Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2022 May 19:13:799625.
doi: 10.3389/fendo.2022.799625. eCollection 2022.

Impact Of Prepregnancy Overweight And Obesity On Treatment Modality And Pregnancy Outcome In Women With Gestational Diabetes Mellitus

Tina Linder  1 , Anna Eder  1 , Cécile Monod  2 , Ingo Rosicky  1 , Daniel Eppel  1 , Katharina Redling  2 , Franziska Geissler  2 , Evelyn A Huhn  2 , Irene Hösli  2 , Christian S Göbl  1   2
Affiliations

Impact Of Prepregnancy Overweight And Obesity On Treatment Modality And Pregnancy Outcome In Women With Gestational Diabetes Mellitus

Tina Linder et al. Front Endocrinol (Lausanne). .

Abstract

Background: We aim to evaluate the impact of prepregnancy overweight on treatment modalities of Gestational Diabetes Mellitus (GDM). We assessed the association of increased pregravid Body Mass Index (BMI) with dosing of basal and rapid acting insulin as well as pregnancy outcome.

Methods: We included 509 gestational diabetic women (normal weight: 200, overweight: 157, obese: 152), attending the pregnancy outpatient clinic at the Department of Obstetrics and Gynecology, Medical University of Vienna, in this retrospective study. We used a prospectively compiled database to assess patient characteristics, treatment approaches - particularly maximum doses of basal and rapid acting insulin or metformin - and pregnancy outcome.

Results: Increased BMI was associated with the need of glucose lowering medication (odds ratio (OR): 1.08 for the increase of 1 kg/m² BMI, 95%CI 1.05-1.11, p<0.001). Mothers with pregestational obesity received the highest amount of insulin. Metformin was more often used in patients with obesity who also required higher daily doses. Maternal BMI was associated with increased risk of cesarean section (OR 1.04, 95%CI 1.01-1.07, p<0.001) and delivering large for gestational age offspring (OR 1.09, 95%CI 1.04-1.13, p<0.001). Birthweight percentiles were highest in patients with obesity who required glucose lowering therapy.

Conclusions: Treatment modalities and outcome in GDM pregnancies are closely related to the extent of maternal BMI. Patients with obesity required glucose lowering medication more often and were at higher risk of adverse pregnancy outcomes. It is crucial to further explore the underlying pathophysiologic mechanisms to optimize clinical management and individual treatment approaches.

Keywords: birth weight; gestational diabetes (GDM); obesity; pharmacotherapy; pregnancy outcome.

PubMed Disclaimer

Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Association of pregestational BMI (BMIPG) with the probability of receiving pharmacotherapy (A), for delivering large for gestational age (LGA) offspring (B) and having delivery by cesarean section (C).
Figure 2
Figure 2
Birth weight percentiles in normal weight (GDM-NW), overweight (GDM-OW) or obese patients with GDM (GDM-OB), categorized further into patients who received glucose lowering pharmacotherapy (PT) or diet only. The grey box represents the interquartile range. The median is indicated by a blue line.
See this image and copyright information in PMC

References

    1. Wexler DJ, Powe CE, Barbour LA, Buchanan T, Coustan DR, Corcoy R, et al. . Research Gaps in Gestational Diabetes Mellitus: Executive Summary of a National Institute of Diabetes and Digestive and Kidney Diseases Workshop. Obstetrics Gynecol (2018) 132:496–505. doi: 10.1097/AOG.0000000000002726 - DOI - PMC - PubMed
    1. Black MH, Sacks DA, Xiang AH, Lawrence JM. Clinical Outcomes of Pregnancies Complicated by Mild Gestational Diabetes Mellitus Differ by Combinations of Abnormal Oral Glucose Tolerance Test Values. Diabetes Care (2010) 33:2524–30. doi: 10.2337/dc10-1445 - DOI - PMC - PubMed
    1. Ouzounian JG, Hernandez GD, Korst LM, Montoro MM, Battista LR, Walden CL, et al. . Pre-Pregnancy Weight and Excess Weight Gain Are Risk Factors for Macrosomia in Women With Gestational Diabetes. J Perinatol (2011) 31:717–21. doi: 10.1038/jp.2011.15 - DOI - PubMed
    1. Study Cooperative Research Group. Hyperglycaemia HAPO. And Adverse Pregnancy Outcome (HAPO) Study: Associations With Maternal Body Mass Index. BJOG (2010) 117:575–84. doi: 10.1111/j.1471-0528.2009.02486.x - DOI - PubMed
    1. Powe CE, Allard C, Battista M-C, Doyon M, Bouchard L, Ecker JL, et al. . Heterogeneous Contribution of Insulin Sensitivity and Secretion Defects to Gestational Diabetes Mellitus. Dia Care (2016) 39:1052–5. doi: 10.2337/dc15-2672 - DOI - PMC - PubMed

Publication types

LinkOut - more resources