title: The mutual effect of pregestational body mass index, maternal hyperglycemia and gestational weight gain on adverse pregnancy outcomes.
abstract: OBJECTIVE
  To investigate the mutual effect of obesity, gestational diabetes (GDM) and gestational weight gain (GWG) on adverse pregnancy outcomes.
  
  
  METHODS
  Charts of patients who delivered in our hospital between June 2001 and June 2006 singleton, live births  >24 weeks gestation were reviewed. Univariate and multivariate logistic regression were used to assess pregnancy outcomes defined as large for gestational age (LGA), primary cesarean section (PCS) and a composite outcome of LGA and/or PCS.
  
  
  RESULTS
  A total of 8595 women were included. Frequency of composite outcome increased with increasing body mass index (BMI), increasing hyperglycemia and above-recommended GWG. In the multivariate logistic regression analysis compared to women with normal BMI, odds ratio (OR) for composite outcome was 1.23 (95% confidence interval [CI] 1.06-1.44) in overweight women, OR = 1.86 (1.51-2.31) in obese women and in severe obesity OR = 2.97 (2.15-4.11). Compared to normoglycemic women, odds for composite outcome in women with abnormal glucose challenge test OR = 1.46 (1.20-1.79), impaired glucose tolerance OR = 1.65 (1.14-2.4) and GDM OR = 1.56 (1.16-2.10). Women with GWG above recommended had OR = 1.58, (1.37-1.81) for composite outcome.
  
  
  CONCLUSIONS
  Higher pregestational BMI, maternal hyperglycemia and above-recommended GWG independently contribute to adverse pregnancy outcomes. Furthermore, there is mutual effect between these three factors and adverse outcomes. Appropriate pregestational weight and adequate GWG might reduce risk of adverse pregnancy outcomes.
authors.affiliation: a Department of Obstetrics and Gynecology , the Lady Davis Carmel Medical Center, Rappaport Faculty of Medicine, Technion, Israel Institute of Technology , Haifa , Israel.
authors.forename: Ariel
authors.initials: A
authors.lastname: Zilberlicht
authors.affiliation: a Department of Obstetrics and Gynecology , the Lady Davis Carmel Medical Center, Rappaport Faculty of Medicine, Technion, Israel Institute of Technology , Haifa , Israel.
authors.forename: Ido
authors.initials: I
authors.lastname: Feferkorn
authors.affiliation: a Department of Obstetrics and Gynecology , the Lady Davis Carmel Medical Center, Rappaport Faculty of Medicine, Technion, Israel Institute of Technology , Haifa , Israel.
authors.forename: Grace
authors.initials: G
authors.lastname: Younes
authors.affiliation: a Department of Obstetrics and Gynecology , the Lady Davis Carmel Medical Center, Rappaport Faculty of Medicine, Technion, Israel Institute of Technology , Haifa , Israel.
authors.forename: Amit
authors.initials: A
authors.lastname: Damti
authors.affiliation: a Department of Obstetrics and Gynecology , the Lady Davis Carmel Medical Center, Rappaport Faculty of Medicine, Technion, Israel Institute of Technology , Haifa , Israel.
authors.forename: Ron
authors.initials: R
authors.lastname: Auslender
authors.affiliation: a Department of Obstetrics and Gynecology , the Lady Davis Carmel Medical Center, Rappaport Faculty of Medicine, Technion, Israel Institute of Technology , Haifa , Israel.
authors.forename: Shlomit
authors.initials: S
authors.lastname: Riskin-Mashiah
mesh_terms: D015992:Body Mass Index; D002585:Cesarean Section; D016640:Diabetes, Gestational / Q000503:physiopathology*; D005260:Female; D005865:Gestational Age; D006801:Humans; D006943:Hyperglycemia / Q000150:complications* / Q000503:physiopathology; D050177:Overweight / Q000150:complications* / Q000503:physiopathology; D011247:Pregnancy; D011256:Pregnancy Outcome; D012189:Retrospective Studies; D015430:Weight Gain / Q000502:physiology*
keywords: Adverse pregnancy outcomes; gestational weight gain; maternal hyperglycemia; pregestational body mass index