Pre-pregnancy weight in Swedish women and the risk of gestational diabetes and subsequent type 2 diabetes-a population-based cohort study.

To investigate the values and characteristics of 75 g oral glucose tolerance test (OGTT) in women with different pre-pregnancy body mass index (BMI) and to evaluate the risk of gestational diabetes mellitus (GDM). Medical records of 9803 pregnant women attending the Peking University First Hospital and delivered between July 1, 2011 and December 31, 2013 were retrospectively analyzed. The frequency of adverse pregnancy outcomes across different degrees pre-pregnancy BMI was calculated. We divided participants into 4 groups based on pre-pregnancy BMI, underweight: BMI<18.5 kg/m(2) (1221 cases), normal weight: 18.5-23.9 kg/m(2) (6594 cases), overweight: 24-27.9 kg/m(2) (1549 cases), obesity: ≥28.0 kg/m(2) (439 cases). The diagnosis of GDM was made when any one of the values was met or exceeded in 75 g OGTT. The characteristics of 75 g OGTT and the incidence of GDM were analyzed. (1) The average age, pre-pregnancy weight, height and pre-pregnancy BMI of the participants was (30.5±3.7) years, (57.7±9.0) kg, (162.8±4.9) cm and (21.8±3.2) kg/m(2), respectively. All the values of 75 g OGTT were presented normal distribution. (2) There was statistical difference in the glucose levels among women with different pre-pregnancy BMI. The fasting, 1-hour, 2-hour glucose were (4.55±0.34), (7.31±1.54), (6.38±1.23) mmol/L in underweight women, (4.65±0.38), (7.70±1.59), (6.70±1.27) mmol/L in normal weight women, (4.82±0.47), (8.29±1.67), (7.04±1.29) mmol/L in overweight women and (4.94±0.48), (8.56±1.64), (7.10±1.35) mmol/L in obesity women (P<0.01). (3) The incidence of GDM was 21.76% (2133/9803) in our study. There were 1374 cases (64.42%, 1374/2133) with only one abnormal OGTT value while 759 cases (35.58%, 759/2133) with two or more abnormal values. The incidence of GDM in women with underweight, normal weight, overweight and obesity was 12.53% (153/1221), 19.71% (1300/6594), 32.73% (507/1549) and 39.41% (173/439), respectively (P<0.05). Meanwhile, the incidence of women with two and more abnormal OGTT value in GDM was increased as the pre-pregnancy increasing. The risk of GDM is increased as pre-pregnancy BMI increasing, and the risk of GDM increases significantly in women with pre-pregnancy overweight or obesity.

Objective To investigate the correlation of pre-pregnancy body mass index and pregnancy weight gain on gestational diabetes mellitus(GDM). Methods A retrospective study was conducted in 545 pregnant women who were diagnosed with GDM and 295 non-diabetic pregnant women who were admitted from January to June in 2018.General clinical data such as age, height, pre-pregnancy weight, pre-delivery weight, and 75 g oral glucose tolerance test(OGTT) blood glucose level, family history of diabetes, pregnancy, and parity were collected, the correlation between pre-pregnancy body mass index and pregnancy weight gain and GDM of the two groups were compared. Results There was no significant difference in age and height between GDM group and non-GDM group(P>0.05). The pre-pregnancy body mass index and gestational weight gain of pregnant women in GDM group and non-GDM group were(23.6±1.9) kg/m2, (22.4±2.6) kg/m2, (16.2±5.4) kg, (14.5±4.8) kg, respectively(P<0.001). The pre-pregnancy body mass, OGTT fasting blood glucose, OGTT 1 hour blood glucose and OGTT 2 hours blood glucose in the GDM group were significantly higher than those in the non-GDM group(P<0.001). The number of pregnant women with a family history of diabetes in the GDM group was significantly higher than that in the non-GDM group(P<0.001). The number of pregnant women in the GDM group was higher than that in the non-GDM group(P<0.05). Comparison of GDM incidence among pregnant women in the pre-pregnancy low body mass group, normal body mass group, super-recombinant group and obese group[18.2%(4/22), 61.7%(319/517), 73.5%(214/291) and 80.0%(8/10)]. With the increase of pre-pregnancy body mass index, the incidence of excess weight gain during pregnancy increased[36.4%(8/22), 43.1%(223/517), 73.5%(214/291), and 100%(10/10)], (P<0.001). The GDM incidence in the group without excess weight gain during pregnancy[54.6%(210/385)] was compared with that in the group with excess weight gain[73.6%(335/455)], (P<0.001). The pre-pregnancy body mass index[(23.6±2.2) kg/m2] of the group with excess weight gain during pregnancy was significantly higher than that of the group without excess weight gain during pregnancy[(22.6±2.1) kg/m2], (P<0.001). After adjusting for potential confounding factors such as family history of diabetes, gestational age, gestational age, pre-pregnancy body mass index, and gestational weight gain, it was found that low pre-pregnancy body mass was the protective factor of GDM, while overweight, obesity and overweight during pregnancy were the risk factors of GDM. Conclusion Overweight and obesity pre-pregnancy and excessive weight gain during pregnancy are risk factors for GDM.The increase in weight during pregnancy is associated with higher body mass index before pregnancy. Key words: Pre-pregnancy body mass index; Weight gain; Gestational diabetes; Overweight; Obesity

BackgroundBoth prepregnancy obesity and gestational diabetes mellitus (GDM) have been linked to adverse neonatal birth weight. However, the mediating role of GDM between prepregnancy obesity and neonatal birth weight is unclear.MethodThe cohort study included 17 260 singleton pregnant women and their newborns. Participants' demographic characteristics, disease history, family history of the disease, and the perinatal outcomes were recorded. The association between maternal prepregnancy body mass index (BMI) status and small for gestational age (SGA) or large for gestational age (LGA) neonates was analyzed using logistic regressions, before and after adjusting for covariates and GDM. The potential mediation of GDM on the association between prepregnancy BMI and adverse birth weight was examined.ResultMultivariate logistic regression demonstrated that prepregnancy underweight women were more likely to deliver SGA neonates compared to those who had normal weights, whereas prepregnancy obese pregnant women were more likely to have LGA neonates. The RMediation analyses illustrated that the mediation effect of GDM on the maternal prepregnancy BMI (continuous variable) and the risk of SGA was not significant, whereas the association between prepregnancy BMI and LGA was statistically mediated by GDM (95%CI of a*b: 0.009‐0.051). The Iacobacci (2012) method indicated that the impact of maternal prepregnancy overweight (Zmediation = 2.418, P = .015) and obesity (Zmediation = 2.165, P = .030) on LGA was partially mediated by GDM, with an indirect effect of 16.3% and 13.1%, respectively.ConclusionPrepregnancy BMI was observed to be associated with SGA and LGA. The association of prepregnancy overweight and obesity with LGA was found to be partially mediated by GDM.

Background: Diabetes Mellitus encompasses a group of metabolic diseases characterized by defective insulin activity. Gestational Diabetes Mellitus (GDM). It is defined as glucose intolerance with first onset or recognition during pregnancy. It is estimated that 7% of all pregnancies are complicated by Gestational Diabetes resulting in more than 200,000 cases annually. Gestational Diabetes is associated with perinatal and obstetric complications. WHO has recently developed new criteria for screening for Gestational Diabetes Mellitus? The aim of this study is to determine the relationship between OGTT indices (FPG, 1hr and 2hr post glucose load) and anthropometric indices (prepregnancy weight and Body Mass Index BMI) Subjects And Materials: This was a cross sectional study comprising 132 antenatal clinic attendees. The participants of the study were screened for Gestational diabetes using oral glucose tolerance test (OGTT) after appropriate history had been taken. Results: The prevalence of Gestational Diabetes was found to be 15.2%. The mean age of occurrence was 30.45 4.30. Pre-pregnancy weight and BMI had a strong association with GDM in contrast to those without GDM. There was a positive correlation between OGTT indices and pre-pregnancy weight and BMI implying that the higher the prepregnancy weight and BMI, the higher the OGTT indices. Conclusion: The prevalence of Gestational diabetes is increasing and more likely to be found in older mothers. There is need to screen all pregnant women for Gestational Diabetes Mellitus in Africa. Preventive measures of risk factors for GDM should be advocated such as maintenance of a normal pre-pregnancy body weight and BMI, younger age of child bearing<35years and lower parity.

Gestational diabetes mellitus, pre-pregnancy body mass index and gestational weight gain predicts fetal growth and neonatal outcomes.

BACKGROUND AND OBJECTIVES:We examined the effect of body mass index in early pregnancy on pregnancy outcome since no study in Saudi Arabia has addressed this question.METHODS:This prospective cohort study involved women registered for antenatal care during the first month of pregnancy at primary health care centers in Al-Hassa, Saudi Arabia. Data was collected from records and by direct interview.RESULTS:The study included 787 women. Compared to normal weight women (n=307), overweight (n=187) and obese (n=226) women were at increased risk for pregnancy-induced hypertension (RR=4.9 [95% CI 1.6-11.1] and 6.1 [95% CI 2.1-17.8], respectively), gestational diabetes (RR=4.4 [95% CI 1.2-16.3] and 8.6 [95% CI 2.6-28.8]), preeclamptic toxemia (RR=3.8 [95% CI 1.1-14.6] and 5.9 [95% CI 1.7-20.4]), urinary tract infections (RR=1.4 [95% CI 0.5-3.9] and 3.7 [95% CI 1.7-6.2]), and cesarean delivery (RR=2.0 [95% CI 1.3-3.0] in obese women). Neonates born to obese women had an increased risk for postdate pregnancy (RR=3.7 [95% CI 1.2-11.6]), macrosomia (RR=6.8 [95% CI 1.5-30.7]), low 1-minute Apgar score (RR=1.9 [95% CI 1.1-3.6]), and admission to neonatal care units (RR=2.1 [95% CI 1.2-2.7]). On the other hand, low birth weight was less frequent among obese women (RR=0.5 [95% CI 0.3-0.9]) while the risk was high among underweight women (RR=2.3 [95% CI 1.4-3.8])CONCLUSION:Even with adequate prenatal care, overweight and obesity can adversely affect pregnancy outcomes.

Objective To investigate the incidence of gestational diabetes mellitus (GDM) and perinatal outcome in Beijing in 2013. Methods Fifteen hospitals in Beijing were selected by systematic and cluster sampling method. Clinical data of 15 194 pregnant women who attended prenatal care and delivered in these hospitals between June 20 and November 30, 2013 were collected. And 2 987 pregnant women were diagnosed with GDM (GDM group), and 11 999 had no diabetes (non-GDM group). The incidence of GDM, perinatal outcome and complications in mother and infant were compared between the two groups. Two independent samples t-test and Chi-square test were used for statistical analysis. Results The incidence of GDM in Beijing was 19.7% (2 987/15 194). The average age was much higher in GDM group than in non-GDM group [(29.4±4.5) vs (28.0±4.2) years, t=285.705, P<0.05]. The pre-pregnancy weight was much higher in GDM group than in non-GDM group [(59.5±10.2) vs (56.1±8.6) kg, t=352.565, P<0.05]. The incidence of GDM in pre-pregnancy overweight and obese women [29.9% (664/2 230) and 38.8% (250/664)] was much higher than in normal pre-pregnancy weight and low pre-pregnancy weight women [18.0% (1 777/9 890) and 12.9% (273/2 118)] (χ2=296.843, P<0.05). The incidence of GDM in pluripara was higher than in primipara [21.2% (910/4 298) vs 19.4% (2 077/10 688), χ2=5.813, P<0.05]. The incidence of GDM in grade Ⅲ hospitals was higher than in grade Ⅱ hospitals [21.1% (1 654/7 849) vs 18.7% (1 333/7 173), χ2=13.440, P<0.05]; and the incidence in urban areas was higher than in rural areas [21.3% (2 028/9 521) vs 17.1% (896/5 249), χ2=39.137, P<0.05]. The rate of cesarean section was 47.1% (1 407/2 987) in GDM group, significantly higher than in non-GDM group [39.8% (4 782/11 999)] (χ2=72.204, P<0.05). The incidences of preterm labor [7.3%(217/2 987)], hypertensive disorders [6.3%(185/2 987)], large-for-gestational-age infants [9.2%(275/2 987)], macrosomia [9.5%(283/2 987)] and neonatal ward admission [8.6%(258/2 987)] were all significantly higher in GDM group than in non-GDM group [5.7% (686/11 999), 3.9%(454/11 999), 5.8%(694/11 999), 7.2% (861/11 999), and 6.5% (778/11 999), respectively] (χ2=10.117, 34.371, 79.378, 20.346 and 17.236, respectively, all P<0.05). Conclusions The incidence of GDM is still high in Beijing, and advanced maternal age and pre-pregnancy overweight or obesity are high risk factors for GDM. The rate of preterm labor, hypertensive disorders, and macrosomia in GDM group is higher than in normal fasting glucose group. Systematic obstetric care for GDM should be intensified in Beijing. Key words: Diabetes, gestational; Pregnancy outcome; Incidence; Retrospective studies; Beijing

The aim of this study was to investigate the association between pre-pregnancy body mass index (BMI) and gestational diabetes mellitus (GDM). This prospective study was conducted on 256 pregnant women without diabetes referred for prenatal care in the first trimester of pregnancy to two referral University Hospitals (Shariati and Arash Hospitals) during the years 2012 and 2013. Eligible participants were selected consecutively and were followed until delivery and 6weeks after that. Body weight and fasting plasma glucose were measured in each trimester, and BMI was calculated. Incidence of GDM was recorded, and BMI in this group was compared with those without GDM. Mean age of women was 28.70±5.57years and among them, 78 women (30.5%) developed GDM of which 21 were obese (52.5%), 25 overweight (27.8%), and 32 (25.4%) were normal weight (p=0.004). Pre-pregnancy obesity (OR 2.74, 95% CI 1.28-5.88, p=0.009), family history of diabetes (OR 2.01, 95% CI 1.13-3.56, p=0.016), and maternal age more than 30years (OR 2.20, 95% CI 1.25-3.88, p=0.006) were three independent predictors for GDM, and pre-pregnancy obesity was the most potent predictor of GDM. Women with high BMI and obesity have a significantly higher risk for developing GDM. Pre-pregnancy obesity, family history of diabetes, and age more than 30years are three independent risk factors for GDM.

BackgroundMaternal gestational smoking, diabetes, alcohol drinking, and pre-pregnancy obesity are thought to increase the risk of cryptorchidism in newborn males, but the evidence is inconsistent.MethodWe conducted a systematic review and meta-analysis of studies on the association between maternal gestational smoking, diabetes, alcohol drinking, and pre-pregnancy obesity and the risk of cryptorchidism. Articles were retrieved by searching PubMed and ScienceDirect, and the meta-analysis was conducted using Stata/SE 12.0 software. Sensitivity analysis was used to evaluate the influence of confounding variables.ResultsWe selected 32 articles, including 12 case—control, five nested case—control, and 15 cohort studies. The meta-analysis showed that maternal smoking (OR = 1.17, 95% CI: 1.11–1.23) or diabetes (OR = 1.21, 95%CI: 1.00–1.46) during pregnancy were associated with increased risk of cryptorchidism. Overall, the association between maternal alcohol drinking (OR = 0.97, 95% CI: 0.87–1.07), pre-pregnancy body mass index (OR = 1.02, 95% CI: 0.95–1.09) and risk of cryptorchidism were not statistically significant. Additional analysis showed reduced risk (OR = 0.89, 95% CI: 0.82–0.96) of cryptorchidism with moderate alcohol drinking during pregnancy. No dose—response relationship was observed for increments in body mass index in the risk of cryptorchidism. Sensitivity analysis revealed an unstable result for the association between maternal diabetes, alcohol drinking and cryptorchidism. Moderate heterogeneity was detected in studies of the effect of maternal alcohol drinking and diabetes. No publication bias was detected.ConclusionMaternal gestational smoking, but not maternal pre-pregnancy overweight or obesity, was associated with increased cryptorchidism risk in the offspring. Moderate alcohol drinking may reduce the risk of cryptorchidism while gestational diabetes may be a risk factor, but further studies are needed to verify this.

Impact of prepregnancy body mass index on pregnancy outcomes, incidence of urinary incontinence and quality of life during pregnancy - An observational cohort study

Objective:The first objective of this study was to investigate the relationship between gestational diabetes mellitus (GDM) and gestational weight gain (WG), waist circumference (WC), prepregnancy, and gestational body mass index (BMI). The second aim of our study was to assess the ability of WG, WC, prepregnancy, and gestational BMI with special reference to their cut-off points on predicting the risk of GDM in pregnant women in Turkey.Materials and Methods:A total of 261 women who underwent screening for GDM with the 75-g glucose tolerance test (GTT) between 24th and 28th gestational weeks were included. According to the 75-g oral GTT results, women were classified into two groups: the GDM group and non-GDM group. The data collected included age, parity, plasma glucose level for fasting, 1- and 2-h tests, WC, prepregnancy and gestational BMI, prepregnancy weight, WG during pregnancy, gestational age at birth, and birth weight.Results:WC at 20-24 weeks of gestation, prepregnancy BMI, and gestational BMI had a predictive capacity for GDM. According to our results, optimal cut-off points for the best predictive value of GDM were WC of 100 cm with a sensitivity of 84% and specificity of 70%, prepregnancy BMI of 25 kg/m2 with a sensitivity of 81.8% and specificity of 76%, and gestational BMI of 28.3 kg/m2 with a sensitivity of 75% and specificity of 77.4%.Conclusion:The measurement of prepregnancy BMI, gestational BMI, and WC may be useful in predicting the risk of GDM. Pregnant women with increased prepregnancy BMI, gestational BMI, and WC measurements may be susceptible to the development of GDM.

BackgroundThe association between maternal obesity and preterm birth remains controversial and inconclusive, and the effects of gestational diabetes mellitus (GDM) and preeclampsia (PE) on the relationship between obesity and preterm birth have not been studied. We aimed to clarify the relationship between prepregnancy body mass index (BMI) and the phenotypes of preterm birth and evaluate the mediation effects of GDM and PE on the relationship between prepregnancy BMI and preterm birth.MethodsWe conducted a prospective cohort study of 43,056 women with live singleton births from 2017 through 2019. According to the WHO International Classification, BMI was classified as underweight (BMI < 18.5 kg/m2), normal weight (BMI 18.5–25 kg/m2), overweight (BMI 25–30 kg/m2) and obese (BMI ≥30 kg/m2). Preterm birth was defined as gestational age less than 37 weeks (extremely, < 28 weeks; very, 28–31 weeks; and moderately, 32–36 weeks). The clinical phenotypes of preterm birth included spontaneous preterm birth (spontaneous preterm labor and premature rupture of the membranes) and medically indicated preterm birth. We further analyzed preterm births with GDM or PE. Multivariable logistic regression analysis and causal mediation analysis were performed.ResultsRisks of extremely, very, and moderately preterm birth increased with BMI, and the highest risk was observed for obese women with extremely preterm birth (OR 3.43, 95% CI 1.07–10.97). Maternal obesity was significantly associated with spontaneous preterm labor (OR 1.98; 95% CI 1.13–3.47), premature rupture of the membranes (OR 2.04; 95% CI 1.08–3.86) and medically indicated preterm birth (OR 2.05; 95% CI 1.25–3.37). GDM and PE mediated 13.41 and 36.66% of the effect of obesity on preterm birth, respectively. GDM mediated 32.80% of the effect of obesity on spontaneous preterm labor and PE mediated 64.31% of the effect of obesity on medically indicated preterm birth.ConclusionsMaternal prepregnancy obesity was associated with all phenotypes of preterm birth, and the highest risks were extremely preterm birth and medically indicated preterm birth. GDM and PE partially mediated the association between obesity and preterm birth.

Tyrimo tikslas. Nustatyti nutukusių nėščiųjų, sergančių gestaciniu diabetu (GD), nėštumo, gimdymo komplikacijas ir vaisiaus būklę bei svorį. Tyrimo metodai. Retrospektyvinis tyrimas, kuriam atrinkta 2019 m. Lietuvos sveikatos mokslų universiteto ligoninės Kauno klinikų Akušerijos ir ginekologijos klinikoje gimdžiusi ir GD sirgusi 581 moteris, jos suskirstytos į dvi grupes: pirmoje – nutukusios moterys (n=202); antroje – iki nėštumo normalią kūno masę turėjusios moterys (n=379). Duomenys analizuoti „SPSS/w26.0“ ir „MS Excel 2016“ kompiuterine programa. Rezultatai. Gestaciniu diabetu sergančių nutukusių moterų glikemija nevalgius didesnė nei normalios kūno masės moterų (5,67 (5–7; 5,78) ir 5,49 (5–8; 5,56), p&lt;0,001), sergančių A2 tipo GD glikemija nevalgius didesnė nutukusių moterų nei nenutukusių (5,69 (5–7; 5,86) ir 5,48 (5–7; 5,58), p=0,006). GTM 0 min. glikemija gestaciniu diabetu sergančioms nutukusioms moterims didesnė nei nenutukusioms (5,45 (3–8; 5,52) ir 5,20 (3–8; 5,19), p&lt;0,001). Nutukusios nėščiosios dažniau nei normalios kūno masės nėščiosios sirgo pirmine hipertenzija (18,8 proc. ir 2,9 proc., p&lt;0,001), nėščiųjų hipertenzinėmis būklėmis (47,5 proc. ir 19 proc., p&lt;0,001) ir nėščiųjų cholestaze (6,4 proc. ir 1,6 proc., p=0,002). Taip pat joms dažniau nustatytas polihidramnionas (19,4 proc. ir 5,5 proc., p&lt;0,001), gimdymas dažniau buvo sužadintas (75,4 proc. ir 24,6 proc.; p&lt;0,001), dažniau atlikta cezario pjūvio operacija (CPO) (24,8 proc. ir 16,4 proc., p=0,015), skubi dažniau nei planinė (66 proc. ir 41,9 proc., p=0,011). Gimdymo metu dažniau diagnozuota distocija (9,4 proc. ir 3,4 proc., p=0,003) ir nestabili vaisiaus būklė (4 proc. ir 1,1 proc., p=0,019). Nutukusių gimdyvių naujagimiai dažniau makrosomiški (22,8 proc. ir 10 proc., p&lt;0,001), jų Apgar balai po 1 min. (9 (2–10; 8,9) ir 9 (3–10; 9,06), p=0,024) ir po 5 min. (10 (6–10; 9,52) ir 10 (6–10; 9,66), p=0,024) buvo reikšmingai žemesni nei normalios kūno masės gimdyvių. Išvados. Nutukusios nėščiosios, sergančios gestaciniu diabetu, patiria daugiau nėštumo bei gimdymo komplikacijų nei nėščiosios, sergančios tik gestaciniu diabetu, bet neturinčios nutukimo.

BackgroundMetabolic diseases during pregnancy result in negative consequences for mothers. Pre-pregnancy body mass index (BMI) and late-pregnancy glycated-hemoglobin (HbA1c) are most important factors independently affecting the risk of gestational diabetes mellitus (GDM). However how both affect the combined risk of other metabolic diseases in women with GDM is unclear. The study aims to investigate the influence of pre-pregnancy BMI and pregnancy glycemic levels on other gestational metabolic diseases in women with GDM.MethodsPregnancies with GDM from January 2015 to December 2018 in the Xi’an longitudinal mother-child cohort study (XAMC) were retrospectively enrolled. Those without other metabolic diseases by the time of oral glucose tolerance test (OGTT) detection were finally recruited and divided into four groups by pre-pregnancy BMI (Underweight <18.5kg/m2; Normal weight 18.5-23.9 kg/m2; Overweight 24.0-27.9 kg/m2; Obesity ≥28.0 kg/m2, respectively) or two groups by HbA1c in late pregnancy (normal HbA1c<5.7%; high HbA1c≥5.7%). Multivariate logistic regression analysis was used to identify risk factors. Interaction between pre-pregnancy BMI (reference group 18.5-23.9 kg/m2) and HbA1c (reference group <5.7%) was determined using strata-specific analysis.ResultsA total of 8928 subjects with GDM were included, 16.2% of which had a composite of metabolic diseases. The pre-pregnancy overweight and obesity, compared with normal BMI, were linked to the elevated risk of the composite of metabolic diseases, particularly pre-eclampsia (both P <0.001) and gestational hypertension (both P <0.001). Meanwhile, patients with high HbA1c had an obvious higher risk of pre-eclampsia (P< 0.001) and gestational hypertension (P= 0.005) compared to those with normal HbA1c. In addition, there were significant interactions between pre-pregnancy BMI and HbA1c (P< 0.001). The OR of pre-pregnancy BMI≥ 28 kg/m2 and HbA1c≥ 5.7% was 4.46 (95% CI: 2.85, 6.99; P< 0.001). The risk of other metabolic diseases, except for pre-eclampsia (P= 0.003), was comparable between the two groups of patients with different HbA1c levels at normal pre-pregnancy BMI group. However, that was remarkably elevated in obese patients (P= 0.004), particularly the risk of gestational hypertension (P= 0.004).ConclusionPre-pregnancy overweight/obesity and late-pregnancy high HbA1c increased the risk of other gestational metabolic diseases of women with GDM. Monitoring and controlling late-pregnancy HbA1c was effective in reducing metabolic diseases, particularly in those who were overweight/obese before conception.

BackgroundWorldwide there has been a dramatic increase in the prevalence of overweight and obesity in women of childbearing age. Growing evidence suggests that maternal overweight and obesity is associated with poor maternal and perinatal outcomes. This study evaluated the impact of maternal pre-pregnancy overweight and obesity on pregnancy, labour and delivery outcomes in a cohort of women with term, singleton pregnancies cared for by family physicians in community based practices.MethodsThis study is a secondary analysis of the All Our Babies Cohort, a prospective, community-based pregnancy cohort in Calgary, Alberta. Maternal self-reported data on height and pre-pregnancy weight from term, singleton, cephalic pregnancies (n = 1996) were linked to clinical data on pregnancy and birth events retrieved from electronic health records. Descriptive and bivariate regression analysis were used to compare pregnancy and birth outcomes between women categorized as normal weight, overweight and obese based on the pre-pregnancy BMI. Multinomial regression analysis stratified by type of labour onset examined the association between pre-pregnancy BMI and mode of delivery controlling for maternal age, pre-existent health conditions, parity, fertility treatments, history of C-section and pregnancy complications.ResultsThe cohort consisted of 65.8% normal weight, 23.6% overweight and 10.6% obese women. Women with increased pre-pregnancy BMI were more likely to develop pregnancy complications such as preeclampsia (OR 3.5, CI 2.0-4.6 for overweight; OR 5.3, CI 3.3-8.5 for obese) and gestational diabetes (OR 3.0, CI 1.8-5.0 for overweight; OR 6.5, CI 3.7-11.2 for obese) than normal weight women. Spontaneous onset of labour was recorded in 71.2% of women with normal pre-pregnancy BMI, whereas 39.3% of overweight and 49% of obese women had their labour induced. For women with spontaneous labour, pre-pregnancy BMI was not a significant risk factor for mode of delivery, controlling for covariates. Among women with induced labor, obesity was a significant risk factor for delivery by C-section (adjusted OR 2.2; CI 1.2-4.1).ConclusionsEven among women with term, singleton pregnancies obtaining prenatal care in community-based settings, obese women who undergo labour induction are at increased risk of obstetrical interventions at delivery. These findings highlight the importance of tailored maternal care in pregnancy and at delivery of pregnant women with increased BMI in order to improve the outcomes and wellbeing of these women and their children.Electronic supplementary materialThe online version of this article (doi:10.1186/s12884-014-0422-y) contains supplementary material, which is available to authorized users.