title: The hyperglycemia and adverse pregnancy outcome study: associations of GDM and obesity with pregnancy outcomes.
abstract: OBJECTIVE
  To determine associations of gestational diabetes mellitus (GDM) and obesity with adverse pregnancy outcomes in the Hyperglycemia and Adverse Pregnancy Outcome (HAPO) Study.
  
  
  METHODS
  Participants underwent a 75-g oral glucose tolerance test (OGTT) between 24 and 32 weeks. GDM was diagnosed post hoc using International Association of Diabetes and Pregnancy Study Groups criteria. Neonatal anthropometrics and cord serum C-peptide were measured. Adverse pregnancy outcomes included birth weight, newborn percent body fat, and cord C-peptide >90th percentiles, primary cesarean delivery, preeclampsia, and shoulder dystocia/birth injury. BMI was determined at the OGTT. Multiple logistic regression was used to examine associations of GDM and obesity with outcomes.
  
  
  RESULTS
  Mean maternal BMI was 27.7, 13.7% were obese (BMI ≥33.0 kg/m(2)), and GDM was diagnosed in 16.1%. Relative to non-GDM and nonobese women, odds ratio for birth weight >90th percentile for GDM alone was 2.19 (1.93-2.47), for obesity alone 1.73 (1.50-2.00), and for both GDM and obesity 3.62 (3.04-4.32). Results for primary cesarean delivery and preeclampsia and for cord C-peptide and newborn percent body fat >90th percentiles were similar. Odds for birth weight >90th percentile were progressively greater with both higher OGTT glucose and higher maternal BMI. There was a 339-g difference in birth weight for babies of obese GDM women, compared with babies of normal/underweight women (64.2% of all women) with normal glucose based on a composite OGTT measure of fasting plasma glucose and 1- and 2-h plasma glucose values (61.8% of all women).
  
  
  CONCLUSIONS
  Both maternal GDM and obesity are independently associated with adverse pregnancy outcomes. Their combination has a greater impact than either one alone.
authors.affiliation: Reproductive Biology, Case Western Reserve University at MetroHealth Medical Center, Cleveland, Ohio, USA.
authors.forename: Patrick M
authors.initials: PM
authors.lastname: Catalano
authors.forename: H David
authors.initials: HD
authors.lastname: McIntyre
authors.forename: J Kennedy
authors.initials: JK
authors.lastname: Cruickshank
authors.forename: David R
authors.initials: DR
authors.lastname: McCance
authors.forename: Alan R
authors.initials: AR
authors.lastname: Dyer
authors.forename: Boyd E
authors.initials: BE
authors.lastname: Metzger
authors.forename: Lynn P
authors.initials: LP
authors.lastname: Lowe
authors.forename: Elisabeth R
authors.initials: ER
authors.lastname: Trimble
authors.forename: Donald R
authors.initials: DR
authors.lastname: Coustan
authors.forename: David R
authors.initials: DR
authors.lastname: Hadden
authors.forename: Bengt
authors.initials: B
authors.lastname: Persson
authors.forename: Moshe
authors.initials: M
authors.lastname: Hod
authors.forename: Jeremy J N
authors.initials: JJ
authors.lastname: Oats
mesh_terms: D000328:Adult; D001724:Birth Weight / Q000502:physiology; D001786:Blood Glucose / Q000032:analysis / Q000378:metabolism; D015992:Body Mass Index; D016640:Diabetes, Gestational / Q000097:blood / Q000453:epidemiology*; D005260:Female; D005951:Glucose Tolerance Test; D006801:Humans; D006943:Hyperglycemia / Q000097:blood / Q000150:complications / Q000453:epidemiology*; D007231:Infant, Newborn; D008297:Male; D009765:Obesity / Q000150:complications / Q000453:epidemiology*; D007744:Obstetric Labor Complications / Q000097:blood / Q000453:epidemiology* / Q000209:etiology; D011247:Pregnancy; D011248:Pregnancy Complications / Q000097:blood / Q000453:epidemiology* / Q000209:etiology; D011256:Pregnancy Outcome / Q000453:epidemiology*; D055815:Young Adult
chemical_list: D001786:Blood Glucose