title: Gestational diabetes mellitus treatment reduces obesity-induced adverse pregnancy and neonatal outcomes: the St. Carlos gestational study.
abstract: BACKGROUND
  Obesity and gestational diabetes mellitus (GDM) increase the morbidity of the mother and newborn, which could increase further should they coexist. We aimed to determine the risk of adverse pregnancy and neonatal outcomes associated with excess weight (EW), and within this group identify potential differences between those with and without GDM.
  
  
  METHODS
  We carried out a post-hoc analysis of the St. Carlos Gestational Study which included 3312 pregnant women, arranged in 3 groups: normal-weight women (NWw) (2398/72.4%), overweight women (OWw) (649/19.6%) and obese women (OBw) (265/8%). OWw and OBw were grouped as EW women (EWw). We analyzed variables related to adverse pregnancy and neonatal outcomes.
  
  
  RESULTS
  The relative risk (95% CI) for GDM was 1.82 (1.47 to 2.25; p<0.0001) for OWw, and 3.26 (2.45 to 4.35; p<0.0001) in OBw. Univariate analysis showed associations of EW to higher rates of prematurity, birth weight >90th centile, newborns admitted to neonatal intensive care unit (NICU), instrumental delivery and cesarean delivery (all p<0.005). Multivariate analysis, adjusted for parity and ethnicity, showed that EW increased the risk of prematurity, admission to NICU, cesarean and instrumental delivery, especially in EWw without GDM. NWw with GDM had a significantly lower risk of admission to NICU and cesarean delivery, compared with NWw without GDM.
  
  
  CONCLUSIONS
  EW is detrimental for pregnancy and neonatal outcomes, and treatment of GDM contributes to lowering the risk in EWw and NWw. Applying the same lifestyle changes to all pregnant women, independent of their weight or GDM condition, could improve these outcomes.
authors.affiliation: Endocrinology and Nutrition Department , Hospital Clínico San Carlos , Madrid , Spain.
authors.forename: Carla
authors.initials: C
authors.lastname: Assaf-Balut
authors.affiliation: Endocrinology and Nutrition Department , Hospital Clínico San Carlos , Madrid , Spain.
authors.forename: Cristina
authors.initials: C
authors.lastname: Familiar
authors.affiliation: Endocrinology and Nutrition Department , Hospital Clínico San Carlos , Madrid , Spain.
authors.forename: Nuria
authors.initials: N
authors.lastname: García de la Torre
authors.affiliation: Endocrinology and Nutrition Department, Hospital Clínico San Carlos, Madrid, Spain; Facultad de Medicina, Universidad Complutense de Madrid,Madrid, Spain.
authors.forename: Miguel A
authors.initials: MA
authors.lastname: Rubio
authors.affiliation: Endocrinology and Nutrition Department, Hospital Clínico San Carlos, Madrid, Spain; Facultad de Medicina, Universidad Complutense de Madrid,Madrid, Spain.
authors.forename: Elena
authors.initials: E
authors.lastname: Bordiú
authors.affiliation: Endocrinology and Nutrition Department , Hospital Clínico San Carlos , Madrid , Spain.
authors.forename: Laura
authors.initials: L
authors.lastname: Del Valle
authors.affiliation: Endocrinology and Nutrition Department , Hospital Clínico San Carlos , Madrid , Spain.
authors.forename: Miriam
authors.initials: M
authors.lastname: Lara
authors.affiliation: Endocrinology and Nutrition Department , Hospital Clínico San Carlos , Madrid , Spain.
authors.forename: Teresa
authors.initials: T
authors.lastname: Ruiz
authors.affiliation: Endocrinology and Nutrition Department , Hospital Clínico San Carlos , Madrid , Spain.
authors.forename: Ana
authors.initials: A
authors.lastname: Ortolá
authors.affiliation: Endocrinology and Nutrition Department , Hospital Clínico San Carlos , Madrid , Spain.
authors.forename: Irene
authors.initials: I
authors.lastname: Crespo
authors.affiliation: Endocrinology and Nutrition Department, Hospital Clínico San Carlos, Madrid, Spain; Facultad de Medicina, Universidad Complutense de Madrid,Madrid, Spain.
authors.forename: Alejandra
authors.initials: A
authors.lastname: Duran
authors.affiliation: Facultad de Medicina, Universidad Complutense de Madrid,Madrid, Spain; Gynecology and Obstetrics Department, Madrid, Spain.
authors.forename: Miguel A
authors.initials: MA
authors.lastname: Herraiz
authors.affiliation: Facultad de Medicina, Universidad Complutense de Madrid,Madrid, Spain; Gynecology and Obstetrics Department, Madrid, Spain.
authors.forename: Nuria
authors.initials: N
authors.lastname: Izquierdo
authors.affiliation: Facultad de Medicina, Universidad Complutense de Madrid,Madrid, Spain; Gynecology and Obstetrics Department, Madrid, Spain.
authors.forename: Noelia
authors.initials: N
authors.lastname: Perez
authors.affiliation: Endocrinology and Nutrition Department, Hospital Clínico San Carlos, Madrid, Spain; Clinical Laboratory Department, Madrid, Spain.
authors.forename: Maria J
authors.initials: MJ
authors.lastname: Torrejon
authors.affiliation: Endocrinology and Nutrition Department, Hospital Clínico San Carlos, Madrid, Spain; Facultad de Medicina, Universidad Complutense de Madrid,Madrid, Spain.
authors.forename: Isabelle
authors.initials: I
authors.lastname: Runkle
authors.affiliation: Endocrinology and Nutrition Department , Hospital Clínico San Carlos , Madrid , Spain.
authors.forename: Carmen
authors.initials: C
authors.lastname: Montañez
authors.affiliation: Endocrinology and Nutrition Department, Hospital Clínico San Carlos, Madrid, Spain; Facultad de Medicina, Universidad Complutense de Madrid,Madrid, Spain.
authors.forename: Alfonso L
authors.initials: AL
authors.lastname: Calle-Pascual
keywords: Clinical Care; Gestational Diabetes Mellitus; Obesity; Overweight