Nutr 2008; 87: 1750-1759
• 10 Simas TA, Liao X, Garrison A. et al. Impact of updated Institute of Medicine guidelines on prepregnancy body mass index categorization, gestational weight gain recommendations, and needed counseling. J Womens Health (Larchmt) 2011; 20: 837-844
• 11 Wıldschut HIJ. Chapter 2: Constitutional and environmental Factors leading to a high Risk Pregnancy. In: James DK, Steer PJ, Weiner CP, Gonik B. eds. High Risk Pregnancy: Management Options. 4th ed. Oxford: Elsevier Ltd.; 2011: 19-25
• 12 Sun D, Li F, Zhang Y. et al. Associations of the pre-pregnancy BMI and gestational BMI gain with pregnancy outcomes in Chinese women with gestational diabetes mellitus. Int J Clin Exp Med 2014; 15: 5784-5789
• 13 Martin KE, Grivell RM, Yelland LN. et al. The influence of maternal BMI and gestational diabetes on pregnancy outcome. Diabetes Res Clin Pract 2015; 108: 508-513
• 14 Bell R, Bailey K, Cresswell T. et al. Trends in prevalence and outcomes of pregnancy in women with pre-existing type I and type II diabetes. BJOG 2008; 115: 445-452
• 15 Kim C, Tabaei BP, Burke R. et al. Missed opportunities for type 2 diabetes mellitus screening among women with a history of gestational diabetes mellitus. Am J Public Health 2006; 96: 1643-1648
• 16 Blomberg M. Maternal and neonatal outcomes among obese women with weight gain below the new Institute of Medicine recommendations. Obstet Gynecol 2011; 117: 1065-1070
• 17 Khalak R, Cummings J, Dexter S. Maternal obesity: significance on the preterm neonate. Int J Obes (Lond) 2015; 39: 1433-1436
• 18 Saereepomcharenkul K. Correlation of BMI to pregnancy outcomes in Thai women delivered in Rajavithi Hospital. J Med Assoc Thai 2011; 94: 52-58
• 19 Hauger MS, Gibbons L, Vik T. et al. Prepregnancy weight status and the risk of adverse pregnancy outcome. Acta Obstet Gynecol Scand 2008; 87: 953-959
• 20 Sebire NJ, Jolly M, Harris JP. et al. Maternal obesity and pregnancy outcome: a study of 287 213 pregnancies in London. Int J Obes Relat Metab Disord 2001; 25: 1175-1182
• 21 Ducarne G, Rodrigues A, Aissaoui F. et al. Pregnancy in obese patients: which risks is it necessary to fear?. Gynecol Obstet Fertil 2007; 35: 19-24
• 22 Kabali C, Werler MM. Pre-pregnant body mass index, weight gain and the risk of delivering large babies among non-diabetic mothers. Int J Gynaecol Obstet 2007; 97: 100-104
• 23 Metzger BE, Couston DR. Summary and recommendations of the Fourth International Workshop-Conference on Gestational Diabetes Mellitus. Diabetes Care 1998; 21 (Suppl. 02) B161-B167
• 24 Robinson H, Tkatch S, Mayes DC. et al. Is maternal obesity a predictor of shoulder dystocia?. Obstet Gynecol 2003; 101: 24-27
• 25 Egger M, Smith GD, Schneider M. et al. Bias in metaanalysis detected by a simple, graphical test. BMJ 1997; 315: 629-634
• 26 Cullen MT, Reece EA, Homko CJ. et al. The changing presentations of diabetic ketoacidosis during pregnancy. Am J Perinatol 1996; 13: 449-451
• 27 Garner P. Type 1 diabetes mellitus and pregnancy. Lancet 1995; 346: 157-161
• 28 Ray JG, Vermeulen MJ, Shapiro JL. et al. Maternal and neonatal outcomes in pregestational and gestational diabetes mellitus, and the influence of maternal obesity and weight gain: the DEPOSIT study. Diabetes Endocrine Pregnancy Outcome Study in Toronto. QJM 2001; 94: 347-356