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Overweight and obesity: a remaining problem in women treated for severe gestational diabetes
Örebro University, School of Medical Sciences. Department of Obstetrics and Gynaecology.
Örebro University, School of Health Sciences. DeDepartment of Obstetrics and Gynaecology, School of Health and Medical Sciences, Örebro University, Örebro, Sweden; Department of Women’s and Children’s Health, Uppsala University, Uppsala, Sweden.
Department of Clinical Epidemiology, Karolinska Institutet, Stockholm, Sweden.
Örebro University, School of Medical Sciences. Department of Obstetrics and Gynaecology.ORCID iD: 0000-0002-2691-7525
2016 (English)In: Diabetic Medicine, ISSN 0742-3071, E-ISSN 1464-5491, Vol. 33, no 8, p. 1045-1051Article in journal (Refereed) Published
Abstract [en]

Aim: To analyse the impact of overweight and obesity on the risk of adverse maternal outcomes and fetal macrosomia in pregnancies of women treated for severe gestational diabetes.

Methods This was a population-based cohort study including all singleton pregnancies in Sweden without pre-existing diabetes in the period 1998-2012. Only mothers with an early- pregnancy BMI of ≥18.5 kg/m² were included. Logistic regression analysis was used to determine odds ratios with 95% CIs for maternal outcomes and fetal growth. Analyses were stratified by maternal gestational diabetes/non-gestational diabetes to investigate the impact of overweight/obesity in each group.

Results: Of 1 249 908 singleton births, 13 057 were diagnosed with gestational diabetes (1.0%). Overweight/obesity had the same impact on the risks of caesarean section and fetal macrosomia in pregnancies with and without gestational diabetes, but the impact of maternal BMI on the risk of preeclampsia was less pronounced in women with gestational diabetes. Normal-weight women with gestational diabetes had an increased risk of caesarean section [odds ratio 1.26 (95% CI 1.16-1.37)], preeclampsia [odds ratio 2.03 (95% CI 1.71-2.41)] and large-for-gestational-age infants [odds ratio 2.25 (95% CI 2.06-2.46)]. Risks were similar in the overweight group without gestational diabetes, caesarean section [odds ratio 1.34 (1.33-1.36)], preeclampsia odds ratio [1.76 (95% CI 1.72-1.81)], large-for-gestational-age [odds ratio 1.76 (95% CI 1.74-1.79)].

Conclusions: Maternal overweight and obesity is associated with similar increments in risks of adverse maternal outcomes and delivery of large-for-gestational-age infants in women with and without gestational diabetes. Obese women with gestational diabetes are defined as a high-risk group. Normal-weight women with gestational diabetes have similar risks of adverse outcomes to overweight women without gestational diabetes.

Place, publisher, year, edition, pages
Hoboken, USA: Wiley-Blackwell Publishing Inc., 2016. Vol. 33, no 8, p. 1045-1051
National Category
Endocrinology and Diabetes
Identifiers
URN: urn:nbn:se:oru:diva-50308DOI: 10.1111/dme.13156ISI: 000379936000005PubMedID: 27172974Scopus ID: 2-s2.0-84978818273OAI: oai:DiVA.org:oru-50308DiVA, id: diva2:931342
Note

Funding Agency:

Research Committee of Örebro County Council

Available from: 2016-05-27 Created: 2016-05-16 Last updated: 2018-11-19Bibliographically approved
In thesis
1. Gestational diabetes, obesity and pregnancy outcomes in Sweden
Open this publication in new window or tab >>Gestational diabetes, obesity and pregnancy outcomes in Sweden
2018 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

The overall aim of the thesis was to evaluate maternal and fetal outcomes in relation to gestational diabetes mellitus (GDM) in both a shortand long term perspective.

Study I was a population based cohort study including 1 249 908 pregnancies during the years 1998-2012. Maternal outcomes and fetal size were studied in relation to BMI and presence/absence of GDM. The conclusions were that maternal overweight and obesity are associated with similar increments in risks of adverse maternal outcomes and delivery of large-for-gestational-age infants in women with and without gestational diabetes. Study II was a population based cohort study using the same cohort as in study I. Fetal outcomes were studied in relation to GDM-status and BMI. Interaction between GDM and BMI for the outcomes was also analyzed. Conclusions were that excess maternal weight and GDM were, both major independent risk factors for adverse, perinatal outcomes, there were no intercation. In study III the same cohort was used to study time trends 1998-2012 in maternal and perinatal outcomes in women with GDM. Trends were also analyzed in women without GDM for comparison. This study showed that there have been improvements in fetal outcomes for women with GDM. But since the improvements were similar or less than the changes in the background population this was probably not due to better medical care for women with GDM alone. The conlusion is that there is still a lot to do to improve outcomes for women with GDM. Study IV was a case control study aiming to evaluate if there was an interaction between GDM and preeclampsia (PE) or if the conditions were independent risk factors for later cardio vascular disease (CVD). We also wanted to analyze how BMI influenced the association between PE and later CVD. We showed that GDM and PE are independently associated with elevated risk for CVD. The association of PE and CVD is not affected by BMI to a great extent as is the case in GDM and CVD.

Place, publisher, year, edition, pages
Örebro: Örebro University, 2018. p. 73
Series
Örebro Studies in Medicine, ISSN 1652-4063 ; 185
Keywords
gestational diabetes, obesity, maternal and perinatal outcomes, maternal health, pregnancy, cardiovascular disease
National Category
General Practice
Identifiers
urn:nbn:se:oru:diva-68976 (URN)978-91-7529-264-9 (ISBN)
Public defence
2018-11-23, Örebro universitet, Campus USÖ, hörsal C3, Södra Grev Rosengatan 32, Örebro, 09:00 (Swedish)
Opponent
Supervisors
Available from: 2018-09-19 Created: 2018-09-19 Last updated: 2018-10-24Bibliographically approved

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Hildén, KarinHanson, UlfFadl, Helena

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