Prevalence and Risk Factors of gestational diabetes in obese adults
DOI:
https://doi.org/10.5281/zenodo.22812643Keywords:
gestational diabetes, obesity, prevalence, risk factors, pregnancyAbstract
Background: Obesity is the strongest modifiable risk factor for gestational diabetes mellitus (GDM), but most prevalence estimates combine obese and non-obese women, obscuring how risk varies within the obese population itself.
Objective: This study determined the prevalence of GDM among obese pregnant adults and identified maternal characteristics independently associated with GDM within this population.
Methods: We conducted a retrospective cross-sectional study of 1,248 pregnant adults with pre-pregnancy BMI of 30 kg/m2 or higher, screened with a 75 g oral glucose tolerance test at 24-28 weeks and diagnosed using IADPSG criteria. Risk factors significant on univariate analysis were entered into multivariable logistic regression.
Results: Overall GDM prevalence was 27.4%, rising from 21.3% in class I obesity to 38.6% in class III obesity. Previous GDM, family history of type 2 diabetes, coexisting polycystic ovary syndrome, maternal age of 35 years or older, excessive gestational weight gain, and obesity class III each remained independently associated with GDM after adjustment.
Conclusions: More than a quarter of obese pregnant adults developed GDM, with risk rising steeply across obesity classes. Risk stratification for obese women should incorporate age, family history, prior GDM, PCOS and weight-gain trajectory rather than treating obesity as a single undifferentiated exposure.
References
Ferrara, A. (2007) Increasing prevalence of gestational diabetes mellitus: a public health perspective. Diabetes Care, 30(Suppl 2): S141-S146. DOI: 10.2337/dc07-s206
HAPO Study Cooperative Research Group (2008) Hyperglycemia and adverse pregnancy outcomes. New England Journal of Medicine, 358(19): 1991-2002. DOI: 10.1056/NEJMoa0707943
Metzger, B.E., Gabbe, S.G., Persson, B., Buchanan, T.A., Catalano, P.A., Damm, P., et al. (2010) International association of diabetes and pregnancy study groups recommendations on the diagnosis and classification of hyperglycemia in pregnancy. Diabetes Care, 33(3): 676-682. DOI: 10.2337/dc09-1848
Sacks, D.A., Hadden, D.R., Maresh, M., Deerochanawong, C., Dyer, A.R., Metzger, B.E., et al. (2012) Frequency of gestational diabetes mellitus at collaborating centers based on IADPSG consensus panel-recommended criteria: the Hyperglycemia and Adverse Pregnancy Outcome (HAPO) Study. Diabetes Care, 35(3): 526-528. DOI: 10.2337/dc11-1641
Feig, D.S., Zinman, B., Wang, X., Hux, J.E. (2014) Trends in incidence of diabetes in pregnancy and serious perinatal outcomes: a large, population-based study in Ontario, Canada, 1996-2010. Canadian Medical Association Journal, 186(13): 963-970. DOI: 10.1503/cmaj.131244
Torloni, M.R., Betran, A.P., Horta, B.L., Nakamura, M.U., Atallah, A.N., Moron, A.F., et al. (2009) Prepregnancy BMI and the risk of gestational diabetes: a systematic review of the literature with meta-analysis. Obesity Reviews, 10(2): 194-203. DOI: 10.1111/j.1467-789X.2008.00541.x
Chu, S.Y., Callaghan, W.M., Kim, S.Y., Schmid, C.H., Lau, J., England, L.J., et al. (2007) Maternal obesity and risk of gestational diabetes mellitus. Diabetes Care, 30(8): 2070-2076. DOI: 10.2337/dc06-2559a
Ryan, E.A., Enns, L. (1988) Role of gestational hormones in the induction of insulin resistance. Journal of Clinical Endocrinology and Metabolism, 67(2): 341-347. DOI: 10.1210/jcem-67-2-341
Barbour, L.A., McCurdy, C.E., Hernandez, T.L., Kirwan, J.P., Catalano, P.M., Friedman, J.E. (2007) Cellular mechanisms for insulin resistance in normal pregnancy and gestational diabetes. Diabetes Care, 30(Suppl 2): S112-S119. DOI:
2337/dc07-s202 10. Catalano, P.M., Huston, L., Amini, S.B., Kalhan, S.C. (1999) Longitudinal changes in glucose metabolism during pregnancy in obese women with normal glucose tolerance and gestational diabetes mellitus. American Journal of Obstetrics and Gynecology, 180(4): 903-916. DOI: 10.1016/S0002-9378(99)70662-9
Kim, S.Y., Dietz, P.M., England, L., Morrow, B., Callaghan, W.M. (2007) Trends in pre-pregnancy obesity in nine states, 1993-2003. Obesity, 15(4): 986-993. DOI: 10.1038/oby.2007.621
Poston, L., Caleyachetty, R., Cnattingius, S., Corvalan, C., Uauy, R., Herring, S., et al. (2016) Preconceptional and maternal obesity: epidemiology and health consequences. Lancet Diabetes & Endocrinology, 4(12): 1025-1036. DOI: 10.1016/S2213-8587(16)30217-0
Yogev, Y., Visser, G.H. (2009) Obesity, gestational diabetes and pregnancy outcome. Seminars in Fetal and Neonatal Medicine, 14(2): 77-84. DOI: 10.1016/j.siny.2008.09.002
Solomon, C.G., Willett, W.C., Carey, V.J., Rich-Edwards, J., Hunter, D.J., Colditz, G.A., et al. (1997) A prospective study of pregravid determinants of gestational diabetes mellitus. JAMA, 278(13): 1078-1083. DOI: 10.1001/jama.1997.03550130052036
Ben-Haroush, A., Yogev, Y., Hod, M. (2004) Epidemiology of gestational diabetes mellitus and its association with Type 2 diabetes. Diabetic Medicine, 21(2): 103-113. DOI: 10.1046/j.1464-5491.2003.00985.x
Hedderson, M.M., Gunderson, E.P., Ferrara, A. (2010) Gestational weight gain and risk of gestational diabetes mellitus. Obstetrics & Gynecology, 115(3): 597-604. DOI: 10.1097/AOG.0b013e3181cfce4f
American College of Obstetricians and Gynecologists (2018) Practice Bulletin No. 190: gestational diabetes mellitus. Obstetrics & Gynecology, 131(2): e49-e64. DOI: 10.1097/AOG.0000000000002501
Xiong, X., Saunders, L.D., Wang, F.L., Demianczuk, N.N. (2001) Gestational diabetes mellitus: prevalence, risk factors, maternal and infant outcomes. International Journal of Gynecology & Obstetrics, 75(3): 221-228. DOI: 10.1016/S0020-7292(01)00496-9
Bener, A., Saleh, N.M., Al-Hamaq, A. (2011) Prevalence of gestational diabetes and associated maternal and neonatal complications in a fast-developing community: global comparisons. International Journal of Women's Health, 3: 367-373. DOI: 10.2147/IJWH.S26094
Wahabi, H.A., Fayed, A., Esmaeil, S., Mamdouh, H., Kotb, R. (2014) Riyadh Mother and Baby Multicenter Cohort Study: the cohort profile. PLoS ONE, 9(2): e88566. DOI: 10.1371/journal.pone.0088566
Alfadhli, E.M. (2015) Gestational diabetes mellitus. Saudi Medical Journal, 36(4): 399-406. DOI: 10.15537/smj.2015.4.10307
Kim, C., Newton, K.M., Knopp, R.H. (2002) Gestational diabetes and the incidence of type 2 diabetes: a systematic review. Diabetes Care, 25(10): 1862-1868. DOI: 10.2337/diacare.25.10.1862
Bellamy, L., Casas, J.P., Hingorani, A.D., Williams, D. (2009) Type 2 diabetes mellitus after gestational diabetes: a systematic review and meta-analysis. Lancet, 373(9677): 1773-1779. DOI: 10.1016/S0140-6736(09)60731-5
Retnakaran, R., Qi, Y., Sermer, M., Connelly, P.W., Hanley, A.J., Zinman, B. (2008) Glucose intolerance in pregnancy and future risk of pre-diabetes or diabetes. Diabetes Care, 31(10): 2026-2031. DOI: 10.2337/dc08-0972
Zhang, C., Ning, Y. (2011) Effect of dietary and lifestyle factors on the risk of gestational diabetes: review of epidemiologic evidence. American Journal of Clinical Nutrition, 94(6 Suppl): 1975S-1979S. DOI: 10.3945/ajcn.110.001032
American Diabetes Association (2023) 15. Management of diabetes in pregnancy: standards of care in diabetes-2023. Diabetes Care, 46(Suppl 1): S230-S253. DOI: 10.2337/dc23-S015
Kampmann, U., Madsen, L.R., Skajaa, G.O., Iversen, D.S., Moeller, N., Ovesen, P. (2015) Gestational diabetes: a clinical update. World Journal of Diabetes, 6(8): 1065-1072. DOI: 10.4239/wjd.v6.i8.1065
Crowther, C.A., Hiller, J.E., Moss, J.R., McPhee, A.J., Jeffries, W.S., Robinson, J.S. (2005) Effect of treatment of gestational diabetes mellitus on pregnancy outcomes. New England Journal of Medicine, 352(24): 2477-2486. DOI: 10.1056/NEJMoa042973
Landon, M.B., Spong, C.Y., Thom, E., Carpenter, M.W., Ramin, S.M., Casey, B., et al. (2009) A multicenter, randomized trial of treatment for mild gestational diabetes. New England Journal of Medicine, 361(14): 1339-1348. DOI: 10.1056/NEJMoa0902430
Catalano, P.M., Shankar, K. (2017) Obesity and pregnancy: mechanisms of short term and long term adverse consequences for mother and child. BMJ, 356: j1. DOI: 10.1136/bmj.j1
Petry, C.J. (2010) Gestational diabetes: risk factors and recent advances in its genetics and pathophysiology. British Journal of Nutrition, 104(6): 775-787. DOI: 10.1017/S0007114510001741
Buchanan, T.A., Xiang, A.H. (2005) Gestational diabetes mellitus. Journal of Clinical Investigation, 115(3): 485-491. DOI: 10.1172/JCI24531
Chiefari, E., Arcidiacono, B., Foti, D., Brunetti, A. (2017) Gestational diabetes mellitus: an updated overview. Frontiers in Endocrinology, 8: 107. DOI: 10.3389/fendo.2017.00107
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