title: The influence of maternal BMI and gestational diabetes on pregnancy outcome.
abstract: OBJECTIVE
  To evaluate the effect of maternal body mass index (BMI) on gestational diabetes (GDM) and the risk of adverse pregnancy outcomes in women who are overweight or obese.
  
  
  METHODS
  A prospective cohort study nested within the LIMIT randomised controlled trial. A total of 1030 women were recruited between 10 and 20 weeks' gestation, with a BMI≥25 kg/m(2), and were grouped into BMI subclasses utilising World Health Organisation criteria. Women underwent a fasting oral glucose tolerance test at 26-28 weeks' gestation, and a diagnosis of GDM was made if fasting blood glucose was ≥5.5 mmol/L or ≥7.8 mmol/L after 2h. Maternal and neonatal health outcomes were evaluated.
  
  
  RESULTS
  The prevalence of GDM increased with increasing maternal BMI (6.74% overweight vs 13.42% obese subclass 1 vs 12.79% obese subclass 2 vs 20.00% obese subclass 3). Women who were diagnosed with GDM were significantly less likely to give birth to an infant with birth weight above 4 kg (RR 0.60; 95% CI 0.36 to 1.00; p=0.05). The need for caesarean delivery (RR 1.27; 95% CI 1.07 to 1.50; p=0.006) and incidence of birth weight >90% (RR 1.38; 95% CI 1.07 to 1.77; p=0.01) was significantly increased in women who were obese, independent of GDM.
  
  
  CONCLUSIONS
  Increasing maternal BMI is a significant risk factor for the development of GDM, and our findings demonstrate a considerably higher prevalence than has been previously described. Raised maternal BMI is a risk factor for high infant birth weight, which may be modified by lifestyle intervention.
authors: The University of Adelaide, Robinson Institute, Ground Floor, Norwich Centre, 55 King William Road, North Adelaide 5006, SA, Australia; Discipline of Obstetrics & Gynaecology, Women's and Children's Hospital, 72 King William Road, North Adelaide 5006, SA, Australia. Electronic address: kate.martin@adelaide.edu.au.
authors: Kate E
authors: KE
authors: Martin
authors: The University of Adelaide, Robinson Institute, Ground Floor, Norwich Centre, 55 King William Road, North Adelaide 5006, SA, Australia; Discipline of Obstetrics & Gynaecology, Women's and Children's Hospital, 72 King William Road, North Adelaide 5006, SA, Australia.
authors: Rosalie M
authors: RM
authors: Grivell
authors: The University of Adelaide, Robinson Institute, Ground Floor, Norwich Centre, 55 King William Road, North Adelaide 5006, SA, Australia.
authors: Lisa N
authors: LN
authors: Yelland
authors: The University of Adelaide, Robinson Institute, Ground Floor, Norwich Centre, 55 King William Road, North Adelaide 5006, SA, Australia; Discipline of Obstetrics & Gynaecology, Women's and Children's Hospital, 72 King William Road, North Adelaide 5006, SA, Australia.
authors: Jodie M
authors: JM
authors: Dodd
mesh_terms: D000328:Adult; D001786:Blood Glucose / Q000378:metabolism*; D015992:Body Mass Index; D016640:Diabetes, Gestational / Q000097:blood / Q000178:diet therapy / Q000453:epidemiology*; D005260:Female; D005951:Glucose Tolerance Test; D006801:Humans; D008019:Life Style; D011247:Pregnancy; D011256:Pregnancy Outcome; D015995:Prevalence; D011446:Prospective Studies; D012307:Risk Factors; D013021:South Australia / Q000453:epidemiology
chemical_list: D001786:Blood Glucose
keywords: Body mass index; Gestational diabetes; Obesity; Pregnancy