Fetal and Placental Weight in Pre-Gestational Maternal Obesity (PGMO) vs. Excessive Gestational Weight Gain (EGWG)-A Preliminary Approach to the Perinatal Outcomes in Diet-Controlled Gestational Diabetes Mellitus.

Mariusz Gujski,Dariusz Szukiewicz,Iwona Bojar,Marta Chołuj,Włodzimierz Sawicki

doi:10.3390/jcm9113530

Abstract

Both pre-gestational maternal obesity (PGMO) and excessive gestational weight gain (EGWG) increase the risk of gestational diabetes mellitus (GDM). Here, we conducted a retrospective study to comparatively examine the relation between fetal birth weight (FW) and placental weight (PW) in PGMO (n = 100) compared to EGWG (n = 100) with respect to perinatal outcomes in diet-controlled GDM. The control group was made up of 100 healthy pregnancies. The mean FW and the mean PW in EGWG were correlated with lowered fetal weight/placental weight ratio (FW/PW ratio). The percentage of births completed by cesarean section accounted for 47%, 32%, and 18% of all deliveries (EGWG, PGMO, and controls, respectively), with the predominance of FW-related indications for cesarean section. Extended postpartum hospital stays due to neonate were more frequent in EGWG, especially due to neonatal jaundice (p < 0.05). The results indicate the higher perinatal risk in mothers with EGWG compared to PGMO during GDM-complicated pregnancy. Further in-depth comparative studies involving larger patient pools are needed to validate these findings, the intent of which is to formulate guidelines for GDM patients in respect to management of PGMO and EGWG.

Highlights

The prevalence of obesity, defined as a body mass index (BMI) ≥ 30 kg/m2, has been increasing worldwide on a pandemic scale with accompanying syndemic health problems [1,2]
Being closely related to perinatal outcomes, the mother’s obesity can affect maternal and newborn health, posing a major challenge for healthcare providers [5,6,7]. It was thoroughly documented by independent authors that gestational diabetes mellitus (GDM), pregnancy-induced hypertension (PIH), emergency cesarean section, postpartum hemorrhage, wound infections, preterm delivery, large for gestational age (LGA), fetal macrosomia, and intrauterine fetal death (IFD) rates are significantly increased in maternal obesity [8]
To the best of our knowledge, this is the first comparative study addressing the allometric relationships between birth weight and placental weight in GDM-complicated pre-gestational maternal obesity (PGMO) and excessive gestational weight gain (EGWG) in the context of the perinatal outcomes

Summary

Introduction

The prevalence of obesity, defined as a body mass index (BMI) ≥ 30 kg/m2, has been increasing worldwide on a pandemic scale with accompanying syndemic health problems [1,2]. Being closely related to perinatal outcomes, the mother’s obesity can affect maternal and newborn health, posing a major challenge for healthcare providers [5,6,7] It was thoroughly documented by independent authors that gestational diabetes mellitus (GDM), pregnancy-induced hypertension (PIH), emergency cesarean section, postpartum hemorrhage, wound infections, preterm delivery, large for gestational age (LGA), fetal macrosomia, and intrauterine fetal death (IFD) rates are significantly increased in maternal obesity [8]. These obstetrical complications are accompanied by higher neonatal morbidity and mortality [9,10]

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