The ranges of insulin response and glucose tolerance in lean, normal, and obese women during pregnancy

Farmer, George; Hamilton-Nicol, D. R.; Sutherland, H. W.; Ross, I.S.; Russell, George; Pearson, Donald

doi:10.1016/s0002-9378(11)91588-9

Cited by 11 publications

(6 citation statements)

References 14 publications

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“…How ever, obese women were found to have an ele vated fasting insulin level. This confirms the results of others [57][58][59] who have also re ported that insulin levels are higher in obese pregnant women. In this study, while mater nal obesity was associated with higher fasting insulin levels, it is not clear whether there were slight differences in the metabolism of glucose that would account for the observed 390 Silliman/Kretchmcr Maternal Obesity and Neonatal Body Fat differences in infant adiposity at birth.…”

Section: Discussionsupporting

confidence: 92%

Maternal Obesity and Body Composition of the Neonate

Silliman

Kretchmer²

1995

Neonatology

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Obese women generally deliver heavier infants, but the body composition of these infants is unknown. The principal objective of this study was to determine if neonates of obese women have more adipose tissue. At 35–36 weeks of gestation, a fasting blood sample was collected from 37 pregnant women. Shortly after birth, the body fat of the neonates was measured with an infant total-body electrical conductivity (TOBEC) instrument using a prediction equation derived from 10 miniature pigs. At 6 weeks post partum, the infant body fat was measured a second time, and the body fat of each mother was measured using an adult TOBEC instrument. We found no differences between the obese (n = 16) and lean subjects (n = 21) in the concentrations of glycerol, β-hydroxybutyrate, triglyceride, total cholesterol, high-density lipoprotein cholesterol, or glucose in the blood. However, the insulin concentration was elevated in the obese women (199 ± 57 pmol/l) as compared with the lean women (128 ± 68 pmol/l, p < 0.01). At birth, maternal adiposity (% body fat) was significantly associated with infant adiposity (r = 0.37, p < 0.05). However, by 6 weeks post partum the association no longer existed. Multiple regression analysis showed that maternal adiposity, fasting glucose level, and gestational age are independently associated at birth with infant adiposity.

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Section: Discussionsupporting

confidence: 92%

Maternal Obesity and Body Composition of the Neonate

Silliman

Kretchmer²

1995

Neonatology

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“…Significant correlations have been identified between birthweight and maternal levels of glucose and other fuels 41 . 42 , 45 –53 Fetal overgrowth may occur even when maternal glucose levels are below the diagnostic threshold for diabetes 45 –52 . The association between maternal glucose levels and birthweight is often strongest in non‐diabetic women with an abnormal glucose screen result as stringent glucose control and reduction of the risk of high birthweight is a major goal of prenatal care for diabetic women 37 .…”

Section: Introductionmentioning

confidence: 99%

Maternal obesity and glucose intolerance during pregnancy among Mexican‐Americans

Kieffer¹

2000

Paediatric Perinatal Epid

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Low birthweight is uncommon among Mexican-American infants, despite the substantial proportion of mothers who live in poverty. This apparent paradox has generated studies of factors protecting fetal growth, but may have masked other important health problems in the Mexican-American community. Obesity, impaired glucose tolerance and diabetes are common among Mexican-American women of childbearing age and during pregnancy. Prevalence of these conditions is two to four times higher in Mexican-American than in non-Hispanic white women. As obesity and glucose intolerance during pregnancy are associated with fetal overgrowth and increased risk of subsequent obesity and type 2 diabetes in mother and child, the adequacy of birthweight as a measure of maternal and infant risk may be obscured in populations with a high prevalence of these conditions. Their possible contribution to the increasing incidence of obesity and type 2 diabetes in Mexican-American children, adolescents and young adults has not been examined. Appropriate preconception, prenatal and follow-up care may identify high-risk women, improve weight and metabolic status and reduce the severity and impact of diabetes and its complications. However, late or no prenatal care is common among Mexican-American women and the frequency of follow-up care is unknown. As low birthweight is a major public health indicator of maternal and neonatal health, perceived 'good birth outcomes' have reduced health policy, programme and research attention to Mexican-American mothers and infants. Studies of the impact of obesity and glucose intolerance during pregnancy on the birthweights of Mexican-American infants should be undertaken, along with systematic assessment of the subsequent health status and preventive health-care needs of women and children in this population.

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“…Associations between maternal BMI and glycaemic status have been reported previously1 and as have adverse pregnancy outcomes with BMI2 and gestational diabetes. This is the first report to disentangle the effects of obesity from that of hyperglycaemia on pregnancy outcomes.…”

Section: Commentarymentioning

confidence: 55%

Higher BMI in pregnant women associated with a greater likelihood of pre-eclampsia, caesarian delivery and higher offspring birth weight and body fat

Bhattacharya

2010

Evid Based Med

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ContextAlthough there are several published reports establishing the association of maternal obesity with adverse pregnancy outcomes, few explore these associations independent of glycaemia. Previous research on this topic have either not reported data on blood glucose levels or confi ned the analysis to women without recorded gestational diabetes. This leaves a large group of pregnant women who have impaired glucose tolerance but not quite clinically diagnosed gestational diabetes whose risks in pregnancy remain poorly understood. The HAPO (Hyperglycaemia and Adverse Pregnancy Outcome) study aimed to describe any adverse outcomes in these women. As part of this epidemiological investigation, accurate data on height and weight of women were collected and utilised in the present analysis to assess the risk of adverse pregnancy outcomes in obese women independent of their glycaemic status. MethodsThis prospective cohort study was based in 15 centres in nine countries in order to recruit a multicultural ethnically diverse population. Maternal body mass index (BMI) was calculated from height and weight recorded at the time of administration of the oral glucose tolerance test, typically between 24 and 32 weeks of gestation. BMI was used in the analysis as a continuous variable and as categories as recommended by the WHO criteria.Primary outcomes assessed were birth weight for gestational age >90th percentile, delivery by primary caesarean section, neonatal hypoglycaemia and cord serum C-peptide >90th percentile. Secondary outcomes included were maternal pre-eclampsia, preterm delivery before 37-week gestation and neonatal adiposity. Shoulder dystocia or birth injury, neonatal hyperbilirubinaemia and admissions to neonatal intensive care units were also reported.Although recruitment continued over 5 years, the follow-up period was from the time of OGT testing in the third trimester to delivery of the baby. Neonatal follow-up was up to 72 h after delivery. FindingsThis report demonstrates that both maternal BMI as well as glycaemic status are independently associated with selected adverse outcomes of pregnancy. A higher birthweight centile was positively associated with maternal BMI with a 12% increase in risk of macrosomia from the lowest BMI group (3.9%) to that in the highest (15.9%). Primary caesarean delivery was also more common in women with higher BMI; the risk increased in a dosedependent manner with increasing maternal BMI.In the case of neonatal hypoglycaemia and hyperinsulinaemia (measured by cord C-peptide), the results showed a similar pattern of association with increasing maternal BMI. Commentary on: HAPO Study Cooperative Research Group. Hyperglycaemia and Adverse Pregnancy Outcome (HAPO) Study: associations with maternal body mass index. BJOG 2010;117:575-84.

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The ranges of insulin response and glucose tolerance in lean, normal, and obese women during pregnancy

Cited by 11 publications

References 14 publications

Maternal Obesity and Body Composition of the Neonate

Maternal Obesity and Body Composition of the Neonate

Maternal obesity and glucose intolerance during pregnancy among Mexican‐Americans

Higher BMI in pregnant women associated with a greater likelihood of pre-eclampsia, caesarian delivery and higher offspring birth weight and body fat

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