Obesity and Gestational Diabetes in Pregnant Care and Clinical Practice

2020 ◽  
Vol 19 (2) ◽  
pp. 154-164
Author(s):  
José Andrés Poblete ◽  
Pablo Olmos
Keyword(s):  
Physical Activity ◽  
Gestational Diabetes ◽  
Gestational Age ◽  
Later Life ◽  
Nutrition Therapy ◽  
Point Of View ◽  
Large For Gestational Age ◽  
Moderate Physical Activity ◽  
Increased Risk

: Obesity and Gestational Diabetes Mellitus (GDM) are the most frequent pathologies affecting mothers and offspring during pregnancy. Both conditions have shown a sustained increase in their prevalence in recent years, and they worsen the outcome of pregnancy and the long-term health of mothers. Obesity increases the risk of GDM and pre-eclampsia during pregnancy and elevates the risk of developing metabolic syndrome in later life. Offspring of obese mothers have an increased risk of obstetric morbidity and mortality and, consistent with the developmental origins of health and disease, a long term risk of childhood obesity and metabolic dysfunction. On the other hand, GDM also increases the risk of pre-eclampsia, caesarean section, and up to 50% of women will develop type 2 diabetes later in life. From a fetal point of view, it increases the risk of macrosomia, large-for-gestational-age fetuses, shoulder dystocia and birth trauma. The insulin resistance and inflammatory mediators released by a hypoxic trophoblast are mainly responsible for the poor pregnancy outcome in obese or GDM patients. The adequate management of both pathologies includes modifications in the diet and physical activity. Drug therapy should be considered when medical nutrition therapy and moderate physical activity fail to achieve treatment goals. The antenatal prediction of macrosomia is a challenge for physicians. The timing and the route of delivery should consider adequate metabolic control, gestational age, and optimal conditions for a vaginal birth. The best management of these pathologies includes pre-conception planning to reduce the risks during pregnancy and improve the quality of life of these patients.

scholarly journals Gestational Weight Gain Influences Neonatal Outcomes in Women With Obesity and Gestational Diabetes

2021 ◽  
Author(s):  
Ana M Ramos-Levi ◽  
Gemma Rodriguez-Carnero ◽  
Cristina Garcia-Fontao ◽  
Antia Fernandez-Pombo ◽  
Paula Andújar-Plata ◽  
...  
Keyword(s):  
Weight Gain ◽  
Birth Weight ◽  
Gestational Diabetes ◽  
Gestational Weight Gain ◽  
Gestational Age ◽  
Perinatal Outcomes ◽  
Large For Gestational Age ◽  
Gestational Weight ◽  
Increased Risk ◽  
The Impact

Abstract Background. Obesity and gestational diabetes mellitus (GDM) are associated to increased risk of perinatal complications and obesity in the offspring. However, the impact of gestational weight gain (GWG) on maternal and fetal outcomes has led to controversial results. Research design and methods. Retrospective study of 220 women with GDM and pre-pregnancy body mass index (BMI) ≥ 30 kg/m2. Pregnant women were classified according to the Institute of Medicine (IOM) recommendations regarding prior BMI and GWG. We evaluated the impact of GWG on birth weight and perinatal outcomes. Results. Mean maternal age was 34.7±5.3 years. Pre-pregnancy obesity was classified as grade I in 55.3% of cases, grade II in 32.0%, and grade III in 12.7%. GWG was adequate (5-9kg) in 24.2%, insufficient (< 5kg) in 41.8% and excessive (> 9kg) in 34.2%. Birthweight was within normal range in 81.9%, 3.6% were small for gestational age (SGA) and 14.4% were large for gestational age (LGA). Insufficient GWG was associated to a higher rate of SGA offspring, excessive GWG was associated to LGA and adequate GWG to normal birth weight. Conclusion. GWG in women with pre-pregnancy obesity and GDM impacts neonatal birthweight. Insufficient GWG is associated to SGA and excessive GWG is associated to LGA. Women with adequate GWG according to IOM guidelines obtained better perinatal outcomes.

scholarly journals The ambiguity of physical activity, exercise and atrial fibrillation

2018 ◽  
Vol 25 (6) ◽  
pp. 624-636 ◽  
Author(s):  
Bente Morseth ◽  
Maja-Lisa Løchen ◽  
Inger Ariansen ◽  
Marius Myrstad ◽  
Dag S Thelle
Keyword(s):  
Physical Activity ◽  
Risk Factors ◽  
Atrial Fibrillation ◽  
Cardiovascular Disease ◽  
Moderate Physical Activity ◽  
Intensive Exercise ◽  
Physiological Alterations ◽  
Increased Risk ◽  
Reduced Risk

Although commonly associated with cardiovascular disease or other medical conditions, atrial fibrillation may also occur in individuals without any known underlying conditions. This manifestation of atrial fibrillation has been linked to extensive and long-term exercise, as prolonged endurance exercise has shown to increase prevalence and risk of atrial fibrillation. In contrast, more modest physical activity is associated with a decreased risk of atrial fibrillation, and current research indicates a J-shaped association between atrial fibrillation and the broad range of physical activity and exercise. This has led to the hypothesis that the mechanisms underlying an increased risk of atrial fibrillation with intensive exercise are different from those underlying a reduced risk with moderate physical activity, possibly linked to distinctive characteristics of the population under study. High volumes of exercise over many years performed by lean, healthy endurance trained athletes may lead to cardiac (patho)physiological alterations involving the autonomic nervous system and remodelling of the heart. The mechanisms underlying a reduced risk of atrial fibrillation with light and moderate physical activity may involve a distinctive pathway, as physical activity can potentially reduce the risk of atrial fibrillation through favourable effects on cardiovascular risk factors.

Nutrition in pregnancy

2020 ◽  
pp. 2568-2574
Author(s):  
David J. Williams
Keyword(s):  
Birth Weight ◽  
Gestational Age ◽  
Later Life ◽  
Large For Gestational Age ◽  
Normal Body Mass Index ◽  
Nutritional Advice ◽  
Increased Risk ◽  
The World ◽  
Negative Effect ◽  
Access To Food

Nutritional requirements for healthy pregnancy vary according to a woman’s pre-pregnancy nutritional state and her access to food during pregnancy: there is no unifying nutritional advice that is appropriate for all pregnant women throughout the world, or even within nations. Around the world, obesity and excessive gestational weight gain are now more common risk factors for pregnancy complications than undernutrition. Compared with mothers who have a normal body mass index or BMI (18.5–24.9 kg/m2), obese mothers have an increased risk of gestational diabetes, pre-eclampsia, caesarean delivery, stillbirth, congenital malformations, and large for gestational age babies. Underweight mothers have an increased risk of small for gestational age babies, and preterm birth. Paternal obesity has a negative effect on fetal growth, probably mediated by inheritance of insulin resistance. Both low birth weight and high birth weight babies have an increased risk of obesity in later life.

Exercise and physical activity in pregnancy

2015 ◽  
Author(s):  
Sir Peter Gluckman ◽  
Mark Hanson ◽  
Chong Yap Seng ◽  
Anne Bardsley
Keyword(s):  
Physical Activity ◽  
Gestational Age ◽  
Late Gestation ◽  
Large For Gestational Age ◽  
Healthy Weight ◽  
Fitness Level ◽  
Beneficial Effects ◽  
Aerobic Conditioning ◽  
In Pregnancy

Exercise has many beneficial effects for pregnant women and their offspring, reducing insulin resistance and blood pressure and supporting angiogenesis, while also helping to maintain a healthy weight and body composition. Exercise/physical activity also been reported to reduce the risks of large for gestational age/small for gestational age babies and of preterm birth. Moderate exercise of 30 minutes or more on most days is recommended. Reasonable goals of aerobic conditioning in pregnancy should be to maintain a good fitness level throughout pregnancy without trying to reach peak fitness level or train for athletic competition. However, extreme exercise in late gestation is cautioned against, as it is associated with lower birth weights and the possibility of long-term adverse consequences on the offspring.

scholarly journals Metformin in pregnancy and risk of adverse long-term outcomes: a register-based cohort study

2022 ◽  
Vol 10 (1) ◽  
pp. e002363
Author(s):  
Kerstin M G Brand ◽  
Laura Saarelainen ◽  
Jaak Sonajalg ◽  
Emmanuelle Boutmy ◽  
Caroline Foch ◽  
...  
Keyword(s):  
Cohort Study ◽  
Gestational Age ◽  
Combination Treatment ◽  
Adverse Outcomes ◽  
Sensitivity Analyses ◽  
Large For Gestational Age ◽  
Long Term Outcomes ◽  
Increased Risk ◽  
Secondary Outcomes

IntroductionThis study aimed to investigate if maternal pregnancy exposure to metformin is associated with increased risk of long-term and short-term adverse outcomes in the child.Research design and methods This register-based cohort study from Finland included singleton children born 2004–2016 with maternal pregnancy exposure to metformin or insulin (excluding maternal type 1 diabetes): metformin only (n=3967), insulin only (n=5273) and combination treatment (metformin and insulin; n=889). The primary outcomes were long-term offspring obesity, hypoglycemia, hyperglycemia, diabetes, hypertension, polycystic ovary syndrome, and challenges in motor–social development. In a sensitivity analysis, the primary outcomes were investigated only among children with maternal gestational diabetes. Secondary outcomes were adverse outcomes at birth. Analyses were conducted using inverse- probability of treatment weighting (IPTW), with insulin as reference.Results  Exposure to metformin or combination treatment versus insulin was not associated with increased risk of long-term outcomes in the main or sensitivity analyses. Among the secondary outcomes, increased risk of small for gestational age (SGA) was observed for metformin (IPTW-weighted OR 1.65, 95% CI 1.16 to 2.34); increased risk of large for gestational age, preterm birth and hypoglycemia was observed for combination treatment. No increased risk was observed for neonatal mortality, hyperglycemia, or major congenital anomalies.Conclusions This study found no increased long-term risk associated with pregnancy exposure to metformin (alone or in combination with insulin), compared with insulin. The increased risk of SGA associated with metformin versus insulin suggests caution in pregnancies with at-risk fetal undernutrition. The increased risks of adverse outcomes at birth associated with combination treatment may reflect confounding by indication or severity.

Pregnancy Outcomes among Women with Class III Obesity with Pre-diabetic Early Hemoglobin A1C

2021 ◽  
Author(s):  
Jacquelyn Dillon ◽  
Courtney J. Mitchell ◽  
Tressa Ellett ◽  
Anne Siegel ◽  
Anna E. Denoble ◽  
...  
Keyword(s):  
Gestational Diabetes ◽  
Gestational Age ◽  
Primary Outcome ◽  
Large For Gestational Age ◽  
Multiple Gestation ◽  
Maternal Body Mass Index ◽  
Class Iii ◽  
Increased Risk ◽  
Class Iii Obesity ◽  
Gestational Age At Delivery

Objective We aimed to assess the risk of developing gestational diabetes mellitus (GDM) in women with a normal A1C (<5.7) compared with those with an A1C in the pre-diabetic range (5.7–6.4). Study Design This study comprises of a retrospective cohort of non-anomalous singleton pregnancies with maternal body mass index (BMI) ≥40 at a single institution from 2013 to 2017. Pregnancies with multiple gestation, late entry to care, type 1 or 2 diabetes, and missing diabetes-screening information were excluded. The primary outcome was development of GDM. Secondary outcomes included fetal growth restriction, macrosomia, gestational age at delivery, large for gestational age, delivery BMI at delivery, total weight gain in pregnancy, induction of labor, shoulder dystocia, and cesarean delivery. Bivariate statistics were used to compare demographics, pregnancy complications, and delivery characteristics of women who had an early A1C < 5.7 and A1C 5.7 to 6.4. Multivariable analyses were used to estimate the odds of the primary outcome. Results Eighty women (68%) had an early A1C <5.7 and 38 (32%) had a A1C 5.7 to 6.4. Women in the lower A1C group were less likely to be Black (45 vs. 74%, p = 0.01). No differences in other baseline demographics were observed. The median A1C was 5.3 for women with A1C < 5.7 and 5.8 for women with A1C 5.7 to 6.4 (p < 0.001). GDM was significantly more common in women with A1C 5.7 to 6.4 (3.8 vs. 24%, p = 0.002). Women with pre-diabetic range A1C had an odd ratio of 11.1 (95% CI 2.49–48.8) for GDM compared with women with a normal A1C. Conclusion Women with class III obesity and a pre-diabetic range A1C are at an increased risk for gestational diabetes when compared with those with a normal A1C in early pregnancy. Key Points

scholarly journals Large for Gestational Age and Risk for Academic Delays and Learning Disabilities: Assessing Modification by Maternal Obesity and Diabetes

2020 ◽  
Vol 17 (15) ◽  
pp. 5473
Author(s):  
Kathleen O’Connor Duffany ◽  
Katharine H. McVeigh ◽  
Heather S. Lipkind ◽  
Trace S. Kershaw ◽  
Jeannette R. Ickovics
Keyword(s):  
New York ◽  
Special Education ◽  
Prenatal Care ◽  
Gestational Diabetes ◽  
Gestational Age ◽  
Maternal Obesity ◽  
Large For Gestational Age ◽  
Obesity And Diabetes ◽  
Increased Risk ◽  
Academic Underperformance

The objective of this study was to examine academic delays for children born large for gestational age (LGA) and assess effect modification by maternal obesity and diabetes and then to characterize risks for LGA for those with a mediating condition. Cohort data were obtained from the New York City Longitudinal Study of Early Development, linking birth and educational records (n = 125,542). Logistic regression was used to compare children born LGA (>90th percentile) to those born appropriate weight (5–89th percentile) for risk of not meeting proficiency on assessments in the third grade and being referred to special education. Among children of women with gestational diabetes, children born LGA had an increased risk of underperforming in mathematics (ARR: 1.18 (95% CI: 1.07–1.31)) and for being referred for special education (ARR: 1.18 (95% CI: 1.02–1.37)). Children born LGA but of women who did not have gestational diabetes had a slightly decreased risk of academic underperformance (mathematics-ARR: 0.94 (95% CI: 0.90–0.97); Language arts-ARR: 0.96 (95% CI: 0.94–0.99)). Children born to women with gestational diabetes with an inadequate number of prenatal care visits were at increased risk of being born LGA, compared to those receiving extensive care (ARR: 1.67 (95% CI: 1.20–2.33)). Children born LGA of women with diabetes were at increased risk of delays; greater utilization of prenatal care among these diabetic women may decrease the incidence of LGA births.

scholarly journals A History of Large for Gestational Age at Birth and Future Risk for Pediatric Neoplasms: A Population-Based Cohort Study

2020 ◽  
Vol 9 (5) ◽  
pp. 1336
Author(s):  
Roy Kessous ◽  
Eyal Sheiner ◽  
Daniella Landau ◽  
Tamar Wainstock
Keyword(s):  
Gestational Age ◽  
Cumulative Incidence ◽  
Population Based ◽  
Large For Gestational Age ◽  
Kidney Tumors ◽  
Childhood Malignancy ◽  
Increased Risk ◽  
Childhood Neoplasms ◽  
Future Risk

Objective: The aim of this study was to evaluate the association between large for gestational age (LGA) at birth and future risk of childhood neoplasm. Study design: a population-based cohort to compare the long-term risk (up to the age of 18 years) of childhood neoplasms (benign and malignant) in children that were born LGA vs. those that were appropriate for gestational age (AGA), between the years 1991–2014. Childhood neoplasms diagnosis were defined according to international classification of disease 9 (ICD-9) codes recorded medical files. Kaplan–Meier survival curves were used in order to compare cumulative incidence of oncological morbidity over the study period. The Cox proportional hazards model was used to control for confounders. Results: 231,344 infants met the inclusion criteria; out of those 10,369 were diagnosed LGA at birth. Children that were LGA at birth had a higher incidence of leukemia (OR 2.25, 95%CI 1.08–4.65, p = 0.025) as well as kidney tumors (OR = 4.7, 95%CI = 1.02–21.9, p = 0.028). In addition, cumulative incidence over time of childhood malignancies, leukemia, and kidney tumors were significantly higher in LGA children (Log Rank = 0.010, 0.021, and 0.028, respectively). In a Cox regression model controlling for other perinatal confounders, LGA at birth remained independently associated with an increased risk for childhood malignancy (adjusted HR 1.51, 95%CI 1.02–2.23, p = 0.039). Conclusion: LGA at birth is associated with increased long-term risk for childhood malignancy and specifically leukemia and kidney tumors. This possible link may help to improve current knowledge regarding potential exposures that are associated with childhood cancer development.

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