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Overweight and obese in gestational diabetes: the impact on pregnancy outcome.
Am J Obstet Gynecol 2005; 192(6):1768-76AJ

Abstract

OBJECTIVE

We sought to investigate the relationship between prepregnancy weight, treatment modality (diet or insulin), level of glycemic control, and pregnancy outcome.

STUDY DESIGN

We recruited women with gestational diabetes (GDM) from inner city prenatal clinics. All women were instructed in the use of an intensified management protocol using memory reflectance meters. Outcomes were analyzed according to maternal prepregnancy body mass index (BMI, kg/m 2) categories: normal weight (BMI 18.5-24.9), overweight (BMI 25-29.9), and obese (BMI > or =30), and by diet or insulin therapy and glycemic control (mean blood glucose <100 mg/dL = good control). Pregnancy outcome variables included a composite outcome (at least 1 of the following: neonatal metabolic complications, large-for-gestational age or macrosomic infants, NICU admission for >24 hours, and the need for respiratory support) (not including oxygen therapy). In addition to composite outcome, a bivariate analysis was performed for each single variable, including preeclampsia and cesarean section delivery.

RESULTS

Four thousand and one women were enrolled. Obese women who achieved targeted levels of glycemic control had comparable pregnancy outcomes to normal weight and overweight women only when they were treated with insulin. Normal weight women treated with diet therapy who achieved targeted levels of glycemic control had good outcomes, but obese women treated with diet therapy who achieved targeted levels of glycemic control, nevertheless, had a 2- to 3-fold higher risk for adverse pregnancy outcome when compared with overweight and normal weight patients with well-controlled GDM. Women with GDM who failed to achieve established levels of glycemic control had significantly higher adverse pregnancy outcomes in all 3 maternal weight groups.

CONCLUSION

In obese women with BMI > or =30 with GDM, achievement of targeted levels of glycemic control was associated with enhanced outcome only in women treated with insulin.

Authors+Show Affiliations

Department of Obstetrics and Gynecology, St Luke's-Roosevelt Hospital Center, University Hospital of Columbia University, NY 10019, USA. odlanger@chpnet.orgNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

15970805

Citation

Langer, Oded, et al. "Overweight and Obese in Gestational Diabetes: the Impact On Pregnancy Outcome." American Journal of Obstetrics and Gynecology, vol. 192, no. 6, 2005, pp. 1768-76.
Langer O, Yogev Y, Xenakis EM, et al. Overweight and obese in gestational diabetes: the impact on pregnancy outcome. Am J Obstet Gynecol. 2005;192(6):1768-76.
Langer, O., Yogev, Y., Xenakis, E. M., & Brustman, L. (2005). Overweight and obese in gestational diabetes: the impact on pregnancy outcome. American Journal of Obstetrics and Gynecology, 192(6), pp. 1768-76.
Langer O, et al. Overweight and Obese in Gestational Diabetes: the Impact On Pregnancy Outcome. Am J Obstet Gynecol. 2005;192(6):1768-76. PubMed PMID: 15970805.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Overweight and obese in gestational diabetes: the impact on pregnancy outcome. AU - Langer,Oded, AU - Yogev,Yariv, AU - Xenakis,Elly M J, AU - Brustman,Lois, PY - 2005/6/23/pubmed PY - 2005/7/26/medline PY - 2005/6/23/entrez SP - 1768 EP - 76 JF - American journal of obstetrics and gynecology JO - Am. J. Obstet. Gynecol. VL - 192 IS - 6 N2 - OBJECTIVE: We sought to investigate the relationship between prepregnancy weight, treatment modality (diet or insulin), level of glycemic control, and pregnancy outcome. STUDY DESIGN: We recruited women with gestational diabetes (GDM) from inner city prenatal clinics. All women were instructed in the use of an intensified management protocol using memory reflectance meters. Outcomes were analyzed according to maternal prepregnancy body mass index (BMI, kg/m 2) categories: normal weight (BMI 18.5-24.9), overweight (BMI 25-29.9), and obese (BMI > or =30), and by diet or insulin therapy and glycemic control (mean blood glucose <100 mg/dL = good control). Pregnancy outcome variables included a composite outcome (at least 1 of the following: neonatal metabolic complications, large-for-gestational age or macrosomic infants, NICU admission for >24 hours, and the need for respiratory support) (not including oxygen therapy). In addition to composite outcome, a bivariate analysis was performed for each single variable, including preeclampsia and cesarean section delivery. RESULTS: Four thousand and one women were enrolled. Obese women who achieved targeted levels of glycemic control had comparable pregnancy outcomes to normal weight and overweight women only when they were treated with insulin. Normal weight women treated with diet therapy who achieved targeted levels of glycemic control had good outcomes, but obese women treated with diet therapy who achieved targeted levels of glycemic control, nevertheless, had a 2- to 3-fold higher risk for adverse pregnancy outcome when compared with overweight and normal weight patients with well-controlled GDM. Women with GDM who failed to achieve established levels of glycemic control had significantly higher adverse pregnancy outcomes in all 3 maternal weight groups. CONCLUSION: In obese women with BMI > or =30 with GDM, achievement of targeted levels of glycemic control was associated with enhanced outcome only in women treated with insulin. SN - 0002-9378 UR - https://www.unboundmedicine.com/medline/citation/15970805/Overweight_and_obese_in_gestational_diabetes:_the_impact_on_pregnancy_outcome_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0002937805000244 DB - PRIME DP - Unbound Medicine ER -