Maternal obesity not maternal glucose values correlates best with high rates of fetal macrosomia in pregnancies complicated by gestational diabetes

: Obesity and gestational diabetes mellitus (GDM) are becoming more common among pregnant women worldwide and are individually associated with a number of placenta-mediated obstetric complications, including preeclampsia, macrosomia, intrauterine growth restriction and stillbirth. The placenta serves several functions throughout pregnancy and is the main exchange site for the transfer of nutrients and gas from mother to fetus. In pregnancies complicated by maternal obesity or GDM, the placenta is exposed to environmental changes, such as increased inflammation and oxidative stress, dyslipidemia, and altered hormone levels. These changes can affect placental development and function and lead to abnormal fetal growth and development as well as metabolic and cardiovascular abnormalities in the offspring. This review aims to summarize current knowledge on the effects of obesity and GDM on placental development and function. Understanding these processes is key in developing therapeutic interventions with the goal of mitigating these effects and preventing future cardiovascular and metabolic pathology in subsequent generations.

Download Full-text

Relevance of dietary glycemic index, glycemic load and fiber intake before and during pregnancy for the risk of gestational diabetes mellitus and maternal glucose homeostasis

Clinical Nutrition ◽

10.1016/j.clnu.2021.03.041 ◽

2021 ◽

Vol 40 (5) ◽

pp. 2791-2799

Author(s):

Xiao Zhang ◽

Yunhui Gong ◽

Karen Della Corte ◽

Dianke Yu ◽

Hongmei Xue ◽

...

Keyword(s):

Diabetes Mellitus ◽

Gestational Diabetes ◽

Gestational Diabetes Mellitus ◽

Glucose Homeostasis ◽

Glycemic Index ◽

Glycemic Load ◽

Fiber Intake ◽

Dietary Glycemic Index ◽

Maternal Glucose

Download Full-text

Maternal obesity influences birth weight more than gestational diabetes

BMC Pregnancy and Childbirth ◽

10.1186/s12884-021-03571-5 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Eman M Alfadhli

Keyword(s):

Birth Weight ◽

Gestational Diabetes ◽

Pregnancy Outcomes ◽

Maternal Obesity ◽

Reference Group ◽

Adverse Pregnancy Outcomes ◽

Antenatal Visit ◽

Oral Glucose ◽

The Mean ◽

Adverse Pregnancy

Abstract Background Maternal obesity and gestational diabetes (GDM) are commonly encountered during pregnancy. Both conditions are independently associated with unfavorable pregnancy consequences. The objective of this study was to compare the effects of obesity and GDM on birth weight, macrosomia, and other adverse pregnancy outcomes. Methods This cohort study involved 531 women with a singleton pregnancy attending the Maternity and Children’s Hospital, Medina, Saudi Arabia, between June 2014 and June 2015. Participants underwent a 75-g oral glucose tolerance test between 24 and 28 weeks. The International Association of Diabetes and Pregnancy Study Groups criteria were used for GDM diagnosis. BMI was assessed at the first antenatal visit, and obesity was defined as a BMI ≥30.0 kg/m2. All women were followed up until delivery. Women were divided into 4 groups: non-GDM nonobese (reference group), GDM nonobese, obese non-GDM, and obese GDM. Clinical characteristics and adverse pregnancy outcomes were compared. Results The mean age and BMI of the participants were 30.5 years and 29.3 kg/m2, respectively. GDM was diagnosed in 50.2% of the participants, and obesity was diagnosed in 47.8% of the participants. Obese women with GDM were the oldest and heaviest among all women. The mean birth weight increased in order among the four groups; it was highest in the infants in the obese GDM group, followed by those in the obese non-GDM, GDM nonobese and reference groups. Obesity and GDM alone or in combination were associated with higher rates of macrosomia and cesarean deliveries than the reference group. Neonatal intensive care unit (NICU) admission was higher in infants in the GDM nonobese and obese GDM groups. The frequency of low Apgar score was significantly higher in infants in the obese GDM group than in infants in the reference group. Conclusions Maternal obesity seems to influence birth weight more than GDM, while GDM is associated with a greater risk of admission to the NICU. The combination of both conditions is associated with the greatest risk of adverse pregnancy outcomes.

Download Full-text

Maternal Obesity, Overweight and Gestational Diabetes Affect the Offspring Neurodevelopment at 6 and 18 Months of Age – A Follow Up from the PREOBE Cohort

PLoS ONE ◽

10.1371/journal.pone.0133010 ◽

2015 ◽

Vol 10 (7) ◽

pp. e0133010 ◽

Cited By ~ 37

Author(s):

Francisco J. Torres-Espinola ◽

Staffan K Berglund ◽

Luz Mª García-Valdés ◽

Mª Teresa Segura ◽

Antonio Jerez ◽

...

Keyword(s):

Gestational Diabetes ◽

Maternal Obesity

Download Full-text

Fetal macrosomia: obstetrical, psychological and social aspects

HEALTH OF WOMAN ◽

10.15574/hw.2020.153.36 ◽

2018 ◽

pp. 36-39

Author(s):

S.I. Zhuk ◽

◽

O.D. Shchurevska ◽

Keyword(s):

Risk Factors ◽

Weight Gain ◽

Gestational Diabetes ◽

Psychosocial Stress ◽

Fetal Macrosomia ◽

Medical Problems ◽

Medical Risk ◽

Pregnancy And Childbirth ◽

Medical Risk Factors ◽

Forced Migrants

One of the main markers of socially unfavorable pregnancy is anthropometric indicators of newborns. They reflect not only the narrow medical problems of complicated gestation but also social problems in general, the quality and access to the medical care. The objective: to determine the risk factors for fetal macrosomia in pregnancy with high levels of psychosocial stress. Materials and methods. The course of pregnancy and childbirth, demographic and medical risk factors for a fetal macrosomia were analyzed in 140 pregnant women with different levels of psychosocial stress. They were divided into 2 groups: 1 group (main) – 56 women-forced migrants from Luhansk and Donetsk regions, 2 group – 84 women with low and moderate level stress according to the questionnaires and psychological tests (L. Reeder, Spielberg–Khanin scale). Results. Gestational diabetes was the main reason for the birth of heavy children in both groups. Women–forced migrants had late manifestation of impaired tolerance to carbohydrates and a higher frequency of pathological weight gain. Male neonates are at risk for macrosomia. Childbirth in women with macrosomia is accompanied by a high frequency of complications and abnormal births. Conclusions. The frequency of births of macrosomic children in women - forced migrants is higher than in women at low risk of psychosocial stress. Risk factors in this group of pregnants include: the level of stress and behavioral responses to stress, impaired carbohydrate tolerance due to gestational diabetes, abnormal weight gain due to malnutrition and male sex of the fetus. Keywords: macrosomia, pregnancy, childbirth, women–forced migrants psychosocial stress, gestational diabetes, weight gain.

Download Full-text

The consequences of obesity and excess weight gain in pregnancy

Proceedings of The Nutrition Society ◽

10.1017/s0029665111003077 ◽

2011 ◽

Vol 70 (4) ◽

pp. 450-456 ◽

Cited By ~ 81

Author(s):

Jane E. Norman ◽

Rebecca Reynolds

Keyword(s):

Insulin Resistance ◽

Weight Gain ◽

Gestational Diabetes ◽

Pregnant Women ◽

Postpartum Haemorrhage ◽

Maternal Obesity ◽

Adverse Pregnancy Outcome ◽

Operative Delivery ◽

Adverse Pregnancy ◽

In Pregnancy

The prevalence of obesity in pregnancy is rising exponentially; about 15–20% of pregnant women now enter pregnancy with a BMI which would define them as obese. This paper provides a review of the strong links between obesity and adverse pregnancy outcome which operate across a range of pregnancy complications. For example, obesity is associated with an increased risk of maternal mortality, gestational diabetes mellitus, thromboembolism, pre-eclampsia and postpartum haemorrhage. Obesity also complicates operative delivery; it makes operative delivery more difficult, increases complications and paradoxically increases the need for operative delivery. The risk of the majority of these complications is amplified by excess weight gain in pregnancy and increases in proportion to the degree of obesity, for example, women with extreme obesity have OR of 7·89 for gestational diabetes and 3·84 for postpartum haemorrhage compared to their lean counterparts. The consequences of maternal obesity do not stop once the baby is born. Maternal obesity programmes a variety of long-term adverse outcomes, including obesity in the offspring at adulthood. Such an effect is mediated at least in part via high birthweight; a recent study has suggested that the odds of adult obesity are two-fold greater in babies weighing more than 4 kg at birth. The mechanism by which obesity causes adverse pregnancy outcome is uncertain. This paper reviews the emerging evidence that hyperglycaemia and insulin resistance may both play a role: the links between hyperglycaemia in pregnancy and both increased birthweight and insulin resistance have been demonstrated in two large studies. Lastly, we discuss the nature and rationale for possible intervention strategies in obese pregnant women.

Download Full-text