Does Maternal Body Mass Index Influence Treatment Effect in Women with Mild Gestational Diabetes?

Brian M. Casey; Lisa Mele; Mark B. Landon; Catherine Y. Spong; Susan M. Ramin; Ronald J. Wapner; Michael W. Varner; Dwight J. Rouse; John M. Thorp Jr.; Patrick Catalano; Margaret Harper; George Saade; Yoram Sorokin; Alan M. Peaceman; for the Eunice Kennedy Shriver National Institute of Child Health and Human Development Maternal-Fetal Medicine Units Network

doi:10.1055/s-0034-1374815

American Journal of Perinatology, Table of Contents

Am J Perinatol 2015; 32(01): 093-100
DOI: 10.1055/s-0034-1374815

Original Article

Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Does Maternal Body Mass Index Influence Treatment Effect in Women with Mild Gestational Diabetes?

Authors

Brian M. Casey

¹Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, Dallas, Texas
Lisa Mele

²The George Washington University Biostatistics Center, Washington, District of Columbia
Mark B. Landon

³Department of Obstetrics and Gynecology, The Ohio State University, Columbus, Ohio
Catherine Y. Spong

⁴ Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda
Susan M. Ramin

⁵Department of Obstetrics and Gynecology, University of Texas Health Science Center at Houston, Houston, Texas
Ronald J. Wapner

⁶Department of Obstetrics and Gynecology, Columbia University, New York, New York
Michael W. Varner

⁷Department of Obstetrics and Gynecology, University of Utah, Salt Lake City, Utah
Dwight J. Rouse

⁸Department of Obstetrics and Gynecology, University of Alabama, Birmingham, Alabama
John M. Thorp Jr.

⁹Department of Obstetrics and Gynecology, University of North Carolina, Chapel Hill, North Carolina
Patrick Catalano

¹⁰Department of Obstetrics and Gynecology, Case Western Reserve University-MetroHealth Medical Center, Cleveland, Ohio
Margaret Harper

¹¹Department of Obstetrics and Gynecology, Wake Forest University Health Sciences, Winston-Salem, North Carolina
George Saade

¹²Department of Obstetrics and Gynecology, University of Texas Medical Branch, Galveston, Texas
Yoram Sorokin

¹³Department of Obstetrics and Gynecology, Wayne State University, Detroit, Michigan
Alan M. Peaceman

¹⁴Department of Obstetrics and Gynecology, Northwestern University, Chicago, Illinois

for the Eunice Kennedy Shriver National Institute of Child Health and Human Development Maternal-Fetal Medicine Units Network

Abstract

Objective The aim of the article is to determine whether maternal body mass index (BMI) influences the beneficial effects of diabetes treatment in women with gestational diabetes mellitus (GDM).

Study Design Secondary analysis of a multicenter randomized treatment trial of women with GDM. Outcomes of interest were elevated umbilical cord c-peptide levels (> 90th percentile 1.77 ng/mL), large for gestational age (LGA) birth weight (> 90th percentile), and neonatal fat mass (g). Women were grouped into five BMI categories adapted from the World Health Organization International Classification of normal, overweight, and obese adults. Outcomes were analyzed according to treatment group assignment.

Results A total of 958 women were enrolled (485 treated and 473 controls). Maternal BMI at enrollment was not related to umbilical cord c-peptide levels. However, treatment of women in the overweight, Class I, and Class II obese categories was associated with a reduction in both LGA birth weight and neonatal fat mass. Neither measure of excess fetal growth was reduced with treatment in normal weight (BMI < 25 kg/m²) or Class III (BMI ≥ 40 kg/m²) obese women.

Conclusion There was a beneficial effect of treatment on fetal growth in women with mild GDM who were overweight or Class I and Class II obese. These effects were not apparent for normal weight and very obese women.

Keywords

gestational diabetes - BMI - treatment effect

Full Text

References

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