Impact of overweight and obesity on pregnancy outcomes in women with gestational diabetes – results from a retrospective multicenter study

ABSTRACT Objective The aim of this study was to evaluate the impact of pre-pregnancy body mass index (BMI) on pregnancy outcomes in women with gestational diabetes (GD). Subjects and methods Retrospective multicenter study using data from the Portuguese National Register. We included women with GD with a singleton pregnancy. GD diagnosis was according to the International Association of the Diabetes and Pregnancy Study Group criteria. Women were divided into groups according to their pre-pregnancy BMI: < 18.5 kg/m2 (underweight), ≥ 18.5 and < 25.0 kg/m2 (normal weight), ≥ 25 and < 30 kg/m2 (overweight) and ≥ 30 kg/m2 (obese). Results We included 3,103 pregnant women with GD, 29.6% (n = 918) were overweight and 27.3% (n = 846) were obese. Compared to normal weight, the overweight and obese groups had a higher percentage of gestational hypertension (4.0% and 8.5% vs. 2.1%), cesarean delivery (32.8% and 41.3% vs. 27.9%), macrosomia (3.9% and 6.7% vs. 2.4%), and large for gestational age (LGA) newborns (8.3% and 13.5% vs. 6.0%). Obesity increased the risk of gestational hypertension (OR 4.5, p < 0.001), preeclampsia (OR 1.9, p = 0.034), cesarean delivery (OR 2.0, p < 0.001), macrosomia (OR 3.1, p < 0.001) and LGA (OR 2.3, p < 0.001). Conclusion In pregnant women with GD, pregnancy complications increase with pre-pregnancy BMI. In obese women, appropriate diet and counseling prior to gestation and more aggressive medical intervention during pregnancy are needed in order to prevent macrosomic and LGA newborns and to reduce maternal complications.

【摘要】
目的 本研究旨在评估孕前体重指数（body mass index, BMI）对妊娠糖尿病（gestational diabetes, GD）患者妊娠结局的影响。
对象与方法 本研究为回顾性多中心研究，数据来源于葡萄牙国家登记数据库。研究纳入单胎妊娠的妊娠糖尿病患者，其妊娠糖尿病诊断依据国际妊娠糖尿病研究组（International Association of the Diabetes and Pregnancy Study Group）制定的标准。根据孕前体重指数将受试者分为四组：＜18.5 kg/m²（体重过轻）、≥18.5且＜25.0 kg/m²（体重正常）、≥25且＜30 kg/m²（超重）以及≥30 kg/m²（肥胖）。
结果 本研究共纳入3103例妊娠糖尿病孕妇，其中29.6%（n=918）为超重人群，27.3%（n=846）为肥胖人群。与体重正常组相比，超重组与肥胖组的妊娠期高血压发生率（4.0%、8.5% vs 2.1%）、剖宫产率（32.8%、41.3% vs 27.9%）、巨大儿发生率（3.9%、6.7% vs 2.4%）以及大于胎龄儿（large for gestational age, LGA）出生率（8.3%、13.5% vs 6.0%）均显著升高。肥胖可显著升高妊娠期高血压（比值比[odds ratio, OR]=4.5，P＜0.001）、子痫前期（OR=1.9，P=0.034）、剖宫产（OR=2.0，P＜0.001）、巨大儿（OR=3.1，P＜0.001）以及LGA（OR=2.3，P＜0.001）的发病风险。
结论 妊娠糖尿病患者的妊娠并发症发生率随孕前体重指数升高而逐步升高。对于肥胖的妊娠糖尿病患者，需在孕前开展针对性饮食指导与健康咨询，并在孕期采取更为积极的医学干预措施，以预防巨大儿及大于胎龄儿的出生，同时降低母体并发症的发生风险。