Clinical consequences of gestational diabetes mellitus and maternal obesity as defined by asian BMI thresholds in Viet Nam: a prospective, hospital-based, cohort study

Abstract

Background: Gestational Diabetes Mellitus (GDM) is common in South East Asia, occurring at relatively lean Body Mass Index (BMI). Outside pregnancy, cardiometabolic risks increase at lower BMI in Asian populations, justifying Asian-specific thresholds for overweight and obesity. We aimed to explore the effects of GDM and obesity on perinatal outcomes using a WHO expert consultation-recommended Asian-specific definition of obesity.

Methods: This is a secondary analysis of a prospective, hospital-based, cohort study in Ho Chi Minh City. Participants were recruited from antenatal clinics between 19^{+ 0}-22^{+ 6} weeks gestation and followed until delivery. GDM screening occurred between 24 and 28 weeks using WHO criteria. Obesity was defined as BMI ≥ 27.5 kg/m², based on weight and height at recruitment. We assessed associations between GDM (singly, and in combination with obesity) and perinatal outcomes. Participants were categorised into four groups: no GDM/non-obese (reference group), GDM/non-obese, no GDM/obese and GDM/obese. Outcomes included primary caesarean section, hypertensive disorders of pregnancy (HDP), large-for-gestational-age (LGA), birth weight, preterm birth, and composite adverse neonatal outcome. Logistic and linear regressions were performed with adjustment for differences in baseline characteristics.

Results: Among 4,970 participants, 908 (18%) developed GDM. Compared to women without GDM, GDM increased risks for preterm birth (OR: 1.40, 95% CI: 1.09-1.78), higher birthweight (birthweight z-score 0.16 versus 0.09, p = 0.027), and LGA (OR 1.14, 0.89-1.46). GDM without obesity was associated with an increased risk of preterm birth (OR 1.35, 1.04-1.74). Obese women without GDM were more likely to deliver by caesarean section and have an LGA baby (1.80, 1.33-2.44 and 2.75, 1.88-4.03). The highest risks were observed amongst women with both GDM and obesity: caesarean Sect. (2.43, 1.49-3.96), LGA (3.36, 1.94-5.80) and preterm birth (2.42, 1.32-4.44).

Conclusions: GDM was associated with an increased risk of preterm birth and larger newborn size. Using an Asian-specific definition of obesity, we demonstrate obese women with GDM are at the highest risk of adverse outcomes. Using a BMI threshold in pregnancy of 27.5 kg/m² (between 19 and 22 weeks gestation) for Asian women can identify women who will benefit from intensified diabetes, nutritional, and obstetric care. This has relevance for obstetric service delivery within Asia, and other health systems providing pregnancy care for Asian expatriate women.

Keywords: Asian BMI threshold; Gestational diabetes mellitus; Large for gestational age; Maternal obesity; Perinatal outcomes; Preterm birth; Primary C-section; South East Asian.

Fig. 1

Flow Diagram of Study Participants. † Gestational Diabetes Mellitus; flow diagram showing participant recruitment from enrolment to corresponding numbers of women who were and were not diagnosed with gestational diabetes. Reasons and number of exclusions are stated accordingly

Fig. 2

Newborn Weight by Mothers with and without Gestational Diabetes Mellitus. GDM (Gestational Diabetes Mellitus); box and whisker plot showing newborn weight (in grams) and newborn weight z-score (adjusted for gestational age at birth and newborn sex) born from mothers with and without GDM

Fig. 3

Relationship between Maternal Gestational Diabetes Mellitus, Obesity (defined: BMI ≥ 27.5 kg/m²), and Perinatal Outcomes. C-section adjusted for age and socioeconomic status; Large for Gestational Age adjusted for age, socioeconomic status, parity; Preterm Birth adjusted for age, socioeconomic status, parity, history of preterm birth

Fig. 4

Comparison of studies examining outcomes in pregnancies affected by GDm in Viet Nam