Maternal Obesity, Gestational Diabetes Increase Perinatal Adverse Event Risk

Maternal obesity increases the risk for perinatal adverse effects especially among individuals with comorbid gestational diabetes, according to study findings in Obesity Reviews.

Among neonatal infants born from patients with gestational diabetes and obesity, common issues include jaundice, increased birth weight, and fetal death. However, whether obesity and gestational diabetes are independent risk factors remains unclear.

Researchers conducted a meta-analysis to assess differences in neonatal outcomes among birth parents with obesity and with or without gestational diabetes. Studies were sourced from the MEDLINE and EMBASE via OVID, Scopus, CINAHL, and the Web of Science Core Collection databases.

Inclusion criteria were study populations of women with maternal obesity, defined by a body mass index (BMI) of 30 kg/m² or greater. Exclusion criteria included patients diagnosed with polycystic ovary syndrome, patients who underwent bariatric surgery, and in vitro fertilization pregnancies. 

The exposure group comprised patients with gestational diabetes and maternal obesity, whereas the control group included patients with maternal obesity only. The neonatal outcomes included large for gestational age (LGA) and macrosomia, small for gestational age (SGA), perinatal mortality, serious morbidity, congenital anomalies, preterm or premature birth, neonatal hypoglycemia, and respiratory distress syndrome. 

The analysis included 28 studies, of which 14 were retrospective, 6 were prospective, and 8 were case-controlled. Among the 10 outcomes of interest, the most commonly studied were LGA (17 studies), preterm delivery (11 studies), birth weight (11 studies), and macrosomia (10 studies). 

LGA was independently associated with both obesity (odds ratio [OR], 1.98; 95% CI, 1.56-2.52; P <.0001) and gestational diabetes (OR, 2.01; 95% CI, 1.89-2.1; P <.0001) relative to participants with normal weight, whereas patients with both obesity and gestational diabetes had an even greater risk for LGA (OR, 3.22; 95% CI, 2.17-4.79; P <.0001). Compared with obesity alone, obesity and gestational diabetes was linked to an increased risk for LGA neonates (OR, 1.47; 95% CI, 1.16-1.87; P =.0014).

Macrosomia risk was higher among patients with maternal obesity compared with normal weight (OR, 2.93; 95% CI, 1.71-5.03; P <.0001). 

Patients with obesity had neonates that were 113 g (95% CI, 69-156; P <.0001) heavier than neonates born to patients with normal weight. Patients with obesity and gestational diabetes birthed neonates that were 176 g (95% CI, 89-263; P <.0001) heavier than neonates born to patients with normal weight.

Relative to normal weight, the presence of both obesity and gestational diabetes was linked to an increased risk for SGA neonates (OR, 1.25; 95% CI, 0.41-3.79) and shoulder dystocia (OR, 1.99; 95% CI, 1.31-3.03; P =.001). 

Study limitations include moderate heterogeneity between studies, variations in diagnostic criteria for gestational diabetes, and the inability to assess the impact of insulin on participants. 

“Attention to interventional strategies that can improve the perinatal outcomes for pregnancies affected by maternal obesity is urgently needed to mitigate both short- and longer-term risks to the unborn child,” the researchers concluded. 

This article originally appeared on Endocrinology Advisor