The Hyperglycemia and Adverse Pregnancy Outcome Study

Abstract

OBJECTIVETo determine associations of gestational diabetes mellitus (GDM) and obesity with adverse pregnancy outcomes in the Hyperglycemia and Adverse Pregnancy Outcome (HAPO) Study.RESEARCH DESIGN AND METHODSParticipants underwent a 75-g oral glucose tolerance test (OGTT) between 24 and 32 weeks. GDM was diagnosed post hoc using International Association of Diabetes and Pregnancy Study Groups criteria. Neonatal anthropometrics and cord serum C-peptide were measured. Adverse pregnancy outcomes included birth weight, newborn percent body fat, and cord C-peptide >90th percentiles, primary cesarean delivery, preeclampsia, and shoulder dystocia/birth injury. BMI was determined at the OGTT. Multiple logistic regression was used to examine associations of GDM and obesity with outcomes.RESULTSMean maternal BMI was 27.7, 13.7% were obese (BMI ≥33.0 kg/m2), and GDM was diagnosed in 16.1%. Relative to non-GDM and nonobese women, odds ratio for birth weight >90th percentile for GDM alone was 2.19 (1.93–2.47), for obesity alone 1.73 (1.50–2.00), and for both GDM and obesity 3.62 (3.04–4.32). Results for primary cesarean delivery and preeclampsia and for cord C-peptide and newborn percent body fat >90th percentiles were similar. Odds for birth weight >90th percentile were progressively greater with both higher OGTT glucose and higher maternal BMI. There was a 339-g difference in birth weight for babies of obese GDM women, compared with babies of normal/underweight women (64.2% of all women) with normal glucose based on a composite OGTT measure of fasting plasma glucose and 1- and 2-h plasma glucose values (61.8% of all women).CONCLUSIONSBoth maternal GDM and obesity are independently associated with adverse pregnancy outcomes. Their combination has a greater impact than either one alone.

A proposal for the use of uniform diagnostic criteria for gestational diabetes in Europe: an opinion paper by the European Board & College of Obstetrics and Gynaecology (EBCOG)

“…This is confirmed by analyses of the HAPO study showing that both maternal GDM and obesity are independently associated with adverse pregnancy outcomes such as LGA, pre-eclampsia, Caesarean section and newborn percentage body fat >90th percentile and that the combination of obesity and GDM confers a greater risk of these adverse pregnancy outcomes than either obesity or GDM alone [36]. Maternal obesity is also a major independent risk factor for gestational hypertension, congenital abnormalities and birth trauma [37].…”

CGM, Pregnancy, and Remote Monitoring

“…These risks include fetal loss, congenital anomalies, abnormal fetal size (large-for-gestational age [LGA]; small-for-gestational age; macrosomia), preeclampsia/eclampsia, cesarean section, neonatal hypoglycemia, and neonatal hyperbilirubinemia, among others. [1][2][3][4] Therefore, the American Diabetes Association (ADA) recommends tight glycemic control throughout gestation 5 (Table 1). One tool that may help achieve optimal glycemic control in pregnancy is the continuous glucose monitor (CGM).…”

White’s classification and pregnancy outcome in women with type 1 diabetes: a population-based cohort study

“…Their sample size was 196, of which only seven patients belonged to White's classes D, R or F, precluding the demonstration of trends across these classes. Moreover, many of the patients studied by Cormier et al were obese, which may predispose to cardiovascular diseases [23] and pregnancy complications [24,25] regardless of White's class. Although age at diabetes diagnosis and diabetes duration were similar in classes D, R and F, SGA rates increased and fetal macrosomia rates decreased from class D to F in our patients.…”