Gestational diabetes, pre-pregnancy obesity and pregnancy weight gain in relation to excess fetal growth: variations by race/ethnicity

Abstract

Aims/hypothesis The escalating rate of childhood obesity is a public health concern worldwide, with children in certain ethnic groups being disproportionately affected. Our objective was to examine the joint effects of pre-pregnancy adiposity, pregnancy weight gain and gestational diabetes (GDM) in relation to excess fetal growth and to identify susceptible races or ethnic populations. Methods The risk for delivery of a large-for-gestational-age (LGA) infant, specific to race and fetal sex, was evaluated in 105,985 pregnancies in the Consortium on Safe Labor from [2002][2003][2004][2005][2006][2007][2008]. Generalised estimating equations were used to estimate the risk for delivery of LGA infants. Joint effects were employed to evaluate the interplay of three risk factors.Models were stratified by racial group considering one, two or three factors (i.e. pre-pregnancy adiposity, pregnancy weight gain and GDM, with 0 factors as the reference group). Results Greater pre-pregnancy adiposity, pregnancy weight gain and GDM were independently associated with increased risk of giving birth to an LGA infant across all races (except GDM among non-Hispanic whites), in both underweight and normal-weight women. Among non-Hispanic white, non-Hispanic black and Hispanic women, the threefactor joint effect was associated with substantially increased odds of LGA (OR [95% CI] 11. 27 [8.40, 15.11], 7.09 [4.81, 10.45] and 10.19 [6.84, 15.19], respectively). However, for Asian women the joint effect of all three factors (OR [95% CI] 5.14 [2.11, 12.50]) was approximately the same as any of the two factors. Conclusions/interpretation GDM, pre-pregnancy obesity and excessive pregnancy weight gain were jointly associated with elevated risk of giving birth to an LGA infant and the effects varied by race. This suggests that those involved in public health efforts aimed at preventing LGA deliveries should consider variations in racial groups when devising effective strategies.

Pregnancy adverse outcomes related to pregravid body mass index and gestational weight gain, according to the presence or not of gestational diabetes mellitus: A retrospective observational study

“…Screening was specifically prescribed during the hospital routine follow-up visit and then performed out of hospital. As is usual for epidemiological studies, the women without screening were considered to be without GDM [2,9,10,15].…”

“…To date, only five recent studies, four from the United States [5,10,15,16] and only one from Europe [9], have explored the impact of GDM, obesity and GWG together. Some limitations may affect these observational studies.…”

“…First, the prevalence of GDM is sometimes very low [9,16] with screening which might not have been universal [5,10,15,16]. Second, women with pregravid diabetes and hypertension were not excluded [5,9,10,15,16], whereas these conditions are often associated with overweight and obesity. Therefore, considering women with 'isolated obesity' might better evaluate the role of obesity per se [12].…”

Racial and ethnic disparities in extremes of fetal growth after gestational diabetes mellitus

“…The investigation of racial/ethnic disparities in fetal growth associated with GDM is potentially confounded by maternal obesity and gestational weight gain, since both are important risk factors for fetal growth independent of GDM [21][22][23][24], and both may vary by race/ethnicity even among women with GDM pregnancies. The purposes of this study were to estimate LGA/SGA risks and assess variation in LGA and SGA risks among women from ten racial/ethnic groups with pregnancies complicated by GDM, where LGA and SGA were identified using racial/ethnic-sex-specific standards adjusted for gestational age at delivery.…”

Associação entre ganho de peso gestacional e prognóstico da gestação

“…5,6 Há evidências de que, independente da raça e do estado nutricional pré-gestacional, o ganho ponderal excessivo durante a gravidez está associado a um risco elevado de neonatos grandes para idade gestacional. 7 Além disso, o ganho ponderal da mãe durante a gestação pode agir como preditor da adiposidade total e distribuição de gordura corporal na infância 8 e na adolescência, 5 predispondo ao desenvolvimento de obesidade e doenças crônicas não transmissíveis, como diabetes e hipertensão arterial. 4,9,10 Com relação à saúde materna, o excesso de ganho ponderal na gestação tem sido associado a intercorrências como diabetes gestacional, pré-eclâmpsia, parto cesáreo, infecções pós-parto e retenção do peso no período pós-parto.…”