Clinical Question: J.K. is a 36 y/o overweight female, who comes to the OB/GYN clinic discussing her risk of becoming pregnant. She wants to know if she is at increased risk of developing gestational diabetes due to her weight?
PICO Question:
Do pregnant ladies who had a pregestational BMI greater or equal to 25 have a higher incidence of gestational diabetes?
PICO elements:
P: pregestational overweight females (BMI greater or equal to 25)
I: weight gain/overweight
C: Pregestational females not overweight (BMI between 18.5 and 25)
O: Gestational Diabetes
Search Strategy:
Search 1 PUBMed:
Keywords: Pre-pregnancy, BMI, Gestational Diabetes
Filter: Publication date within the last year
Number of articles returned: 719
Search 2 PUBMed:
Keywords: Pre-pregnancy, Body mass index, gestational diabetes
Filter: Publication date within the last 5 years
Number of articles returned 3,400
1. Gestational weight gain and gestational diabetes among Emirati and Arab women in the United Arab Emirates: results from the MISC cohort
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6892062/
Abstract
Background
Nutritional status of women during pregnancy has been considered an important prognostic indicator of pregnancy outcomes.
Objectives
To investigate the pattern of gestational weight gain (GWG) and gestational diabetes mellitus (GDM) and their risk factors among a cohort of Emirati and Arab women residing in the United Arab Emirates (UAE). A secondary objective was to investigate pre-pregnancy body mass index (BMI) and its socio-demographic correlates among study participants.
Methods
Data of 256 pregnant women participating in the cohort study, the Mother-Infant Study Cohort (MISC) were used in this study. Healthy pregnant mothers with no history of chronic diseases were interviewed during their third trimester in different hospitals in UAE. Data were collected using interviewer-administered multi-component questionnaires addressing maternal sociodemographic and lifestyle characteristics. Maternal weight, weight gain, and GDM were recorded from the hospital medical records.
Results
Among the study participants, 71.1% had inadequate GWG: 31.6% insufficient and 39.5% excessive GWG. 19.1% reported having GDM and more than half of the participants (59.4%) had a pre-pregnancy BMI ≥ 25 kg/m2. The findings of the multiple multinomial logistic regression showed that multiparous women had decreased odds of excessive gain as compared to primiparous [odds ratio (OR): 0.17; 95% CI: 0.05–0.54]. Furthermore, women with a pre-pregnancy BMI ≥ 25 kg/m2 had increased odds of excessive gain (OR: 2.23; 95%CI: 1.00–5.10) as compared to those with pre-pregnancy BMI < 25 kg/m2. Similarly, women who had a pre-pregnancy BMI ≥ 25 kg/m2 were at higher risk of having GDM (OR: 2.37; 95%CI: 1.10–5.12). As for the associations of women’s characteristics with pre-pregnancy BMI, age and regular breakfast consumption level were significant predictors of higher pre-pregnancy BMI.
Conclusions
This study revealed alarming prevalence rates of inadequate, mainly excessive, GWG and GDM among the MISC participants. Pre-pregnancy BMI was found a risk factor for both of these conditions (GWG and GDM). In addition, age and regular breakfast consumption were significant determinants of pre-pregnancy BMI. Healthcare providers are encouraged to counsel pregnant women to maintain normal body weight before and throughout pregnancy by advocating healthy eating and increased physical activity in order to reduce the risk of excessive weight gain and its associated complications.
2. The effect of pre-pregnancy body mass index and excessive gestational weight gain on the risk of gestational diabetes in advanced maternal age
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5601658/?report=reader#R8
The effect of pre-pregnancy body mass index and excessive gestational weight gain on the risk of gestational diabetes in advanced maternal age
Beibei Dong, Hong Yu, […], and Ling Li
Additional article information
Abstract
Background and purpose
With the popularization of a two-child policy in China, the number of pregnant women of advanced maternal age will increase steadily. We aimed to assess the association between pre-pregnancy body mass index (BMI) and weight gain in the first and second trimester and the risk of gestational diabetes (GDM) in the advanced maternal age group and control group defined as maternal age of 20–35 years.
Results
The risk of GDM for obesity before pregnancy was 2.707 (95% CI: 1.042–7.029) folds and 3.612 (95% CI: 1.182–11.039) folds in the control group and advanced maternal age group, respectively. Excessive weight gain in the first trimester was significant related to a higher risk of developing GDM with the odds ratio (OR) of 2.655 (95% CI: 1.265–5.571) and 4.170 (95% CI: 1.437–12.100) in the control group and advanced maternal age group, respectively.
Materials and Methods
This prospective cohort study included 565 pregnant women with singleton pregnancy who were recruited in their first prenatal visit from the antenatal clinic in March and December 2016. Maternal weight was recorded before pregnancy, in the first prenatal visit and at the time of screening oral glucose tolerance test (OGTT). All women underwent 2 h 75g-OGTT at 24–28 weeks (24 weeks on average). GDM was diagnosed according to the standards issued by the Ministry of Health of China in 2011.
Conclusions
Elevated pre-pregnancy BMI independently increases the risk of GDM, particularly in advanced maternal age. Excessive weight gain in the first trimester is significantly associated with the incidence of GDM regardless of pre-pregnancy BMI.
3. Pre-pregnancy weight change and incidence of gestational diabetes mellitus: A finding from a prospective cohort study
https://www-sciencedirect-com.york.ezproxy.cuny.edu/science/article/pii/S0168822716305757
Abstract
Aims
In a population-based cohort study we examined the associations between early adult pre-pregnancy weight change and the risk of gestational diabetes mellitus (GDM).
Methods
The study included 3111 women from the 1973–78 cohort of the Australian Longitudinal Study on Women’s Health. These women have been surveyed regularly since 1996. Women without diabetes and GDM were followed-up between 2003 and 2012. Generalized estimating equations were used to assess the effect of baseline (1996, mean age 20 years) and pre-pregnancy body mass index (BMI) and the pre-pregnancy weight changes on the incidence of GDM. The full models were adjusted for sociodemographic and lifestyle factors.
Results
From 2003 to 2012, 229 GDM cases (4.4%) were reported in 5242 pregnancies. Relative to normal BMI women, obese women at baseline (RR: 1.8, 95% CI: 1.1, 2.8) and prior to pregnancy (RR: 2.7, 95% CI: 2.0, 3.6) were at greater risk of GDM. Weight gains prior to each study pregnancy were strongly associated with increased GDM risk with an adjusted RR ranging from 2.0 to 2.9. Within under/normal range of BMI, women with a moderate/high (>2.5%/year) weight gain had 2.7 (95% CI: 1.3, 5.5) times the risk of GDM compared with women with stable weight.
Conclusions
Early adult weight gain, even within normal BMI range, is an important risk factor for the development of GDM. Weight gain prevention from early adulthood to prior to pregnancy appears to be the main strategy to prevent the incidence of GDM.
4. Pregnancy Outcomes Based on Pre-Pregnancy Body Mass Index in Japanese Women
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4900523/#__ffn_sectitle
Abstract
Objective
To verify whether body mass index (BMI) classification proposed by the Institute of Medicine (IOM) is valid in Japanese women.
Method
A study was conducted in 97,157 women with singleton pregnancies registered in the Japan Society of Obstetrics and Gynecology (JSOG) Successive Pregnancy Birth Registry System between January 2013 and December 2013, to examine pregnancy outcomes in four groups stratified by pre-pregnancy BMI category according to the 2009 criteria recommended by the Institute of Medicine (IOM). The groups comprised 17,724 underweight women with BMI <18.5, 69,126 normal weight women with BMI 18.5–24.9, 7,502 overweight women with BMI 25–29.9, and 2,805 obese women with BMI ≥30. The pregnancy outcomes were also compared among subgroups stratified by a gestational weight gain below, within, and above the optimal weight gain.
Results
The higher the pre-pregnancy BMI, the higher the incidences of pregnancy-induced hypertension, gestational diabetes mellitus, macrosomia, cesarean delivery, postpartum hemorrhage, and post-term birth, but the lower the incidence of small for gestational age (SGA). In all pre-pregnancy BMI category groups, excess gestational weight gain was associated with a higher
frequency of large for gestational age and macrosomia; poor weight gain correlated with a higher frequency of SGA, preterm birth, preterm premature rupture of membranes, and spontaneous preterm birth; and optimal weight gain within the recommended range was associated with a better outcome.
Conclusion
The BMI classification by the IOM was demonstrated to be valid in Japanese women.
5. Risk of Adverse Pregnancy Outcomes by Pre-pregnancy Body Mass Index: A Population-Based Study to Inform Pre-pregnancy Weight Loss Counseling
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4285688/
Abstract
Objective
To estimate the absolute risks of adverse maternal and perinatal outcomes based on small differences in prepregnancy body mass (eg, 10% of body mass or 10-20 lbs).
Methods
This population-based cohort study (n=226,958) was drawn from all singleton pregnancies in British Columbia (Canada) from 2004-2012. The relationships between prepregnancy BMI (as a continuous, non-linear variable) and adverse pregnancy outcomes were examined using logistic regression models. Analyses were adjusted for maternal age, height, parity, and smoking in pregnancy. Adjusted absolute risks of each outcome are reported according to incremental differences in prepregnancy BMI and weight in pounds.
Results
Conclusion
These results can inform prepregnancy weight loss counseling by defining achievable weight loss goals for patients that may reduce their risk of poor perinatal outcomes.
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Summary of the Evidence:
| Author (Date) | Level of Evidence | Sample/Setting (# of subjects/ studies, cohort definition etc. ) | Outcome(s) studied | Key Findings | Limitations and Biases |
| Hashim, 2019 | Cohort | 256 participants | Gestational Weight Gain (GWG), Gestational Diabetes (GDM) | Increased Pre-pregancny BMI is a risk factor for both GWG and GDM | Small number of participants. This study was conducted only using Emirati or Arab females. |
| Dong, 2017 | Cohort | 565 participants | Gestational Diabetes | High pre-pregnancy BMI is an independent risk factor for GDM | Small number of participants. All participants were from the same hospital. |
| Adane, 2017 | Cohort | 3,111 particpants | Gestational Diabetes | Weight gain prior to pregnancy, even within normal BMI, is a risk factor for developing GDM | Participants were between 18 – 23 years old |
| Enomoto, 2016 | Retrospect | 97,157 participants | Pregnancy outcomes | The higher pre-pregnancy BMI , the worse the pregnancy outcomes (HTN, GDM, macrosomia, cesarean delivery, postpartum hemorrhage, and post-term birth) | This study only used Japanese women. |
| Schummers, 2015 | Cohort | 226,958 participants | Adverse pregnancy outcomes | Pre-pregnancy BMI was associated with Preeclampsia, gestation diabetes, preterm delivery, macrosomia, shoulder dystocia, cesarean delivery, stillbirth, NICU stay, newborn mortality. | This study did not look at the long term outcomes. Race was excluded in this study. |
Conclusion(s):
Pre-pregnancy BMI greater or equal to 25 is a risk factor for gestational weight gain and gestational diabetes mellitus. (Hashim) Maternal age is also a factor and increases the risk of GDM. Additionally, weight gain during the first trimester even when the BMI before pregnancy was healthy is a risk factor for GDM. (Dong) Weight gain before pregnancy even if it is within a normal BMI is associated with GDM. (Adane) Pre-gestational weight and gestational weight are also associated with other pregnancy complications such as hypertension, macrosomia, cesarean delivery, postpartum hemorrhage and post-term birth. (Schummers, Enomoto)
Clinical Bottom Line:
Since J.K. is overweight she does have a higher risk of developing gestational diabetes if she becomes pregnant. She should lose weight before becoming pregnant. Healthcare providers should encourage females to maintain a healthy weight before and during pregnancy to prevent complications during pregnancy.
