Background The incidence rates of obesity and gestational diabetes mellitus (GDM) are increasing in parallel. This study aimed to evaluate the relationship between different obesity indices, including prepregnancy body mass index (preBMI), the first-trimester abdominal circumference (AC), and first-trimester abdominal circumference/height ratio (ACHtR), and GDM, and the efficacy of these three indices in predicting GDM was assessed. Methods A total of 15,472 pregnant women gave birth to a singleton at the Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China. Prepregnancy weight was self-reported by study participants, body height and AC were measured by nurses at the first prenatal visit during weeks 11 to 13+6 of pregnancy. GDM was diagnosed through a 75-g oral glucose tolerance test at 24–28 gestational weeks. Using receiver operator characteristic (ROC) curve analysis, we evaluated the association between obesity indices and GDM. Results A total of 1912 women (12.4%) were diagnosed with GDM. Logistic regression analysis showed that AC, ACHtR, and preBMI (P < 0.001) were all independent risk factors for the development of GDM. In the normal BMI population, the higher the AC or ACHtR was, the more likely the pregnant woman was to develop GDM. The area under the ROC curve (AUC) was 0.63 (95% CI: 0.62–0.64) for the AC, 0.64 (95% CI: 0.62–0.65) for the ACHtR and 0.63 (95% CI: 0.62–0.64) for the preBMI. An AC ≥ 80.3 cm (sensitivity: 61.6%; specificity: 57.9%), an ACHtR of ≥ 0.49 (sensitivity: 67.3%; specificity: 54.0%), and a preBMI ≥ 22.7 (sensitivity: 48.4%; specificity: 71.8%) were determined to be the best cut-off levels for identifying subjects with GDM. Conclusions An increase in ACHtR may be an independent risk factor for GDM in the first trimester of pregnancy. Even in the normal BMI population, the higher the AC and ACHtR are, the more likely a pregnant woman is to develop GDM. AC, ACHtR in the first trimester and preBMI might be anthropometric indices for predicting GDM, but a single obesity index had limited predictive value for GDM.
ObjectiveTo analyze pregnancy complications and outcomes of mothers with obesity or gestational diabetes mellitus (GDM).Methods15065 mothers were categorized into four and three groups by pre-pregnancy body mass index (preBMI) and abdominal circumference (AC), respectively, or divided into GDM or non-GDM groups. Logistic regression analysis was utilized to identify independent factors associated with pregnancy complications and outcomes.ResultsThe overweight and obesity groups accounted for 16.0% and 4.0% of the total population, respectively. GDM incidence rate was 12.3%. The overweight and obesity groups (pre-pregnancy body mass index [preBMI] ≥ 24 kg/m2) were at higher risks for GDM, hypertensive disorders of pregnancy (HDP), gestational proteinuria, postpartum hemorrhage, preterm delivery, fetal malformation or stillbirth, neonatal asphyxia, large for gestational age (LGA), shoulder dystocia, and increased cesarean section rate. Similar results were obtained with AC grouping. GDM pregnant women had higher risks of HDP, preterm delivery, small for gestational age (SGA), LGA, and increased cesarean section rate.ConclusionPeople with obesity had a higher risk of adverse pregnancy outcomes. The recommended preBMI is 19.2-22.7 kg/m2. The recommended AC at 11-13+6 gestational weeks is 74.0-84.0 cm, and that value in normal preBMI is 74.0-82.0 cm.
Background: Endometriosis can affect the systemic metabolic indicators, including body mass index, glucose metabolism and lipid metabolism, while the association between metabolic indexes and the occurrence and ART outcome of endometriosis is unclear. We aimed to evaluate the characteristics of systemic metabolic indexes of endometriosis patients with infertility and their effects on pregnancy outcome after ART treatment. Methods:A retrospective cohort study involve 412 endometriosis patients and 1551 controls was conducted. Primary outcome was metabolic indexes, and secondary measures consisted of the influence of metabolic indexes on the number of retrieved oocytes and ART outcomes, as well as the relation between blood glucose and prevalence of GDM. Results:Endometriosis patients had higher INS [6.90(5.10-9.50) vs 6.50(4.80-8.90) μU/mL, P = 0.005]. A prediction model for endometriosis combining the number of previous pregnancies, CA125, fasting blood Glu and INS, had a sensitivity of 73.9%, specificity of 67.8% and area AUC of 0.77. There were no significant differences in ART outcomes and complications. The levels of Glu were associated with GDM both in endometriosis group (aOR 12.95, 95% CI 1.69–99.42; P = 0.014) and in control group (aOR 4.15, 95% CI 1.50–11.53; P = 0.006). Conclusions: Endometriosis patients had abnormal metabolic indexes, in which serum Glu and serum INS are related to the occurrence of endometriosis, the number of retrieved oocytes and the occurrence of GDM. A prediction model based on metabolic indexes was established, representing a promising non-invasive method to predict endometriosis patients with known pregnancy history.
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