University of Oulu

Ijäs H, Koivunen S, Raudaskoski T, Kajantie E, Gissler M, Vääräsmäki M (2019) Independent and concomitant associations of gestational diabetes and maternal obesity to perinatal outcome: A register-based study. PLoS ONE 14(8): e0221549.

Independent and concomitant associations of gestational diabetes and maternal obesity to perinatal outcome : a register-based study

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Author: Ijäs, Hilkka1,2; Koivunen, Sanna1,2; Raudaskoski, Tytti1;
Organizations: 1PEDEGO Research Unit (Research Unit for Pediatrics, Dermatology, Clinical Genetics, Obstetrics and Gynecology), Medical Research Center Oulu (MRC Oulu), Oulu University Hospital and University of Oulu, Oulu, Finland
2THL National Institute for Health and Welfare, Department of Chronic Disease Prevention, Helsinki and Oulu, Finland
3Children’s Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
4Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway
5Karolinska Institute, Stockholm, Sweden
Format: article
Version: published version
Access: open
Online Access: PDF Full Text (PDF, 0.6 MB)
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Language: English
Published: Public Library of Science, 2019
Publish Date: 2020-04-27


Aims: Gestational diabetes (GDM) is often accompanied by maternal overweight. Our aim was to evaluate the separate and concomitant effects of GDM and maternal overweight/obesity on perinatal outcomes.

Methods: We used the Finnish Medical Birth Register to identify all 24,577 women with a singleton pregnancy who delivered in 2009 in Finland and underwent an oral glucose tolerance test (OGTT). Women were divided into groups according to the result of OGTT (GDM/no GDM) and pre-pregnancy body mass index (BMI): normal weight (≤24.9 kg/m²), overweight (25.0–29.9 kg/m²), and obese (≥30.0 kg/m²). Primary outcomes included macrosomia, caesarean delivery, and treatment at neonatal ward. Normal weight women without GDM constituted the reference group.

Results: Compared to reference group, overweight or obese women without GDM had an increased risk of macrosomia [odds ratio adjusted for age, parity, smoking and socio-economic status (aOR)1.18 (95% CI 1.09–1.28) and 1.50 (95% CI 1.19–1.88)], and caesarean delivery [aORs 1.17 (95% CI 1.07–1.28) and 1.52 (95% CI 1.37–1.69)], respectively. In normal weight GDM women the risk of macrosomia [aOR 1.17 (95% CI 0.85–1.62)] and caesarean delivery [aOR 1.10 (95% CI 0.96–1.27)] was not significantly increased as compared to normal weight women without GDM. GDM increased the risk of treatment at neonatal ward in all BMI categories and maternal obesity without GDM was also a risk factor for treatment at neonatal ward. Interaction p values between BMI and GDM on these outcomes were <0.001.

Conclusions: Maternal overweight and obesity without GDM increased the risk of macrosomia and caesarean delivery when compared to the reference group. These risks were amplified when overweight/obesity was accompanied by GDM. Obesity without GDM was a risk factor for treatment at neonatal ward; GDM increased this risk in all BMI categories. Our results suggest that especially maternal obesity should be considered as a risk factor for adverse pregnancy outcomes and GDM further amplifies this risk.

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Series: PLoS one
ISSN: 1932-6203
ISSN-E: 1932-6203
ISSN-L: 1932-6203
Volume: 14
Issue: 8
Article number: e0221549
DOI: 10.1371/journal.pone.0221549
Type of Publication: A1 Journal article – refereed
Field of Science: 3123 Gynaecology and paediatrics
3121 General medicine, internal medicine and other clinical medicine
Funding: This study was funded by Academy of Finland (Grants 127437, 129306, 130326, 134791, 263924 and 315690 to EK); the European Commission (Horizon2020 award 733280 RECAP Research on Children and Adults Born Preterm to Eero Kajantie); the Finnish Foundation for Pediatric Research (to Eero Kajantie); the Juho Vainio Foundation (to Eero Kajantie and Marja Vääräsmäki); the Novo Nordisk Foundation (to Eero Kajantie and Marja Vääräsmäki); the Signe and Ane Gyllenberg Foundation (to Eero Kajantie); the Sigrid Jusélius Foundation (to Eero Kajantie); and the Yrjö Jahnsson Foundation (to Eero Kajantie and Marja Vääräsmäki). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
Copyright information: © 2019 Ijäs et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.