title: Obesity or diabetes: which is more hazardous to the health of the offspring?
abstract: OBJECTIVE
  To examine impact on perinatal outcome of untreated gestational diabetes (GDM) and non-diabetics stratified by body mass index (BMI).
  
  
  METHODS
  This is a secondary analysis of our investigation of the consequences of not treating GDM. We evaluated 555 untreated GDMs matched to 1100 non-diabetics. BMI was determined using subjects' recalled pre-pregnancy weight. A primary composite variable consisted of stillbirth, neonatal macrosomia/large-for-gestational-age (LGA), neonatal hypoglycemia, erythrocytosis and hyperbilirubinemia. Secondary outcomes included shoulder dystocia, respiratory complications, cesarean delivery and pregnancy-related hypertension.
  
  
  RESULTS
  Untreated subjects in the normal weight category had an ∼2-fold increase for composite outcome and LGA and a 7-fold increase in metabolic complications. The overweight untreated group showed composite outcome, LGA and metabolic complications 2-3-fold higher and induction of labor 5-fold higher. For obese untreated GDMs, significantly higher rates of composite outcome, LGA and metabolic complications, induction of labor and cesarean delivery were 10-, 3-, 5-, 4- and 9-fold, respectively. Perinatal outcome for normal weight untreated GDM was similar to obese non-diabetics.
  
  
  CONCLUSIONS
  Maternal obesity and GDM independently affect adverse pregnancy outcome. The combination has a greater impact than each one alone. However, glycemic level contributes a greater portion to the adverse pregnancy equation.
authors.forename: Oded
authors.initials: O
authors.lastname: Langer
mesh_terms: D000328:Adult; D015992:Body Mass Index; D016640:Diabetes, Gestational / Q000453:epidemiology*; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D007232:Infant, Newborn, Diseases / Q000453:epidemiology*; D008297:Male; D009765:Obesity / Q000453:epidemiology*; D011247:Pregnancy; D011256:Pregnancy Outcome; D013781:Texas / Q000453:epidemiology; D055815:Young Adult
keywords: Obesity; pregnancy outcome; untreated GDM