The Association of Adverse Perinatal Outcomes in Pregnancies with gestational diabetes and excessive gestational weight gain according to obesity status.
Henry Lesser, Vani Movva, Amanda Young, Celia Gray, Dhanya Mackeen
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引用次数: 0
Abstract
Objective: Obesity, gestational diabetes mellitus (GDM), and excessive gestational weight gain (EGWG) are associated with adverse outcomes. It is unclear which carries the greatest risk. In this study, the relationship of obesity, GDM, and EGWG independently and concomitantly was analyzed to determine if one is a greater risk factor than the other.
Study design: A retrospective cohort study of singleton gestations at Geisinger from 10/2007-3/2023 was performed. Exclusion criteria were pregravid BMI <18 kg/m2, gestational age (GA)<34 weeks, pregestational diabetes or chronic hypertension, prior cesarean delivery (CD) or contraindication to vaginal delivery. Patients were grouped by BMI class and the order of groups within each BMI for the test for trend were no GDM/no EGWG, GDM/no EGWG, no GDM/EGWG, and GDM/EGWG. The rates of HDP (hypertensive disorders of pregnancy), severe HDP, CD, large for gestational age (LGA), shoulder dystocia, and neonatal intensive care unit (NICU) admission >35 weeks were evaluated. A test for trend and odds ratios with 95% CIs were reported. P-values were reported across the GDM/EGWG groups per BMI category.
Results: 42,627 pregnancies were included. At each BMI category, HDP, severe HDP, CD, LGA, and shoulder dystocia generally increased from patients with no GDM/no EGWG to those with GDM/no EGWG to those with no GDM/EGWG to those with GDM/EGWG. NICU admission ≥35 weeks did not follow this progression.
Conclusions: EGWG poses a greater risk than GDM regardless of pregravid BMI for HDP, severe HDP, CD, LGA, and shoulder dystocia. Attention should be given to determine the optimal strategy to manage pregnancies experiencing EGWG.
期刊介绍:
The American Journal of Perinatology is an international, peer-reviewed, and indexed journal publishing 14 issues a year dealing with original research and topical reviews. It is the definitive forum for specialists in obstetrics, neonatology, perinatology, and maternal/fetal medicine, with emphasis on bridging the different fields.
The focus is primarily on clinical and translational research, clinical and technical advances in diagnosis, monitoring, and treatment as well as evidence-based reviews. Topics of interest include epidemiology, diagnosis, prevention, and management of maternal, fetal, and neonatal diseases. Manuscripts on new technology, NICU set-ups, and nursing topics are published to provide a broad survey of important issues in this field.
All articles undergo rigorous peer review, with web-based submission, expedited turn-around, and availability of electronic publication.
The American Journal of Perinatology is accompanied by AJP Reports - an Open Access journal for case reports in neonatology and maternal/fetal medicine.