PEDEGO Research Unit (Research Unit for Pediatrics, Dermatology, Clinical Genetics, Obstetrics and Gynecology), Medical Research Center Oulu (MRC Oulu), Oulu University Hospital and University of Oulu, Oulu, Finland.
THL National Institute for Health and Welfare, Department of Chronic Disease Prevention, Helsinki and Oulu, Finland.
PLoS One. 2019 Aug 29;14(8):e0221549. doi: 10.1371/journal.pone.0221549. eCollection 2019.
Gestational diabetes (GDM) is often accompanied by maternal overweight. Our aim was to evaluate the separate and concomitant effects of GDM and maternal overweight/obesity on perinatal outcomes.
We used the Finnish Medical Birth Register to identify all 24,577 women with a singleton pregnancy who delivered in 2009 in Finland and underwent an oral glucose tolerance test (OGTT). Women were divided into groups according to the result of OGTT (GDM/no GDM) and pre-pregnancy body mass index (BMI): normal weight (≤24.9 kg/m2), overweight (25.0-29.9 kg/m2), and obese (≥30.0 kg/m2). Primary outcomes included macrosomia, caesarean delivery, and treatment at neonatal ward. Normal weight women without GDM constituted the reference group.
Compared to reference group, overweight or obese women without GDM had an increased risk of macrosomia [odds ratio adjusted for age, parity, smoking and socio-economic status (aOR)1.18 (95% CI 1.09-1.28) and 1.50 (95% CI 1.19-1.88)], and caesarean delivery [aORs 1.17 (95% CI 1.07-1.28) and 1.52 (95% CI 1.37-1.69)], respectively. In normal weight GDM women the risk of macrosomia [aOR 1.17 (95% CI 0.85-1.62)] and caesarean delivery [aOR 1.10 (95% CI 0.96-1.27)] was not significantly increased as compared to normal weight women without GDM. GDM increased the risk of treatment at neonatal ward in all BMI categories and maternal obesity without GDM was also a risk factor for treatment at neonatal ward. Interaction p values between BMI and GDM on these outcomes were <0.001.
Maternal overweight and obesity without GDM increased the risk of macrosomia and caesarean delivery when compared to the reference group. These risks were amplified when overweight/obesity was accompanied by GDM. Obesity without GDM was a risk factor for treatment at neonatal ward; GDM increased this risk in all BMI categories. Our results suggest that especially maternal obesity should be considered as a risk factor for adverse pregnancy outcomes and GDM further amplifies this risk.
妊娠期糖尿病（GDM）常伴有母体超重。我们的目的是评估 GDM 和母体超重/肥胖对围产期结局的单独和共同影响。
我们使用芬兰医疗出生登记处的数据，确定了所有在芬兰于 2009 年分娩的、进行过口服葡萄糖耐量试验（OGTT）的 24577 名单胎妊娠妇女，并根据 OGTT 结果（GDM/无 GDM）和孕前体重指数（BMI）将妇女分为几组：正常体重（≤24.9kg/m2）、超重（25.0-29.9kg/m2）和肥胖（≥30.0kg/m2）。主要结局包括巨大儿、剖宫产和新生儿病房治疗。无 GDM 的正常体重妇女构成参考组。
与参考组相比，无 GDM 的超重或肥胖妇女巨大儿的风险增加[年龄、产次、吸烟和社会经济状况调整后的比值比（aOR）1.18（95%可信区间 1.09-1.28）和 1.50（95%可信区间 1.19-1.88）]和剖宫产的风险增加[aORs 1.17（95%可信区间 1.07-1.28）和 1.52（95%可信区间 1.37-1.69）]。正常体重 GDM 妇女的巨大儿风险[aOR 1.17（95%可信区间 0.85-1.62）]和剖宫产风险[aOR 1.10（95%可信区间 0.96-1.27）]与无 GDM 的正常体重妇女相比无显著增加。GDM 增加了所有 BMI 类别中新生儿病房治疗的风险，而无 GDM 的母体肥胖也是新生儿病房治疗的一个危险因素。这些结局的 BMI 和 GDM 之间的交互 p 值<0.001。
与参考组相比，无 GDM 的母体超重和肥胖增加了巨大儿和剖宫产的风险。当超重/肥胖伴有 GDM 时，这些风险会放大。无 GDM 的肥胖是新生儿病房治疗的一个危险因素；GDM 增加了所有 BMI 类别的这种风险。我们的研究结果表明，尤其是母体肥胖应被视为不良妊娠结局的危险因素，而 GDM 进一步放大了这种风险。
