title: Adverse Outcomes and Potential Targets for Intervention in Gestational Diabetes and Obesity.
abstract: OBJECTIVE
  To evaluate the association of obesity with pregnancy outcomes in women with gestational diabetes mellitus (GDM) and identify potentially modifiable risk factors for adverse outcomes in obese women with GDM.
  
  
  METHODS
  This was a retrospective cohort study of 1,344 women with GDM who delivered between 2009 and 2012. Demographic data, blood sugar values, gestational weight gain, and maternal and neonatal outcome data were abstracted from the medical record and compared among normal-weight, overweight, and obese women.
  
  
  RESULTS
  Overweight and obese women had higher mean fasting and postprandial blood sugars despite higher doses of and more frequent use of medication. Obesity was independently associated with macrosomia (adjusted odds ratio [OR] 2.03, 95% confidence interval [CI] 1.07-3.89, P=.03), indicated preterm birth (adjusted OR 2.21, 95% CI 1.02-4.78, P=.04), and hypertensive disorders of pregnancy (adjusted OR 2.19, 95% CI 1.38-3.49, P=.001). In our stratified analyses, obese women with fasting blood sugars greater than 88.7 mg/dL and postprandial blood sugars greater than 123.8 mg/dL had higher rates of macrosomia (13.1% compared with 5.7%, P=.004 for fasting, 13.0% compared with 6.5%, P=.01 for postprandial blood sugars) and indicated preterm birth (11.4% compared with 6.1%, P=.04 for fasting, 11.9% compared with 5.8%, P=.01 for postprandial blood sugars) when compared with obese women with lower values. Hypertensive disorders of pregnancy were significantly increased in obese women with postdiagnosis weight gain greater than 0.6 lb per week (29.4% compared with 15.2%, P<.001) when compared with obese women with less weight gain.
  
  
  CONCLUSIONS
  Prepregnancy obesity is independently associated with adverse pregnancy outcomes in women with GDM, and interventions to optimize glycemic control and limit weight gain postdiagnosis may improve outcomes in these high-risk women.
  
  
  METHODS
  II.
authors.affiliation: Department of Obstetrics and Gynecology, University of Oklahoma College of Medicine, and the Harold Hamm Diabetes Center, Oklahoma City, Oklahoma; and the Department of Obstetrics, Gynecology and Reproductive Sciences, Magee Women's Research Institute, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania.
authors.forename: Christina
authors.initials: C
authors.lastname: Scifres
authors.forename: Maisa
authors.initials: M
authors.lastname: Feghali
authors.forename: Andrew D
authors.initials: AD
authors.lastname: Althouse
authors.forename: Steve
authors.initials: S
authors.lastname: Caritis
authors.forename: Janet
authors.initials: J
authors.lastname: Catov
mesh_terms: D000328:Adult; D001786:Blood Glucose / Q000032:analysis; D015992:Body Mass Index; D015897:Comorbidity; D016640:Diabetes, Gestational / Q000097:blood / Q000175:diagnosis / Q000453:epidemiology; D005260:Female; D005320:Fetal Macrosomia / Q000453:epidemiology*; D005951:Glucose Tolerance Test / Q000379:methods; D006801:Humans; D046110:Hypertension, Pregnancy-Induced / Q000453:epidemiology*; D008501:Medical Records, Problem-Oriented; D009765:Obesity / Q000175:diagnosis / Q000453:epidemiology; D011247:Pregnancy; D011256:Pregnancy Outcome; D047928:Premature Birth / Q000453:epidemiology*; D014481:United States / Q000453:epidemiology; D015430:Weight Gain
chemical_list: D001786:Blood Glucose