title: Impact of obesity on maternal and neonatal outcomes in insulin-resistant pregnancy.
abstract: OBJECTIVE
  To determine the impact of obesity on pregnancies complicated by insulin resistance.
  
  
  METHODS
  Secondary analysis of prospective cohort of women with gestational diabetes mellitus (GDM) and type 2 diabetes mellitus (DM). The exclusion criteria were type 1 DM, multiple gestation, fetal anomalies, unknown prepregnancy, and body mass index (BMI). Primary maternal outcome was a composite of any of the following: severe preeclampsia, eclampsia, third- to fourth-degree laceration, readmission, wound infection, or antepartum hospitalization. Primary neonatal outcome was a composite of any of the following: hypoglycemia, preterm delivery, admission to level 3 nursery, oxygen requirement > 6 hours after birth, shoulder dystocia, 5-minute Apgar ≤3, cord pH < 7.0, and cord base excess < -12 mmol/L. Obese women (BMI ≥30.0 kg/m(2)) were compared with nonobese women (BMI < 30.0 kg/m(2)).
  
  
  RESULTS
  Of 356 subjects with DM, 233 (66%) were obese. Obese women were not at further increased risk of the composite maternal outcome (adjusted odds ratio [AOR] = 0.68, 95% confidence interval [CI] = 0.43-1.09), the composite neonatal outcome (AOR = 0.76, 95% CI = 0.48-1.21), or cesarean (58.8 vs. 52.9%, p = 0.28, AOR = 1.47, 95% CI = 0.91-2.39).
  
  
  CONCLUSIONS
  We did not find evidence that obesity worsened pregnancy outcomes in women with GDM and type 2 DM, suggesting that obese women may not require more stringent antepartum treatment strategies.
authors.affiliation: Department of Obstetrics and Gynecology, The University of Alabama at Birmingham, Birmingham, Alabama.
authors.forename: Lorie M
authors.initials: LM
authors.lastname: Harper
authors.affiliation: Department of Obstetrics and Gynecology, Washington University in St. Louis, St. Louis, Missouri.
authors.forename: Allyson
authors.initials: A
authors.lastname: Renth
authors.affiliation: Department of Obstetrics and Gynecology, Washington University in St. Louis, St. Louis, Missouri.
authors.forename: W Todd
authors.initials: WT
authors.lastname: Cade
authors.affiliation: Department of Obstetrics and Gynecology, Washington University in St. Louis, St. Louis, Missouri.
authors.forename: Ryan
authors.initials: R
authors.lastname: Colvin
authors.affiliation: Department of Obstetrics and Gynecology, Washington University in St. Louis, St. Louis, Missouri.
authors.forename: George A
authors.initials: GA
authors.lastname: Macones
authors.affiliation: Department of Obstetrics and Gynecology, Washington University in St. Louis, St. Louis, Missouri.
authors.forename: Alison G
authors.initials: AG
authors.lastname: Cahill
mesh_terms: D000328:Adult; D015992:Body Mass Index; D002585:Cesarean Section / Q000706:statistics & numerical data; D015331:Cohort Studies; D003924:Diabetes Mellitus, Type 2 / Q000453:epidemiology*; D016640:Diabetes, Gestational / Q000453:epidemiology*; D004420:Dystocia / Q000453:epidemiology; D004461:Eclampsia / Q000453:epidemiology; D005260:Female; D005320:Fetal Macrosomia / Q000453:epidemiology; D006801:Humans; D007003:Hypoglycemia / Q000453:epidemiology; D007231:Infant, Newborn; D007333:Insulin Resistance; D007363:Intensive Care Units, Neonatal / Q000706:statistics & numerical data; D022125:Lacerations / Q000453:epidemiology; D008297:Male; D009765:Obesity / Q000453:epidemiology*; D007744:Obstetric Labor Complications / Q000453:epidemiology; D016017:Odds Ratio; D011225:Pre-Eclampsia / Q000453:epidemiology; D011247:Pregnancy; D011248:Pregnancy Complications / Q000453:epidemiology*; D011254:Pregnancy in Diabetics / Q000453:epidemiology*; D047928:Premature Birth / Q000453:epidemiology; D011446:Prospective Studies; D012720:Severity of Illness Index; D013530:Surgical Wound Infection / Q000453:epidemiology; D055815:Young Adult