ATLANTIC DIP: The Impact of Obesity on Pregnancy Outcome in Glucose-Tolerant Women

Abstract

OBJECTIVEA prospective study of the impact of obesity on pregnancy outcome in glucose-tolerant women.RESEARCH DESIGN AND METHODSThe Irish Atlantic Diabetes in Pregnancy network advocates universal screening for gestational diabetes. Women with normoglycemia and a recorded booking BMI were included. Maternal and infant outcomes correlated with booking BMI are reported.RESULTSA total of 2,329 women fulfilled the criteria. Caesarean deliveries increased in overweight (OW) (odds ratio 1.57 [95% CI 1.24–1.98]) and obese (OB) (2.65 [2.03–3.46]) women. Hypertensive disorders increased in OW (2.30 [1.55–3.40]) and OB (3.29 [2.14–5.05]) women. Reported miscarriages increased in OB (1.4 [1.11–1.77]) women. Mean birth weight was 3.46 kg in normal BMI (NBMI), 3.54 kg in OW, and 3.62 kg in OB (P < 0.01) mothers. Macrosomia occurred in 15.5, 21.4, and 27.8% of babies of NBMI, OW, and OB mothers, respectively (P < 0.01). Shoulder dystocia occur in 4% (>4 kg) compared with 0.2% (<4 kg) babies (P < 0.01). Congenital malformation risk increased for OB (2.47 [1.09–5.60]) women.CONCLUSIONSOW and OB glucose-tolerant women have greater adverse pregnancy outcomes.

The maternal and fetal impacts of obesity and gestational diabetes on pregnancy outcome

“…24 Trends from the published literature consistently show higher caesarean section rates with increasing BMI. 13,18,25,26 In our population of glucose tolerant women, the aOR for elective caesarean section was 1.7 in overweight mothers and 4.4 in women with grade III obesity when compared to mothers with normal BMI. A similar trend was seen for emergency caesarean section, the aOR rising from 1.4 to 3.5 across the range of BMI categories from overweight to grade III obesity.…”

“…The majority of studies investigating maternal and neonatal outcomes in obesity have included obese mothers who have gestational diabetes but studies from Ireland and Denmark confirm that obesity is an independent risk factor for adverse pregnancy outcome in glucose tolerant women. [12][13][14][15] Adverse maternal outcomes…”

“…20 The association between PET and raised BMI occurs independently of gestational diabetes, and demonstrates a linear rise in risk with increasing BMI, from a doubling of risk in overweight mothers to a fourfold increase in those categorized as grade III obesoty. 8,13 Mechanical complications associated with pregnancy such as pelvic pain and lower back pain are reported more frequently in overweight and obese women during pregnancy. 21 Not only do these women have to bear the burden of the expanding gravid uterus, but also the increased tissue mass of obesity, which of itself also expands throughout gestation.…”

“…This progression to emergency caesarean section may be partially explained by the fewer successful instrumental deliveries observed in mothers with raised BMI (aOR 0.66). 8,13 In those proceeding to delivery by caesarean section, obesity carries a risk of failed regional anaesthesia, inadequate analgesia, difficulty with intravenous access and requirement for general anaesthetia, which is in turn complicated by obesity-related difficulty with intubation. 25,27 Operative wounds following caesarean sections are also more likely to get infected and break down, leading to specific recommendations for subcutaneous suturing and antibiotic prophylaxis.…”

“…12,16,31 Congenital abnormalities are also described more commonly in infants of obese mothers, including neural tube defects, orofacial abnormalities, cardiac defects, limb reduction defects and intestinal tract anomalies such as anorectal atresia and omphalocele. 8,13,32 The most commonly occurring congenital anomalies are neural tube defects (aOR 1.87 obese; 1.2 overweight) followed by cardiovascular anomaly (aOR 1.30 obese; 1.17 overweight). Within these groups spina bifida (aOR 2.2 obese) and cardiac septal anomalies (aOR 1.20) were the most frequent.…”