Nuffield Department of Women's & Reproductive Health, University of Oxford, Oxford, UK.
The Oxford University Clinical Research Unit (OUCRU), Ho Chi Minh City, Viet Nam.
BMC Pregnancy Childbirth. 2022 Mar 9;22(1):195. doi: 10.1186/s12884-022-04533-1.
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.
This is a secondary analysis of a prospective, hospital-based, cohort study in Ho Chi Minh City. Participants were recruited from antenatal clinics between 19-22 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/m, 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.
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).
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/m (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.
妊娠糖尿病（GDM）在东南亚很常见，发生在相对偏瘦的身体质量指数（BMI）。在怀孕之外，亚洲人群的心血管代谢风险在较低的 BMI 下增加，这证明了亚洲特有的超重和肥胖标准是合理的。我们旨在使用世界卫生组织专家咨询推荐的亚洲特有的肥胖定义，探讨 GDM 和肥胖对围产期结局的影响。
这是胡志明市一项前瞻性、基于医院的队列研究的二次分析。参与者在妊娠 19-22 周时从产前诊所招募，并一直随访至分娩。GDM 筛查使用世界卫生组织标准在 24-28 周进行。根据招募时的体重和身高，将肥胖定义为 BMI≥27.5kg/m²。我们评估了 GDM（单独和与肥胖相结合）与围产期结局之间的关系。参与者分为四组：无 GDM/非肥胖（参考组）、GDM/非肥胖、无 GDM/肥胖和 GDM/肥胖。结局包括主要剖宫产、妊娠高血压疾病（HDP）、巨大儿（LGA）、出生体重、早产和复合不良新生儿结局。使用逻辑和线性回归，根据基线特征的差异进行调整。
在 4970 名参与者中，908 名（18%）发生 GDM。与无 GDM 的女性相比，GDM 增加了早产（OR：1.40，95%CI：1.09-1.78）、更高的出生体重（出生体重 z 评分 0.16 与 0.09，p=0.027）和 LGA（OR 1.14，0.89-1.46）的风险。无肥胖的 GDM 与早产风险增加相关（OR 1.35，1.04-1.74）。无 GDM 的肥胖女性更有可能通过剖宫产分娩，并且婴儿为 LGA（1.80，1.33-2.44 和 2.75，1.88-4.03）。在同时患有 GDM 和肥胖的女性中，风险最高：剖宫产（2.43，1.49-3.96）、LGA（3.36，1.94-5.80）和早产（2.42，1.32-4.44）。
GDM 与早产风险增加和新生儿体型增大有关。使用亚洲特有的肥胖定义，我们表明患有 GDM 的肥胖女性面临最高的不良结局风险。在妊娠 19-22 周时使用 27.5kg/m²的 BMI 阈值（亚洲女性）可以识别出将受益于强化糖尿病、营养和产科护理的女性。这对亚洲的产科服务提供具有重要意义，也对为亚洲外籍女性提供妊娠护理的其他卫生系统具有重要意义。
