title: The effect of maternal body mass index on perinatal outcomes in women with diabetes.
abstract: OBJECTIVE
  To determine the effect of increasing maternal obesity, including superobesity (body mass index [BMI] ≥ 50 kg/m2), on perinatal outcomes in women with diabetes.
  
  
  METHODS
  Retrospective cohort study of birth records for all live-born nonanomalous singleton infants ≥ 37 weeks' gestation born to Missouri residents with diabetes from 2000 to 2006. Women with either pregestational or gestational diabetes were included.
  
  
  RESULTS
  There were 14,595 births to women with diabetes meeting study criteria, including 7,082 women with a BMI > 30 kg/m2 (48.5%). Compared with normal-weight women with diabetes, increasing BMI category, especially superobesity, was associated with a significantly increased risk for preeclampsia (adjusted relative risk [aRR] 3.6, 95% confidence interval [CI] 2.5, 5.2) and macrosomia (aRR 3.0, 95% CI 1.8, 5.40). The majority of nulliparous obese women with diabetes delivered via cesarean including 50.5% of obese, 61.4% of morbidly obese, and 69.8% of superobese women. The incidence of primary elective cesarean among nulliparous women with diabetes increased significantly with increasing maternal BMI with over 33% of morbidly obese and 39% of superobese women with diabetes delivering electively by cesarean.
  
  
  CONCLUSIONS
  Increasing maternal obesity in women with diabetes is significantly associated with higher risks of perinatal complications, especially cesarean delivery.
authors.affiliation: Department of Obstetrics and Gynecology, Oregon Health and Science University, Portland, Oregon.
authors.forename: Nicole E
authors.initials: NE
authors.lastname: Marshall
authors.affiliation: Department of Pediatrics, Saint Louis University, St. Louis, Missouri.
authors.forename: Camelia
authors.initials: C
authors.lastname: Guild
authors.affiliation: Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, San Francisco, California.
authors.forename: Yvonne W
authors.initials: YW
authors.lastname: Cheng
authors.affiliation: Department of Obstetrics and Gynecology, Oregon Health and Science University, Portland, Oregon.
authors.forename: Aaron B
authors.initials: AB
authors.lastname: Caughey
authors.affiliation: Department of Pediatrics, Saint Louis University, St. Louis, Missouri.
authors.forename: Donna R
authors.initials: DR
authors.lastname: Halloran
mesh_terms: D000293:Adolescent; D000328:Adult; D015992:Body Mass Index; D002585:Cesarean Section / Q000706:statistics & numerical data; D016640:Diabetes, Gestational; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D008297:Male; D008923:Missouri; D009765:Obesity / Q000150:complications*; D011247:Pregnancy; D011248:Pregnancy Complications; D011256:Pregnancy Outcome; D011254:Pregnancy in Diabetics; D012189:Retrospective Studies; D012307:Risk Factors; D055815:Young Adult