The hyperglycemia and adverse pregnancy outcome study: Associations of GDM and obesity with pregnancy outcomes

Patrick M. Catalano, H. David McIntyre, J. Kennedy Cruickshank, David R. McCance, Alan R. Dyer, Boyd E. Metzger*, Lynn P. Lowe, Elisabeth R. Trimble, Donald R. Coustan, David R. Hadden, Bengt Persson, Moshe Hod, Jeremy J.N. Oats

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

511 Scopus citations

Abstract

OBJECTIVE - To determine associations of gestational diabetes mellitus (GDM) and obesity with adverse pregnancy outcomes in the Hyperglycemia and Adverse Pregnancy Outcome (HAPO) Study. RESEARCH DESIGN AND METHODS - Participants underwent a 75-g oral glucose tolerance test (OGTT) between 24 and 32 weeks. GDM was diagnosed post hoc using International Association of Diabetes and Pregnancy Study Groups criteria. Neonatal anthropometrics and cord serum C-peptide were measured. Adverse pregnancy outcomes included birth weight, newborn percent body fat, and cord C-peptide >90th percentiles, primary cesarean delivery, preeclampsia, and shoulder dystocia/birth injury. BMI was determined at the OGTT. Multiple logistic regression was used to examine associations of GDM and obesity with outcomes. RESULTS - Mean maternal BMI was 27.7, 13.7% were obese (BMI ≥33.0 kg/m 2), and GDM was diagnosed in 16.1%. Relative to non-GDM and nonobese women, odds ratio for birth weight >90th percentile for GDM alone was 2.19 (1.93-2.47), for obesity alone 1.73 (1.50-2.00), and for both GDM and obesity 3.62 (3.04-4.32). Results for primary cesarean delivery and preeclampsia and for cord C-peptide and newborn percent body fat >90th percentiles were similar. Odds for birth weight >90th percentile were progressively greater with both higher OGTT glucose and higher maternal BMI. There was a 339-g difference in birth weight for babies of obese GDM women, compared with babies of normal/underweight women (64.2% of all women) with normal glucose based on a composite OGTT measure of fasting plasma glucose and 1- and 2-h plasma glucose values (61.8% of all women). CONCLUSIONS - Both maternal GDM and obesity are independently associated with adverse pregnancy outcomes. Their combination has a greater impact than either one alone.

Original languageEnglish (US)
Pages (from-to)780-786
Number of pages7
JournalDiabetes care
Volume35
Issue number4
DOIs
StatePublished - Apr 2012

ASJC Scopus subject areas

  • Internal Medicine
  • Endocrinology, Diabetes and Metabolism
  • Advanced and Specialized Nursing

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