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Pre-pregnancy body mass index and the risk of adverse outcome in type 1 diabetic pregnancies: a population-based cohort study
Department of Clinical Science, Intervention and Technology, Karolinska Institute, Stockholm, Sweden.
Division of Women’s Health, NIHR Biomedical Research Centre, Kings Health’s Partners, King’s College London, London, UK.
Department of Woman and Child Health, Uppsala University, Uppsala, Sweden.
Department of Clinical Science, Intervention and Technology, Karolinska Institute, Stockholm, Sweden.
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2012 (English)In: BMJ Open, ISSN 2044-6055, E-ISSN 2044-6055, Vol. 2, no 1, article id e000601Article in journal (Refereed) Published
Abstract [en]

Objective: To assess the risk of perinatal complications in overweight and obese women with and without type 1 diabetes (T1DM).

Design: Prospective population-based cohort study.

Setting: This study was based on data from the Swedish Medical Birth Registry from 1998 to 2007.

Participants: 3457 T1DM and 764 498 non-diabetic pregnancies were included. T1DM was identified based on ICD code O24.0. Mothers were categorised according to pre-pregnancy body mass index (BMI: weight in kilograms per height in square metres) as normal weight (BMI 18.5-24.9), overweight (BMI 25-29.9) or obese (BMI ≥30). Only women with singleton pregnancies and with data on BMI were included. PRIMARY/SECONDARY OUTCOMES: The primary outcome was large for gestational age (LGA: birth weight >90th percentile) infants. Secondary outcomes were major malformations, pre-eclampsia (PE), preterm delivery, perinatal mortality, delivery by Caesarean section and neonatal overweight. Logistic regression analysis was performed with normal weight non-diabetic women as the reference category and also within the diabetic cohort with normal weight type 1 diabetic women as the reference. The ORs were adjusted for ethnicity, maternal age, height, parity, smoking and chronic hypertension.

Results: 35% of women with T1DM were overweight and 18% were obese, as compared with 26% and 11%, respectively, in non-diabetic pregnancies. The incidences of adverse outcome increased with greater BMI category. As compared with non-diabetic normal weight women, the adjusted OR for obese T1DM for LGA was 13.26 (95% CI 11.27 to 15.59), major malformations 4.11 (95% CI 2.99 to 5.65) and PE 14.19 (95% CI 11.50 to 17.50). T1DM was a significant effect modifier of the association between BMI and LGA, major malformations and PE (p<0.001).

Conclusion: High pre-pregnancy BMI is an important risk factor for adverse outcome in type 1 diabetic pregnancies. The combined effect of both T1DM and overweight or obesity constitutes the greatest risk. It seems prudent to strive towards normal pre-pregnancy BMI in women with T1DM.

Place, publisher, year, edition, pages
London, United Kingdom: BMJ Publishing Group Ltd, 2012. Vol. 2, no 1, article id e000601
National Category
Surgery
Research subject
Obstetrics and Gynaecology
Identifiers
URN: urn:nbn:se:oru:diva-27159DOI: 10.1136/bmjopen-2011-000601ISI: 000315037200058PubMedID: 22334581Scopus ID: 2-s2.0-84857835821OAI: oai:DiVA.org:oru-27159DiVA, id: diva2:601912
Available from: 2013-01-30 Created: 2013-01-30 Last updated: 2017-12-06Bibliographically approved

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