3
Revista Matronas

Revista Matronas

DICIEMBRE 2015 N° 3 Volumen 3

Effects of high maternal body mass index and excessive weight gain during pregnancy on clinical outcomes in women with gestational diabetes

Section: Originales

Authors

1 María Elena Corral Segade, 2 María del Carmen Amezcua Prieto, 3 María José Pacheco Adamuz, 4 Raquel Fernández Heredia, 5 Aranzazu Abril Bernal, 6 Laura Hernández Pérez

Position

1 Matrona. Hospital La Inmaculada (Huercal- Ovéra, Almería).2 Profesora ayudante doctora. Departamento de Medicina Preventiva y Salud Pública. Universidad de Granada (Granada).3 Matrona. Complejo Hospitalario de Jaén (Jaén).4 Matrona. Hospital  Nuestra Señora de la Salud (Granada). 5 Matrona. Hospital de Manises (Manises, Valencia).6 Enfermera. Centro de Salud de Cambre (A Coruña).

Contact email: ecesegade@gmail.com

Abstract

Introduction/purpose: the number of obese women with gestational diabetes mellitus (GDM) has increased worldwide. This is a high risk population during pregnancy. However, at present, specific effects of obesity and excessive weight gain during pregnancy in such population have not been clearly defined.
We aimed to investigate the impact of high body mass index (BMI) (including overweight and obesity) and excessive weight gain on obstetrical, neonatal, and postnatal outcomes in pregnancies resulting in GDM.
Methods: a retrospective cohort study was carried out in women with full-term pregnancies and GDM receiving therapy and delivering live-born neonates in Hospital de Jaén in 2012.    Based on their pre-gestational BMI   (kg/m2) participants were classified into: normal weight (BMI 18.5-24.9), overweight (BMI 25- 29.9), and obesity (BMI ≥ 30). Similarly, total weight gain during pregnancy was grouped into "normal" and "excessive", based on guidelines on weight gain by the Institute of Medicine. Data analysis was performed with chi-squared test and multivariable regression, with "normal BMI" and "normal weight gain" being taken as reference groups.  
Results: 123 women fully met inclusion criteria. Proportions of women with normal weight, overweight, and obesity were 31.7% (39 out of 123, BMI: 22.5 ± 1.2), 30.9% (38 out of 123, BMI: 26.7 ± 1.5), 37.4% (46 out of 123, BMI: 35.8 ± 4.6), respectively. No difference associated to age, gestation weeks (GW) until birth, glycated hemoglobin (HbA1c) or neonatal weight was found, except for a lower adherence to diet in obese and overweight women
(p < 0.05). Mean weight gain was higher in normal weight women (10.6 ± 5.1) than in women with overweight or obesity (8.5 ± 5.9; 5.8 ± 5.9). On the contrary, overweight and obese women were more likely to exceed recommendations by Institute of Medicine (p < 0.05). Pregnancy outcomes in overweight women did not differ from those in normal weight women. However, obese women showed a higher risk for pre-eclampsia (odds ratio [OR] 17.90, 95% confidence interval [CI], 2.24-143.27), postpartum impaired glucose tolerance (OR 3.29, 95% CI, 1.07- 10.12) and a higher risk of neonatal hospital admission (OR 7.63, 95% CI, 1.15 - 50.49). Women with a weight gain exceeding recommendations by Institute of Medicine showed a higher risk for instrumental delivery (OR 3.56, 95% CI, 1.05 - 12.03) and impaired glucose tolerance (OR 19.48, 95% CI, 1.62 - 234.03) than women with a normal weight gain.
Conclusions: our findings suggest that pregnant women with overweight and GDM do not show a higher risk for adverse outcomes compared to women with a normal weight and no GDM. However, newborns delivered by women with obesity and GDM are more likely to be admitted to a hospital nursery room. Finally, excessive weight gain during pregnancy in women con GDM and overweight/obesity results in a higher incidence of impaired glucose tolerance.

Keywords:

Diabetes Mellitus; overweight; Obesity; weight gain and pregnancy

Versión en Español

Título:

Efectos de un elevado índice de masa corporal materno y de una ganancia poderal excesiva durante la gestación en los resultados de embarazos complicados con diabetes gestacional

Artículo completo no disponible en este idioma / Full article is not available in this language

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