Early Pregnancy Central Obesity and Risk of Prenatal and Postpartum Diabetes and Hypertensive Disorders.

<p dir="ltr"><b>Objective:</b> Despite BMI’s limitations in assessing obesity, little is known about central obesity’s role in pregnancy and postpartum cardiometabolic conditions. We investigated associations of central obesity with perinatal cardiometabolic conditions, independently and jointly with BMI.</p><p dir="ltr"><b>Research Design and Methods: </b>We examined associations of early pregnancy central obesity measures (waist circumference, waist-to-hip ratio, waist-to-height ratio, body roundness index; n=3,055) with gestational diabetes, hypertensive disorders of pregnancy, postpartum pre-diabetes/diabetes, and postpartum chronic hypertension using modified Poisson (prenatal outcomes) and Cox (postpartum outcomes) regression.</p><p dir="ltr"><b>Results: </b>There was a dose-response relationship between increasing central obesity and all outcomes, even after adjusting for BMI. Among individuals with healthy pre-pregnancy BMI, central obesity was associated with higher risk of gestational diabetes (RR 1.92-2.42), postpartum pre-diabetes/diabetes (HR 1.50-2.16), and postpartum chronic hypertension (HR 2.04-3.63).</p><p dir="ltr"><b>Conclusions: </b>Early pregnancy central obesity measures may enhance perinatal cardiometabolic risk assessment, helping identify at-risk individuals who could be missed using BMI alone.</p>

<p dir="ltr"><b>Objective:</b> Despite BMI’s limitations in assessing obesity, little is known about central obesity’s role in pregnancy and postpartum cardiometabolic conditions. We investigated associations of central obesity with perinatal cardiometabolic conditions, independently and jointly with BMI.</p><p dir="ltr"><b>Research Design and Methods: </b>We examined associations of early pregnancy central obesity measures (waist circumference, waist-to-hip ratio, waist-to-height ratio, body roundness index; n=3,055) with gestational diabetes, hypertensive disorders of pregnancy, postpartum pre-diabetes/diabetes, and postpartum chronic hypertension using modified Poisson (prenatal outcomes) and Cox (postpartum outcomes) regression.</p><p dir="ltr"><b>Results: </b>There was a dose-response relationship between increasing central obesity and all outcomes, even after adjusting for BMI. Among individuals with healthy pre-pregnancy BMI, central obesity was associated with higher risk of gestational diabetes (RR 1.92-2.42), postpartum pre-diabetes/diabetes (HR 1.50-2.16), and postpartum chronic hypertension (HR 2.04-3.63).</p><p dir="ltr"><b>Conclusions: </b>Early pregnancy central obesity measures may enhance perinatal cardiometabolic risk assessment, helping identify at-risk individuals who could be missed using BMI alone.</p>

We aimed to investigate the relationship between GDM and IL-27, IL-6, and body roundness index (BRI), a new anthropometric measurement more sensitive than BMI in identifying obesity and predicting cardiometabolic outcomes. We enrolled 80 patients, 40 pregnant women with GDM and 40 healthy pregnant women at midgestation. The women’s anthropometric measurements were recorded and serum markers and IL-6, IL-27 were analysed. At the time of delivery maternal, neonatal results were recorded. Women with GDM had significantly higher pregestational, midgestational and prepartum BMI and midgestational BRI; HOMA-IR; HbA1c; and IL-6 values and lower HDL values (p < .05). There was no statistically significant difference in IL-27 values between the groups (p = .939). In multivariate logistic regression analysis, HbA1c, IL-6 (>4.886 pg/mL), and BRI (>6.708) were found as independent risk factors associated with GDM (p < .05). Mean BRI was significantly associated with obesity (p < .001) and BRI higher than 6.708 was found to have 67.5% sensitivity and 80% specificity in the prediction of GDM. Women with GDM had elevated IL-6 levels, but no relationship was detected between IL-27 and GDM. BRI is a new anthropometric index that strongly correlated with BMI and seems to be a reliable alternative to BMI for the evaluation of obesity in GDM patients. IMPACT STATEMENT What’s already known on this subject? Gestational diabetes mellitus (GDM) is the most common systemic disease in pregnancy. The risk of GDM was 3 times higher in obese pregnant women compared to normal weighted patients. IL-6 is an adipose-derived cytokine that was found to be associated with GDM. The body roundness index (BRI) is a new sensitive anthropometric index for detecting obesity and its secondary cardiometabolic results. What do the results of this study add? Our results showed that BRI was strongly correlated with obesity in GDM patients. HbA1c, IL-6 and BRI were found as independent risk factors associated with GDM. IL 27, a cytokine associated with inflammatory diseases, was not associated with GDM. What are the implications of these findings for clinical practice and/or further research? BRI could be a reliable alternative to BMI for the evaluation of obesity in pregnant women and predicting cardiometabolic outcomes.

Visceral adiposity is an independent risk factor for cardiovascular disease. Traditional anthropometric measures like body mass index (BMI), waist circumference (WC), and waist-to-hip ratio (WHR) have limited accuracy, while a newer measure, body roundness index (BRI), is touted as being a better predictor of visceral adiposity but requires further validation. The aim of this study is to compare BRI with other traditional metrics of adiposity: WC, BMI and percentage (%) body fat, visceral adiposity and insulin sensitivity among the multiethnic cohorts in Asia. This was a cross-sectional study of 264 young, healthy and normoglycemic adult males (101 Chinese, 85 Malay, 82 South Asian) with ages of 28.4 ± 6.0, 27.6 ± 5.1 and 26.0 ± 4.8 years. Anthropometric measures (BMI, WC, WHR, BRI), bioimpedance analysis (for percentage body fat), MRI-measured visceral and subcutaneous adipose tissue (VAT, SAT), and hyperinsulinaemic-euglycaemic clamp for insulin sensitivity index (ISI) were assessed. BRI correlated significantly with VAT (r = 0.72), SAT (r = 0.85), and ISI (r = -0.51), but performed similarly to BMI, WC and percentage body fat. BRI showed consistent results across ethnic groups, with the highest VAT correlation in Malays (r = 0.76). Percentage body fat measured by bioimpedance was as effective as Magnetic Resonance Imaging (MRI) in predicting adiposity, while WHR had the weakest correlation with VAT. BRI, while strongly correlated with visceral adiposity and ISI, does not outperform simpler measures like WC or percentage body fat. Bioimpedance, being non-invasive, demonstrates utility in assessing visceral adiposity in clinical settings. Ethnic-specific thresholds for BRI and WC may improve precision in obesity-related health assessments.

General obesity measured by body mass index (BMI) is a major risk factor for gestational diabetes (GDM) and postpartum diabetes; however, the role of central obesity, assessed by waist-to-hip ratio (WHR) and waist circumference (WC), is understudied. We examined the prospective associations of general and central obesity with the risk of GDM and postpartum prediabetes or diabetes. Among 3,055 pregnant individuals in the prospective PETALS cohort, BMI was assessed preconceptionally and waist and hip circumference were measured at gestational weeks 10-13. Modified Poisson and Cox regression models assessed the risk of GDM (by Carpenter and Coustan criteria) and postpartum prediabetes or diabetes (by lab, diagnosis, and/or medication), respectively, in association with general obesity (BMI: Asian ≥27.5, non-Asian ≥30.0 kg/m2) and central obesity (WHR ≥0.85 or WC ≥88cm), adjusting for cofounders including continuous BMI. In total, 304 individuals developed GDM and 631 developed postpartum prediabetes or diabetes (mean ± SD follow-up: 4.3 ± 2.5 years). Compared to individuals without general and central obesity (by WHR), GDM risk increased by 1.91 (95% CI 1.10-3.31), 2.39 (1.67-3.43), and 2.69 (1.75-4.13)-fold for those with general obesity and without central obesity, without general obesity and with central obesity, and with both general and central obesity; postpartum prediabetes or diabetes risk increased by 1.70 (1.17-2.47), 1.45 (1.15-1.82), and 1.98 (1.44-2.72)-fold, respectively. Associations were strongest in Hispanic followed by Black individuals. Similar results were observed for central obesity by WC. Central obesity was a stronger risk factor for GDM than general obesity and exhibited incremental risk beyond general obesity for both GDM and postpartum prediabetes or diabetes. Clinicians should recognize the importance of screening for central obesity to identify pregnant individuals at higher risk of future dysglycemia. Disclosure Y. Zhu: None. R.F. Chehab: None. L. Chen: None. A. Ngo: None. M. Greenberg: None. A. Ferrara: None. Funding National Institute of Environmental Health Sciences (R01ES019196), National Heart, Lung, and Blood Institute (R01HL157666), National Institute on Minority Health and Health Disparities (R01MD018459), and Kaiser Permanente Center for Upstream Prevention of Adiposity and Diabetes Mellitus (UPSTREAM).

Introduction and Objective: We evaluated how early body roundness index (BRI), an anthropometric using waist circumference, affected rates of gestational diabetes (GDM) and hypertensive disorders of pregnancy (HDP). Methods: This is a secondary analysis of the Nulliparous Outcomes in Pregnancy: Monitoring Mothers to Be cohort, which followed nulliparous patients during pregnancy. First visit natural waist circumference and height were used to calculate BRI via 364.2 − 365.5 × √(1 − [WC / 2π]2 / [0.5 × ht]2. Characteristics and outcomes were compared with BRI quartiles. Area under the curve (AUC) was compared between BRI and BMI. Multivariable logistic regression estimated the association of BRI &amp;gt;50th%ile with GDM and HDP with stratified analyses by BMI category. Results: Analysis included 9,675 individuals. Increasing BRI quartile was associated with GDM (1.8 vs 2.3 vs 4.6 vs 8.2%, p&amp;lt;0.001) and HDP (16.7 vs 18.9 vs 23.4 vs 34.1%, p&amp;lt;0.001). There were minor differences in AUC for BRI vs BMI for GDM (0.69 ±0.01 vs 0.66 ±0.01, p=0.001) and HDP (0.60 ±0.01 vs 0.62 ± 0.1, p&amp;lt;0.001). BRI &amp;gt;50th%ile was associated with GDM but not HDP in normal and overweight BMI groups (Table). Conclusion: Early elevated BRI is associated with GDM but may not offer advantage clinically over BMI. Studies are needed to determine if BRI can predict GDM risk in pregnant individuals with normal and overweight BMIs. Disclosure K.J. Pape: None. T. Bynarowicz: None. D.M. Haas: None. L.D. Yee: None. R. Silver: None. J. Chung: None. L.D. Levine: None. C.M. Scifres: Consultant; Otsuka/Visterra Pharmaceuticals.

Association of Early-life Trauma With Gestational Diabetes and Hypertensive Disorders of Pregnancy.

Objective To explore the changes in gravida's age and its influences on maternal and neonatal complications under China's two-child policy. Methods This study retrospectively analyzed the clinical data such as adverse gestational complications and fetal condition of 42 771 gravidas delivering at Changzhou Maternity and Child Health Care Hospital Affiliated to Nanjing Medical University from July 2013 to December 2017. According to their age at delivery, they were divided into three groups: the younger maternal age group (1 140 cases, <20 years), the advanced maternal age group (4 307 cases, ≥35 years) and the median maternal age group (37 324 cases, ≥20 and <35 years). Chi-square test was used to compare the differences among groups. Cochran-Armitage test was used for trend analysis. The risks of various complications in younger and advanced maternal age groups were analyzed by binary logistic regression analysis. Results (1) The proportion of advanced maternal age pregnancies tended to rise gradually year by year (Z=-9.909, P<0.001). However, the figure of younger gravidas remained low and presented a downward trend (Z=10.685, P<0.001). (2) The incidence of pregnant complications in the younger, advanced and the median maternal age groups were 52.8% (602/1 140), 72.3% (3 116/4 307) and 56.5% (21 091/37 324), respectively. Compared with the median maternal age group, the advanced maternal age group was at greater risks of premature delivery [9.0% (3 343/37 324) vs 11.6% (499/4 307), χ2=124.233, P<0.001], fetal growth restriction (FGR) [0.6% (218/37 324) vs 1.2% (50/4 307), χ2=20.087, P<0.001], postpartum hemorrhage [5.7% (2 120/37 324) vs 7.8% (336/4 307), χ2=31.299, P<0.05], hypertensive disorders in pregnancy(HDP) [4.2% (1 561/37 324) vs 8.7% (376/4 307), χ2=180.013, P<0.001], gestational diabetes mellitus (GDM) [7.6% (2 845/37 324) vs 15.1% (650/4 307), χ2=280.126, P<0.001] and placenta previa [1.7% (621/37 324) vs 3.8% (165/4 307), χ2=97.904, P<0.001], and the younger maternal age group was at greater risks of HDP [4.2% (1 561/37 324) vs 5.9% (67/1 140), χ2=4.234, P=0.040], fetal distress [3.5% (1 325/37 324) vs 5.1% (58/1 140), χ2=7.546, P=0.006], premature delivery [9.0% (3 343/37 324) vs 15.0% (171/1 140), χ2=48.668, P<0.001] and FGR [0.6% (218/37 324) vs 1.1% (12/1 140), χ2=4.086, P=0.043]. (3) Gestational complications in the younger maternal age group were mainly related to the fetuses such as premature rupture of membranes (PROM) and premature delivery, while the advanced maternal age group had a higher incidence of maternal complications, especially GDM and HDP. (4) Most of the gravidas of advanced maternal age with HDP developed severe preeclampsia (47.9%, 180/376), while mild preeclampsia was dominant in the median maternal aged HDP women (45.4%, 708/1 561). (5) The advanced maternal age group had higher risk of stillbirth, premature delivery, FGR, placenta previa, GDM, HDP and postpartum hemorrhage [OR(95%CI): 1.91 (1.29-2.84), 1.33 (1.21-1.46), 1.66 (1.21-2.28), 2.56 (2.15-3.04), 2.39 (2.19-2.61), 2.36 (2.11-2.65), 1.46 (1.31-1.62); all P<0.05], but lower risks of fetal distress and PROM [OR(95%CI): 0.79 (0.65-0.95) and 0.88 (0.81-0.96); both P<0.05]. The younger maternal age group had a higher risk of premature delivery [OR(95%CI): 1.97 (1.61-2.40); P<0.001], but significant lower risks of PROM and GDM [OR(95%CI): 0.77 (0.62-0.95) and 0.05 (0.02-0.16); both P<0.05]. Conclusions Maternal age is closely related to the adverse outcomes of pregnancy. Two-child policy in China will bring about changes in maternal age and composition of pregnant complications. Key words: Pregnancy; Age factors; Pregnancy outcome

Data on the safety of inactivated COVID-19 vaccines in pregnant women is limited and monitoring pregnancy outcomes is required. We aimed to examine whether vaccination with inactivated COVID-19 vaccines before conception was associated with pregnancy complications or adverse birth outcomes. We conducted a birth cohort study in Shanghai, China. A total of 7000 healthy pregnant women were enrolled, of whom 5848 were followed up through delivery. Vaccine administration information was obtained from electronic vaccination records. Relative risks (RRs) of gestational diabetes mellitus (GDM), hypertensive disorders in pregnancy (HDP), intrahepatic cholestasis of pregnancy (ICP), preterm birth (PTB), low birth weight (LBW), and macrosomia associated with COVID-19 vaccination were estimated by multivariable-adjusted log-binomial analysis. After exclusion, 5457 participants were included in the final analysis, of whom 2668 (48.9%) received at least two doses of an inactivated vaccine before conception. Compared with unvaccinated women, there was no significant increase in the risks of GDM (RR = 0.80, 95% confidence interval [CI], 0.69, 0.93), HDP (RR = 0.88, 95% CI, 0.70, 1.11), or ICP (RR = 1.61, 95% CI, 0.95, 2.72) in vaccinated women. Similarly, vaccination was not significantly associated with any increased risks of PTB (RR = 0.84, 95% CI, 0.67, 1.04), LBW (RR = 0.85, 95% CI, 0.66, 1.11), or macrosomia (RR = 1.10, 95% CI, 0.86, 1.42). The observed associations remained in all sensitivity analyses. Our findings suggested that vaccination with inactivated COVID-19 vaccines was not significantly associated with an increased risk of pregnancy complications or adverse birth outcomes.

Cardiovascular risk management following gestational diabetes and hypertensive disorders of pregnancy: a narrative review.

BackgroundDietary diversity scores (DDS) are considered as metrics for monitoring the implementation of the UN’s Sustainable Development Goals, but they need to be rigorously evaluated.ObjectiveTo examine two DDS, the Food Groups Index (FGI), and the Minimum Dietary Diversity-Women (MDD-W), alongside two dietary quality scores, the Alternate Healthy Eating Index (AHEI-2010) and the Prime Diet Quality Score (PDQS), with risks of gestational diabetes mellitus (GDM) and hypertensive disorders of pregnancy (HDPs).DesignThe analysis included 21,312 (GDM) and 19,917 (HDPs) singleton births reported in the Nurses’ Health Study II cohort (1991–2001), among women without major chronic disease or GDM/HDPs. Scores were derived using prepregnancy diet collected by a comprehensive food frequency questionnaire. Multivariable models were utilized to calculate relative risks (RR) and confidence intervals (95%CIs).ResultsIncident GDM (n = 916) and HDPs (n = 1,421) were reported. The MDD-W and FGI were not associated with risk of GDM or HDPs, but the AHEI-2010 and PDQS were associated with a lower risk of GDM and marginally lower risk of HDP. The RR’s of GDM comparing the highest vs. lowest quintiles were 1.00 (95%CI: 0.79, 1.27; p-trend = 0.82) for MDD-W, 0.96 (95%CI: 0.76, 1.22; p-trend = 0.88) for FGI, 0.63 (95%CI: 0.50, 0.81; p-trend <0.0001) for the AHEI-2010 and 0.68 (95%CI: 0.54, 0.86; p-trend = 0.003) for the PDQS. Similarly, the RR’s of HDPs were 0.92 (95%CI: 0.75, 1.12, p-trend = 0.94) for MDD-W, 0.97 (95%CI: 0.79, 1.17; p-trend = 0.83) for FGI, 0.84 (95%CI: 0.70, 1.02; p-trend = 0.07) for AHEI-2010 and 0.89 (95%CI: 0.74, 1.09; p-trend = 0.07) for PDQS.ConclusionsMDD-W and FGI did not predict the risk of GDM and HDPs. These DDS should not be widely used as metrics for achieving dietary goals in their present form. The Prime Diet Quality Score warrants further testing as a promising measure of a sustainable and healthy diet on a global scale.

The aim of the present study was to define cut-off points of body mass index (BMI) and waist circumference (WC) for gestational diabetes mellitus (GDM) and to investigate any interactions between high BMI and high WC on the risk of GDM in pregnant Chinese women. From 2010 to 2012, 17 803 women in Tianjin, China, who were at 4-12 weeks gestation were recruited to the study. Gestational diabetes mellitus was diagnosed according to the criteria of the International Association of Diabetes and Pregnancy Study Group at 24-28 weeks gestation. Binary logistic regression was used to obtain odds ratios (ORs) and 95% confidence intervals (CIs) while controlling for the confounding effects of traditional risk factors. Restricted cubic spline was used to identify cut-off points of WC and BMI, if any, for GDM. Gestational diabetes mellitus developed in 1383 (7.8%) women. The risk of GDM increased steeply with increasing WC from ≥78.5 cm and BMI ≥22.5 kg/m2 . If BMI <22.5 kg/m2 and WC <78.5 cm were used as the reference, BMI between ≥22.5 and <24.0 kg/m2 (multivariable OR 1.76; 95%CI 1.47-2.10) and WC between ≥78.5 and <85.0 cm (multivariable OR 1.53; 95%CI 1.31-1.78) were independently associated with increased risks of GDM. In addition, the presence of both BMI ≥22.5 kg/m2 and WC ≥78.5 cm further increased the OR to 2.83 (95% CI 2.44-3.28), with significant additive interaction. Body mass index ≥22.5 kg/m2 and WC ≥78.5 cm measured up to 12 weeks of gestation were independently and synergistically associated with increased risks of GDM in Chinese pregnant women.

Quantifying the mediating effect of body mass index on the relation between a Mediterranean diet and development of maternal pregnancy complications: the Australian Longitudinal Study on Women’s Health

BackgroundAlthough insulin resistance has been associated with unfavorable pregnancy outcomes, the ability of non-insulin-based insulin resistance indicators to predict adverse pregnancy outcomes has yet to be thoroughly understood. The study aims to investigate the association and predictability of triglyceride glucose-body mass index (TyG-BMI), a biomarker of non-insulin-based insulin resistance, with the risks of adverse pregnancy outcomes.MethodThe retrospective study included 1,136 subjects. Group-based trajectory modeling (GBTM) was employed to identify the TyG-BMI index trajectory. Logistic regression, restricted cubic spline (RCS) regression, and subgroup analysis were used to assess the association between the TyG-BMI index trajectory and the first-trimester TyG-BMI index with the risks of adverse pregnancy outcomes. Receiver-operating characteristic (ROC) curve analysis and the DeLong test were utilized to evaluate the prediction ability of the first-trimester TyG-BMI index for adverse pregnancy outcomes.ResultsGBTM revealed three distinct trajectories of the TyG-BMI index. Using the “low-stable” trajectory as a reference, the “high-stable” trajectory was independently associated with an increased risk of gestational diabetes mellitus (GDM) (aOR = 2.01, 95% CI 1.20–3.37), hypertensive disorders of pregnancy (HDP) (aOR = 6.05, 95% CI 3.00–12.18), and large for gestational age (LGA) (aOR = 2.83, 95% CI 1.28–6.25). The highest quartile of the first-trimester TyG-BMI index was independently linked to elevated GDM (aOR = 3.27, 95% CI 1.92–5.59), HDP (aOR = 9.26, 95% CI 3.19–26.88), and LGA (aOR = 2.26, 95% CI 1.00–5.09)risks. Additionally, the third quartile of the first-trimester TyG-BMI index had 2.21-fold increased odds of GDM (aOR = 2.21, 95% CI 1.27–3.82). The first-trimester TyG-BMI index demonstrated a significant linear association with GDM, HDP, SGA, and LGA risks. Compared to the TyG-BMI index trajectory, the highest quartile of the first-trimester TyG-BMI index exhibited a stronger association with the risks of GDM and HDP (aOR = 3.09 and 7.39, respectively). Furthermore, according to the ROC curve, the first-trimester TyG-BMI index outperformed the TyG index and triglyceride/high-density lipoprotein cholesterol (TG/HDL-c) ratio at predicting HDP (0.726 [0.650–0.801] vs. 0.603 [0.527–0.679] vs. 0.615 [0.537–0.693]), LGA (0.619 [0.540–0.699] vs. 0.534 [0.454–0.613] vs. 0.540 [0.458–0.622]), and GDM (0.664 [0.622–0.705] vs. 0.632 [0.588–0.676] vs. 0.604 [0.560–0.649]). According to the DeLong test, the first-trimester TyG-BMI index was a more valuable predictor for LGA and HDP compared to TyG index and TG/HDL-c ratio.ConclusionHigher levels of first-trimester TyG-BMI and a “high-stable” trajectory were linked to a greater risk of adverse pregnancy outcomes. Furthermore, as compared to TyG and TG/HDL-c, the first-trimester TyG-BMI index is a valuable predictor for HDP, GDM, and LGA.

No interventions to prevent GDM in 11 systematic reviews were of clear benefit or harm. A combination of exercise and diet, supplementation with myo-inositol, supplementation with vitamin D and metformin were of possible benefit in reducing the risk of GDM, but further high-quality evidence is needed. Omega-3-fatty acid supplementation and universal screening for thyroid dysfunction did not alter the risk of GDM. There was insufficient high-quality evidence to establish the effect on the risk of GDM of diet or exercise alone, probiotics, vitamin D with calcium or other vitamins and minerals, interventions in pregnancy after a previous stillbirth, and different asthma management strategies in pregnancy. There is a lack of trials investigating the effect of interventions prior to or between pregnancies on risk of GDM.