title: Pregnancy adverse outcomes related to pregravid body mass index and gestational weight gain, according to the presence or not of gestational diabetes mellitus: A retrospective observational study.
abstract: OBJECTIVE
  This study retrospectively evaluated the complications associated with prepregnancy overweight (OW) or obesity (OB) and gestational weight gain (GWG) in women with or without universally screened and treated gestational diabetes mellitus (GDM).
  
  
  METHODS
  A total of 15,551 non-Asian women without pregravid diabetes or hypertension who delivered singleton babies (2002-2010) were classified according to GDM (13.5%), pregestational body mass index (BMI; normal range: 18.5-24.9kg/m(2)), OW (26.2%), OB (13.9%; BMI≥30kg/m(2)) and GWG (<7kg: 32%; 7-11.5kg: 37%; 11.6-16kg: 23%;>16kg: 8%). Main outcome measures were large/small for gestational age (LGA/SGA), caesarean section, preeclampsia, preterm delivery and shoulder dystocia.
  
  
  RESULTS
  GDM was associated with more LGA babies [Odds Ratio (OR): 2.12, 95% confidence interval (CI): 1.85-2.43], caesarean section (OR: 1.49, 95% CI: 1.34-1.65) and preeclampsia (OR: 1.59, 95% CI: 1.21-2.09). OW/OB and GWG were associated with LGA infants whatever the GDM status, and with SGA babies only in women without GDM. LGA status was independently associated with GWG in women with GDM (11.6-16kg: OR: 1.74, 95% CI: 1.49-2.03 and>16kg OR: 3.42, 95% CI: 2.83-4.13 vs 7-11.5kg) and in women without GDM (OR: 2.14, 95% CI: 1.54-2.97 or OR: 2.65, 95% CI: 1.68-4.17, respectively), and with BMI only in women without GDM (OR: 1.12, 95% CI: 1.00-1.24, per 10kg/m(2)). SGA status was independently associated with OW (OR: 0.86, 95% CI: 0.77-0.98), OB (OR: 0.84, 95% CI: 0.72-0.98) and GWG<7kg (1.14, 95% CI: 1.01-1.29) only in women without GDM.
  
  
  CONCLUSIONS
  In our European cohort and considering the triumvirate of GDM, BMI and GWG, GDM was the main contributor to caesarean section and preeclampsia. OW/OB and GWG contributed to LGA and SGA infants mainly in women without GDM.
authors.affiliation: Department of Endocrinology-Diabetology-Nutrition, CRNH-IdF, CINFO, Paris 13 University, Sorbonne Paris Cité, Jean-Verdier Hospital, AP-HP, Bondy, France; Sorbonne Paris Cité, UMR U1153 Inserm, U1125 Inra, Cnam, Université Paris 13, Bobigny, France. Electronic address: emmanuel.cosson@jvr.aphp.fr.
authors.forename: E
authors.initials: E
authors.lastname: Cosson
authors.affiliation: Department of Endocrinology-Diabetology-Nutrition, CRNH-IdF, CINFO, Paris 13 University, Sorbonne Paris Cité, Jean-Verdier Hospital, AP-HP, Bondy, France.
authors.forename: C
authors.initials: C
authors.lastname: Cussac-Pillegand
authors.affiliation: Department of Obstetrics and Gynecology, Paris 13 University, Sorbonne Paris Cité, Jean-Verdier Hospital, AP-HP, Bondy, France.
authors.forename: A
authors.initials: A
authors.lastname: Benbara
authors.affiliation: Department of Obstetrics and Gynecology, Paris 13 University, Sorbonne Paris Cité, Jean-Verdier Hospital, AP-HP, Bondy, France.
authors.forename: I
authors.initials: I
authors.lastname: Pharisien
authors.affiliation: Department of Endocrinology-Diabetology-Nutrition, CRNH-IdF, CINFO, Paris 13 University, Sorbonne Paris Cité, Jean-Verdier Hospital, AP-HP, Bondy, France.
authors.forename: M T
authors.initials: MT
authors.lastname: Nguyen
authors.affiliation: Department of Endocrinology-Diabetology-Nutrition, CRNH-IdF, CINFO, Paris 13 University, Sorbonne Paris Cité, Jean-Verdier Hospital, AP-HP, Bondy, France.
authors.forename: S
authors.initials: S
authors.lastname: Chiheb
authors.affiliation: Department of Endocrinology-Diabetology-Nutrition, CRNH-IdF, CINFO, Paris 13 University, Sorbonne Paris Cité, Jean-Verdier Hospital, AP-HP, Bondy, France.
authors.forename: P
authors.initials: P
authors.lastname: Valensi
authors.affiliation: Department of Obstetrics and Gynecology, Paris 13 University, Sorbonne Paris Cité, Jean-Verdier Hospital, AP-HP, Bondy, France.
authors.forename: L
authors.initials: L
authors.lastname: Carbillon
mesh_terms: D000328:Adult; D015992:Body Mass Index; D002585:Cesarean Section; D016640:Diabetes, Gestational / Q000453:epidemiology*; D005260:Female; D006801:Humans; D007236:Infant, Small for Gestational Age; D009765:Obesity / Q000453:epidemiology; D011225:Pre-Eclampsia; D011247:Pregnancy; D011256:Pregnancy Outcome / Q000453:epidemiology*; D011379:Prognosis; D012189:Retrospective Studies; D015430:Weight Gain / Q000502:physiology*; D055815:Young Adult
keywords: Gestational diabetes mellitus; Gestational weight gain; Obesity; Pregnancy; Prognosis