Gestational diabetes versus obesity as risk factors for pregnancy‐induced hypertensive disorders and fetal macrosomia

Hoorn, Jessika van; Dekker, Gus; Jeffries, Bill

doi:10.1111/j.0004-8666.2002.00035.x

Cited by 36 publications

(28 citation statements)

References 15 publications

(8 reference statements)

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“…This finding has been observed by others as well (25,26) and suggests an underlying vascular pathology that might predate pregnancy and result in abnormal placentation (27), leading to placental hypoperfusion and the release of circulating compounds able to alter the maternal vascular endothelium (28).…”

Section: Postpartum Testingsupporting

confidence: 72%

“…Roberts et al (24) studied 11 women with preeclampsia and 11 nonpreeclamptic control subjects in the third trimester using the minimal model technique and found no differences between the groups. In a retrospective review, Van Hoorn et al (25) found no difference in preeclampsia rates in women with GDM (19.6%, n ϭ 51) compared with control subjects (17.1%, n ϭ 258). They also report that the preeclamptic women were taller (by 1.9 cm; P Ͻ 0.05) and had higher DBP at booking (P Ͻ 0.001) than the control subjects.…”

Section: Postpartum Testingmentioning

confidence: 97%

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Insulin Resistance and Preeclampsia in Gestational Diabetes Mellitus

Montoro

Kjos²,

Chandler³

et al. 2005

Diabetes Care

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OBJECTIVE -To compare the degree of insulin resistance in women with gestational diabetes mellitus (GDM) who do and do not develop preeclampsia.RESEARCH DESIGN AND METHODS -We conducted a prospective cohort study of initially normotensive women with GDM who underwent oral glucose tolerance tests (OGTTs), intravenous glucose tolerance tests (IVGTTs), and glucose clamp studies in the early third trimester (n ϭ 150) and 15 months postpartum (n ϭ 89). After delivery, the women were categorized as nonpreeclamptic or preeclamptic (systolic blood pressure [SBP] Ն140 mmHg, diastolic blood pressure [DBP] Ն90 mmHg, and at least Ͼ1ϩ proteinuria or Ͼ300 mg/24 h). Metabolic parameters between the groups were compared by 2 or Fisher's exact tests and ANOVA with P Ͻ 0.05 as significant.RESULTS -A total of 29 women (19%) developed preeclampsia, which was mild in 21 and severe in 8 women. At entry, there were no differences in age, weight indexes, and glycemic measures between the nonpreeclamptic and preeclamptic groups. Those with preeclampsia were significantly taller (61.5 Ϯ 2.4 vs. 60.1 Ϯ 2.3 in, P ϭ 0.003), were more often nulliparous (38 vs. 16%, P ϭ 0.01), and had higher entry SBP (112 Ϯ 10 vs. 103 Ϯ 6.9 mmHg, P Ͻ 0.0001) and DBP (64 Ϯ 9 vs. 59 Ϯ 5 mmHg, P ϭ 0.002). No significant differences between the groups were found in any measures of the OGTT glucose levels, insulin sensitivity index, glucose effectiveness, acute response to glucose, or disposition index, nor were there any differences found in the euglycemic clamp measures of basal or steady-state levels of glucose, insulin, free fatty acid, hepatic glucose output, peripheral glucose clearance, C-peptide, or glucagon. At 15 months postpartum, blood pressure levels remained significantly higher in the preeclamptic group (n ϭ 19) compared with the nonpreeclamptic group (n ϭ 70). No differences in any glycemic or insulin resistance measures were found.CONCLUSIONS -Women with GDM were uniformly insulin resistant. Those who developed preeclampsia, when compared with those who remained nonpreeclamptic, were not more insulin resistant in either the third trimester or 15 months postpartum. However, women who developed preeclampsia had blood pressure levels that were significantly higher, although still in the normal range, than those of women who remained nonpreeclamptic. Diabetes Care 28:1995-2000, 2005H ypertension, a common disorder complicating pregnancy (6 -9%), remains a leading cause of maternal mortality (ϳ15%) in the U.S. (1) and worldwide (2). Hypertensive disorders are increased two-to threefold in pregnancies complicated by diabetes, and insulin resistance has been proposed as an important etiologic factor (3). Women with pregestational and gestational diabetes mellitus (GDM) have been reported to have both increased risk of preeclampsia (10 -50 and 10 -30%, respectively) and insulin resistance when compared with women with normal glucose tolerance whose rate of preeclampsia is 5-7% (1-6). Several studies have reported an association between preeclampsia and i...

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Section: Postpartum Testingsupporting

confidence: 72%

Section: Postpartum Testingmentioning

confidence: 97%

Insulin Resistance and Preeclampsia in Gestational Diabetes Mellitus

Montoro

Kjos²,

Chandler³

et al. 2005

Diabetes Care

View full text Add to dashboard Cite

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“…Glucose tolerance status, and especially obesity, acted in a dose-dependent manner, increasing the risk of perinatal complications as glucose intolerance and BMI increased. Glucose intolerance or obesity was not significantly associated with PIH or macrosomia in an Australian cohort [22]. The present study, partially reported in [15], identifies pregestational BMI and abnormal glucose tolerance categories as independent predictors of perinatal outcome with similar ORs for abnormal glucose tolerance categories and upper BMI quartiles.…”

Section: Discussionsupporting

confidence: 53%

“…However, few studies have attempted to discern the relative influences of overweight and GDM [22][23][24][25][26][27]. Obesity and hyperglycaemia have been reported to be independent predictors of different obstetric and perinatal complications, but obesity was a stronger risk factor for macrosomia, Caesarean section and hypertension than hyperglycaemia [24][25][26][27].…”

Section: Discussionmentioning

confidence: 99%

Body mass index has a greater impact on pregnancy outcomes than gestational hyperglycaemia

et al. 2005

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Aims/hypothesis: We evaluated diabetes-related pregnancy outcomes in a cohort of Spanish women in relation to their glucose tolerance status, prepregnancy BMI and other predictive variables. Methods: The present paper is part of a prospective study to evaluate the impact of American Diabetes Association (2000) criteria in the Spanish population. A total of 9,270 pregnant women were studied and categorised as follows according to prepregnancy BMI quartiles and glucose tolerance status: (1) negative screenees; (2) false-positive screenees; (3) gestational diabetes mellitus (GDM) according to American Diabetes Association criteria only; and (4) GDM according to National Diabetes Data Group criteria (NDDG). We evaluated fetal macrosomia, Caesarean section and seven secondary outcomes as diabetes-related pregnancy outcomes. The population-attributable and population-prevented fractions of predictor variables were calculated after binary logistic regression analysis with multiple predictors. Results: Both prepregnancy BMI and abnormal glucose tolerance categories were independent predictors of pregnancy outcomes. The upper quartile of BMI accounted for 23% of macrosomia, 9.4% of Caesarean section, 50% of pregnancy-induced hypertension and 17.6% of large-for-gestational-age newborns. In contrast, NDDG GDM accounted for 3.8% of macrosomia, 9.1% of pregnancy-induced hypertension and 3.4% of preterm births. Conclusions/ interpretation: In terms of population impact, prepregnancy maternal BMI exhibits a much stronger influence than abnormal blood glucose tolerance on macrosomia, Caesarean section, pregnancy-induced hypertension and large-for-gestational-age newborns.

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“…Controversy exists as to whether pregravid obesity alone, GDM, hyperglycemia, and treatment modality are independent risk factors for adverse pregnancy outcome. The majority of studies have not controlled for obesity, parity, or level of glycemic control, and in many studies, sample sizes were too small to allow sufficient statistical power (57)(58)(59)(60)(61)(62). Recently, in a prospective study on 4,001 GDM patients (63), it was shown that obese and overweight GDM patients achieving established levels of glucose control with insulin therapy showed no increased risk for composite adverse outcomes, macrosomia, and LGA in comparison to normal-weight GDM patients with good control.…”

Section: Level Of Glycemia and Fetal Metabolicmentioning

confidence: 99%