Does maternal body mass index influence treatment effect in women with mild gestational diabetes?
OBJECTIVE
The aim of the article is to determine whether maternal body mass index (BMI) influences the beneficial effects of diabetes treatment in women with gestational diabetes mellitus (GDM).


METHODS
Secondary analysis of a multicenter randomized treatment trial of women with GDM. Outcomes of interest were elevated umbilical cord c-peptide levels (> 90th percentile 1.77 ng/mL), large for gestational age (LGA) birth weight (> 90th percentile), and neonatal fat mass (g). Women were grouped into five BMI categories adapted from the World Health Organization International Classification of normal, overweight, and obese adults. Outcomes were analyzed according to treatment group assignment.


RESULTS
A total of 958 women were enrolled (485 treated and 473 controls). Maternal BMI at enrollment was not related to umbilical cord c-peptide levels. However, treatment of women in the overweight, Class I, and Class II obese categories was associated with a reduction in both LGA birth weight and neonatal fat mass. Neither measure of excess fetal growth was reduced with treatment in normal weight (BMI < 25 kg/m(2)) or Class III (BMI ≥ 40 kg/m(2)) obese women.


CONCLUSIONS
There was a beneficial effect of treatment on fetal growth in women with mild GDM who were overweight or Class I and Class II obese. These effects were not apparent for normal weight and very obese women.
Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, Dallas, Texas.
Brian M
BM
Casey
The George Washington University Biostatistics Center, Washington, District of Columbia.
Lisa
L
Mele
Department of Obstetrics and Gynecology, The Ohio State University, Columbus, Ohio.
Mark B
MB
Landon
Catherine Y
CY
Spong
Department of Obstetrics and Gynecology, University of Texas Health Science Center at Houston, Houston, Texas.
Susan M
SM
Ramin
Department of Obstetrics and Gynecology, Columbia University, New York, New York.
Ronald J
RJ
Wapner
Department of Obstetrics and Gynecology, University of Utah, Salt Lake City, Utah.
Michael W
MW
Varner
Department of Obstetrics and Gynecology, University of Alabama, Birmingham, Alabama.
Dwight J
DJ
Rouse
Department of Obstetrics and Gynecology, University of North Carolina, Chapel Hill, North Carolina.
John M
JM
Thorp
Department of Obstetrics and Gynecology, Case Western Reserve University-MetroHealth Medical Center, Cleveland, Ohio.
Patrick
P
Catalano
Department of Obstetrics and Gynecology, Wake Forest University Health Sciences, Winston-Salem, North Carolina.
Margaret
M
Harper
Department of Obstetrics and Gynecology, University of Texas Medical Branch, Galveston, Texas.
George
G
Saade
Department of Obstetrics and Gynecology, Wayne State University, Detroit, Michigan.
Yoram
Y
Sorokin
Department of Obstetrics and Gynecology, Northwestern University, Chicago, Illinois.
Alan M
AM
Peaceman
D000273:Adipose Tissue; D000328:Adult; D015190:Blood Glucose Self-Monitoring; D015992:Body Mass Index; D002096:C-Peptide / Q000097:blood; D016640:Diabetes, Gestational / Q000628:therapy*; D004035:Diet Therapy; D005260:Female; D005312:Fetal Blood / Q000737:chemistry; D005320:Fetal Macrosomia / Q000453:epidemiology*; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use*; D007328:Insulin / Q000627:therapeutic use*; D009765:Obesity; D050177:Overweight; D011247:Pregnancy; D011248:Pregnancy Complications; D012720:Severity of Illness Index; D016896:Treatment Outcome; D055815:Young Adult
D002096:C-Peptide; D007004:Hypoglycemic Agents; D007328:Insulin