title: Gestational diabetes, pre-pregnancy obesity and pregnancy weight gain in relation to excess fetal growth: variations by race/ethnicity.
abstract: OBJECTIVE
  The escalating rate of childhood obesity is a public health concern worldwide, with children in certain ethnic groups being disproportionately affected. Our objective was to examine the joint effects of pre-pregnancy adiposity, pregnancy weight gain and gestational diabetes (GDM) in relation to excess fetal growth and to identify susceptible races or ethnic populations.
  
  
  METHODS
  The risk for delivery of a large-for-gestational-age (LGA) infant, specific to race and fetal sex, was evaluated in 105,985 pregnancies in the Consortium on Safe Labor from 2002-2008. Generalised estimating equations were used to estimate the risk for delivery of LGA infants. Joint effects were employed to evaluate the interplay of three risk factors. Models were stratified by racial group considering one, two or three factors (i.e. pre-pregnancy adiposity, pregnancy weight gain and GDM, with 0 factors as the reference group).
  
  
  RESULTS
  Greater pre-pregnancy adiposity, pregnancy weight gain and GDM were independently associated with increased risk of giving birth to an LGA infant across all races (except GDM among non-Hispanic whites), in both underweight and normal-weight women. Among non-Hispanic white, non-Hispanic black and Hispanic women, the three-factor joint effect was associated with substantially increased odds of LGA (OR [95% CI] 11.27 [8.40, 15.11], 7.09 [4.81, 10.45] and 10.19 [6.84, 15.19], respectively). However, for Asian women the joint effect of all three factors (OR [95% CI] 5.14 [2.11, 12.50]) was approximately the same as any of the two factors.
  
  
  CONCLUSIONS
  GDM, pre-pregnancy obesity and excessive pregnancy weight gain were jointly associated with elevated risk of giving birth to an LGA infant and the effects varied by race. This suggests that those involved in public health efforts aimed at preventing LGA deliveries should consider variations in racial groups when devising effective strategies.
authors.affiliation: Epidemiology Branch, Division of Epidemiology, Statistics, and Preventive Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, 6100 Executive Blvd, Rockville, MD 20852, USA. katherine.bowers@cchmc.org
authors.forename: K
authors.initials: K
authors.lastname: Bowers
authors.forename: S K
authors.initials: SK
authors.lastname: Laughon
authors.forename: M
authors.initials: M
authors.lastname: Kiely
authors.forename: J
authors.initials: J
authors.lastname: Brite
authors.forename: Z
authors.initials: Z
authors.lastname: Chen
authors.forename: C
authors.initials: C
authors.lastname: Zhang
mesh_terms: D050154:Adiposity; D000328:Adult; D001741:Black or African American; D001724:Birth Weight; D001835:Body Weight; D015331:Cohort Studies; D016640:Diabetes, Gestational / Q000175:diagnosis* / Q000208:ethnology*; D005006:Ethnicity; D005260:Female; D005320:Fetal Macrosomia / Q000175:diagnosis; D006630:Hispanic or Latino; D006801:Humans; D007231:Infant, Newborn; D008297:Male; D009765:Obesity / Q000208:ethnology*; D011247:Pregnancy; D011248:Pregnancy Complications; D012307:Risk Factors; D015430:Weight Gain; D055815:Young Adult