Reported prevalence of gestational diabetes in Scotland: the relationship with obesity, age, socioeconomic status, smoking and macrosomia, and how many are we missing?

Aims/Introduction: Gestational diabetes mellitus (GDM) is defined as ‘carbohydrate intolerance of varying degrees of severity with onset or first recognition during pregnancy,’ and is associated with increased fetal and maternal risks. The aims of the present study were to investigate the prevalence of GDM in Scotland over 32 years (1981–2012), and using the data from 2012, to assess how GDM related to maternal body mass index, maternal age, parity, smoking, Scottish Index of Multiple Deprivation, infant gender and macrosomia status. Materials and Methods: GDM prevalence along with anthropometric, obstetric and demographic data were collected on a total of 1,891,097 women with a delivery episode between 1 January 1981 and 31 December 2012 using data extracted from the Scottish Morbidity Record 02. Univariate and multivariate logistic regression analysis was undertaken to investigate their association with GDM. Results: A ninefold increase in GDM prevalence was observed from 1981 to 2012 (P < 0.001). GDM prevalence in 2012 was 1.9%. Maternal body mass index, age, parity status, Scottish index of multiple deprivation and fetal macrosomia were positively associated with GDM. Reported smoking status at booking was inversely associated with GDM. Multivariable analysis showed that fetal macrosomia was not associated with GDM status. Conclusions: The present study confirmed that the reporting of GDM is low in Scotland, and that GDM is associated with maternal body mass index, maternal age, multiparity and social deprivation. GDM was negatively associated with smoking and requires further investigation. The lack of association between GDM and macrosomia (following multivariate analysis) might reflect the screening processes undertaken in Scotland

Associations of maternal caffeine intake during pregnancy with abdominal and liver fat deposition in childhood

Background: Maternal caffeine intake during pregnancy is associated with an increased risk of childhood obesity. Studies in adults suggest that caffeine intake might also directly affect visceral and liver fat deposition, which are strong risk factors for cardio-metabolic disease. Objective: To assess the associations of maternal caffeine intake during pregnancy with childhood general, abdominal, and liver fat mass at 10 years of age. Methods: In a population-based cohort from early pregnancy onwards among 4770 mothers and children, we assessed maternal caffeine intake during pregnancy and childhood fat mass at age 10 years. Results: Compared with children whose mothers consumed <2 units of caffeine per day during pregnancy, those whose mothers consumed 4-5.9 and ≥6 units of caffeine per day had a higher body mass index, total body fat mass index, android/gynoid fat mass ratio, and abdominal subcutaneous and visceral fat mass indices. Children whose mothers consumed 4-5.9 units of caffeine per day had a higher liver fat fraction. The associations with abdominal visceral fat and liver fat persisted after taking childhood total body fat mass into account. Conclusions: High maternal caffeine intake during pregnancy was associated with higher childhood body mass index, total body fat, abdominal visceral fat, and liver fat. The associations with childhood abdominal visceral fat and liver fat fraction were independent of childhood total body fat. This suggests differential fat accumulation in these depots, which may increase susceptibility to cardio-metabolic disease in later life

The effect of maternal obesity and lipid profile on first-trimester serum progesterone levels

Prepregnancy overweight increases the risk of adverse perinatal outcomes. Maternal lipid profile plays a key role in the production of pregnancy hormones. The influence that obesity has on the specific mechanisms that may be involved and the potential associations with abnormal conditions in pregnancy are still poorly understood. OBJECTIVE: This study aimed to evaluate the effect of maternal body mass index and lipid profile on first-trimester serum progesterone levels. STUDY DESIGN: This was a prospective cohort study including 734 pregnant people. First-trimester maternal serum progesterone, cholesterol, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, and triglycerides were measured between 9 and 11 weeks’ gestation. Free β-hCG, PAPP-A, age, body mass index, smoking status, gestational age at delivery, fetal sex, and birthweight were also recorded. Pregnant people were classified according to their body mass index into underweight (n=21), normal weight (n=395), overweight (n=221), obesity class I (n=64), and obesity class II/III (n=33) groups. RESULTS: Gestational age at sampling was 10.0 4±1.12 weeks. Serum progesterone levels decreased as maternal body mass index increased (35.84±12.00 ng/mL, 33.08±11.27 ng/mL, 28.04±8.91 ng/mL, 24.37±8.56 ng/mL, and 19.87±11.00 mL for underweight, normal weight, overweight, obesity class I, and obesity class II/III groups, respectively; P<.000001). There were statistically significant negative correlations between maternal progesterone and body mass index, triglycerides, and cholesterol/high-density lipoprotein cholesterol ratio, and positive correlations with gestational age at sampling, maternal age, cholesterol, high-density lipoprotein cholesterol, crown–rump length, free β-hCG, and PAPP-A. Linear regression showed that the only independent predictor variables for progesterone levels were body mass index (P<.0001), PAPP-A (P<.0001), high-density lipoprotein cholesterol (P<.0001), and free β-hCG (P<.0001) (R2=0.33; P<.0000001). CONCLUSION: First-trimester serum progesterone levels were lower in overweight pregnant people and markedly decreased in those with obesity, especially obesity class II/III. Maternal high-density lipoprotein cholesterol was independently related to progesterone levels as a protective factor. Benefits of progesterone supplementation in pregnant people with obesity need further evaluatio

Effect of maternal body mass index on pregnancy outcome and newborn weight

<p>Abstract</p> <p>Background</p> <p>Maternal obesity has been associated with adverse pregnancy outcomes, such as pre-eclampsia, eclampsia, pre- and post-term delivery, induction of labor, macrosomia, increased rate of caesarean section, and post-partum hemorrhage. The objective of this study was to determine the effect of maternal Body Mass Index (BMI) on pregnancy outcomes.</p> <p>Methods</p> <p>1000 pregnant women were enrolled in the study. In order to explore the relationship between maternal first trimester Body Mass Index and pregnancy outcomes, participants were categorized into five groups based on their first trimester Body Mass Index. The data were analyzed using Pearson Chi-square tests in SPSS 18. Differences were considered significant if p < 0.05.</p> <p>Results</p> <p>Women with an above-normal Body Mass Index had a higher incidence of pre-eclampsia, induction of labor, caesarean section, pre-term labor, and macrosomia than women with a normal Body Mass Index (controls). There was no significant difference in the incidence of post-term delivery between the control group and other groups.</p> <p>Conclusion</p> <p>Increased BMI increases the incidence of induction of labor, caesarean section, pre-term labor and macrosomia. The BMI of women in the first trimester of pregnancy is associated with the risk of adverse pregnancy outcome.</p

Maternal body mass index in outcome of pregnancy

Background: The increasing prevalence of obesity in young women is a major public health concern. These trends have a major impact on pregnancy outcomes in these women, which have been documented by several researchers. The objective of this study was to assess antenatal, intra-partum complications, perinatal outcome in pregnant women with high BMI.Methods: A total number of 100 cases were included in the study out of which, 50 cases were pregnant women with high BMI (> or = 30 kg/m2), 50 were pregnant women with normal BMI (20-24 kg/m2). Their pregnancy outcome were observed and compared. The outcome variables evaluated in study were rates of preeclampsia, gestational diabetes, cesarean delivery, failed induction, operative vaginal deliveries, birth weight, and postpartum infection.Results: Most of the patients that is, 60% of obese group and 68% of control group were between 20-25years, 28% of obese group and 8% of control group were between 31-35years. In our study most of the patients, 66% of obese group and 56% of control group were primiparas, whereas 34% of obese and 44% of normal group were multipara. There is a fourfold increase in the incidence of pre-eclampsia in the obese group compared to normal BMI group. Incidence of gestational diabetes is 2% in normal group compared to 8% in obese group that is fourfold increase in incidence in obese group. Pre-term labor is 8% among obese and 2% among control groups, a significant increase. Incidence of induction of labor is doubled in obese group, incidence being 20% in control group and 40% in obese group. Incidence of instrumental delivery is 14% in obese group and 6% in control group. 32% of obese group underwent cesarean section when compared to 12% of control group. The incidence of cesarean section is 3times higher in obese group. Macrosomia is the most common complication observed in the study, the incidence being 22% in obese group and 2% in control group. There is increase in incidence by eleven fold. Incidence of low APGAR score is increased by twofold.Conclusions: Maternal BMI shows strong associations with pregnancy complications and outcome. Both maternal and fetal complications are increased

Correlation Between Body Mass Index With The Incidence Of Preeclampsia

Introduction: Indonesia is on its way to achieve the Millennium Development Goals (MDG’s) of reducing the maternal mortality ratio by three-quarters between 1990 and 2015. Preeclampsia was the second cause of maternal mortality in Indonesia that was 7-10% from all maternal mortality that happened. Preeclampsia is a disease that occurs during pregnancy, which usually appear after 20 weeks and is characterized by an increase in blood pressure during pregnancy (systolic/diastolic ≥140/90 mmHg) with proteinuria and edema. Research shows an association between high Body Mass Index with an increase in the occurrence of preeclampsia. Aim: This research purpose is to determine the correlation between Body Mass Index with incidence of preeclampsia. Methods: This research used an observational analytic cross-sectional design. The sample used was 46 data from mother with preeclampsia and 46 from mother with normal pregnancy. The data used were secondary data from X hospital on January 2014 until December 2015, selected based on the inclusion and exclusion criteria. Data analysed using Spearman test. Result: Preeclampsia was significantly correlated to high body mass index (p=0,000, correlation coefficient is 0,632), where 58.7% of obese mothers, 28.26% of overweight mothers were diagnosed with preeclampsia, while only 8.7% of normal weight mothers, and 4.34% of underweight mothers had preeclampsia. Conclusion: The results showed that there was a significant correlation between Body Mass Index and preeclampsia , suggesting that mothers with high body mass index were at a higher risk of preeclampsi

Macronutrient Balance and Dietary Glycemic Index in Pregnancy Predict Neonatal Body Composition

The influence of maternal macronutrient balance and dietary glycemic index (GI) on neonatal body composition has received little study. We hypothesized that the overall quantity and quality of macronutrients, particularly carbohydrate, in the maternal diet could have trimester-specific effects on neonatal growth and body composition in women at risk of gestational diabetes. Maternal diet was assessed using 3-day food records in mid (n = 96) and late (n = 88) pregnancy as part of the GI Baby 3 study. Neonatal body composition was assessed by air-displacement plethysmography within 48 h of birth, adjusted for length, and expressed as fat mass index (FMI) and fat-free mass index (FFMI). In mid pregnancy, higher maternal intake of carbohydrate energy was negatively correlated with infant FFMI (p = 0.037). In late pregnancy, higher dietary GI was associated with lower FFMI (p = 0.010) and higher carbohydrate energy predicted lower FMI (p = 0.034). Higher fat intake (%E) and saturated fat, but not protein, also predicted neonatal body composition (higher FFMI in mid pregnancy and higher FMI in late pregnancy). Depending on pregnancy stage, a high carbohydrate-low fat diet, particularly from high glycemic sources, may reduce neonatal indices of both lean mass and adiposity

Maternal hypertensive disorders in pregnancy and early childhood cardiometabolic risk factors:The Generation R Study

The objective of this study was to determine the associations between hypertensive disorders of pregnancy and early childhood cardiometabolic risk factors in the offspring. Therefore, 7794 women from the Generation Rotterdam Study were included, an ongoing population-based prospective birth cohort. Women with a hypertensive disorder of pregnancy were classified as such when they were affected by pregnancy induced hypertension, pre-eclampsia or the haemolysis, elevated liver enzymes and low platelet count (HELLP) syndrome during pregnancy. Early childhood cardiometabolic risk factors were defined as the body mass index at the age of 2, 6, 12, 36 months and 6 years. Additionally, it included systolic blood pressure, diastolic blood pressure, total fat mass, cholesterol, triglycerides, insulin and clustering of cardiometabolic risk factors at 6 years of age. Sex-specific differences in the associations between hypertensive disorders and early childhood cardiometabolic risk factors were investigated. Maternal hypertensive disorders of pregnancy were inversely associated with childhood body mass index at 12 months (confounder model: -0.15 SD, 95% CI -0.27; -0.03) and childhood triglyceride at 6 years of age (confounder model: -0.28 SD, 95% CI -0.45; -0.10). For the association with triglycerides, this was only present in girls. Maternal hypertensive disorders of pregnancy were not associated with childhood body mass index at 2, 6 and 36 months. No associations were observed between maternal hypertensive disorders of pregnancy and systolic blood pressure, diastolic blood pressure, body mass index, fat mass index and cholesterol levels at 6 years of age. Our findings do not support an independent and consistent association between maternal hypertensive disorders of pregnancy and early childhood cardiometabolic risk factors in their offspring. However, this does not rule out possible longer term effects of maternal hypertensive disorders of pregnancy on offspring cardiometabolic health

Early Life Risk Factors for Incident Atrial Fibrillation in the Helsinki Birth Cohort Study

Background-Early life risk factors are associated with cardiometabolic disease, but have not been fully studied in atrial fibrillation (AF). There are discordant results from existing studies of birth weight and AF, and the impact of maternal body size, gestational age, placental size, and birth length is unknown. Methods and Results-The Helsinki Birth Cohort Study includes 13 345 people born as singletons in Helsinki in the years 1934-1944. Follow-up was through national registries, and ended on December 31, 2013, with 907 incident cases. Cox regression analyses stratified on year of birth were constructed for perinatal variables and incident AF, adjusting for offspring sex, gestational age, and socioeconomic status at birth. There was a significant U-shaped association between birth weight and AF (P for quadratic term = 0.01). The lowest risk of AF was found among those with a birth weight of 3.4 kg (3.8 kg for women [85th percentile] and 3.0 kg for men [17th percentile]). High maternal body mass index (>= 30 kg/m(2)) predicted offspring AF; hazard ratio 1.36 (95% CI 1.07-1.74, P = 0.01) compared with normal body mass index ( Conclusions-High maternal body mass index during pregnancy and maternal height are previously undescribed predictors of offspring AF. Efforts to prevent maternal obesity might reduce later AF in offspring. Birth weight has a U-shaped relation to incident AF independent of other perinatal variables.Peer reviewe

Maternal body mass index and feto-maternal outcome: a comparative study

Background: Increasing BMI in women poses multiple threat of illness especially in the reproductive age group impacting pregnancy. Pregnant women with overweight and obesity are at a higher risk of developing complications at all stages of the physiological pregnancy. A focus on the methods to prevent this trend of increasing weight gain in adolescence is essential curb the complications due to obesity.Methods: This prospective study was conducted in the Department of Obstetrics and Gynecology, Madras Medical College, Chennai. Written informed consent was obtained and pregnant women visiting the antenatal OP were registered. Detailed history taking and examination was carried out with the measurement of body mass index as weight in kg/height in meter square. The women were followed up for the antepartum, intrapartum, post-partum variables and neonatal outcome.Results: Two hundred pregnant women with high BMI >25 kg/m2 and two hundred pregnant women with normal BMI were selected and were followed prospectively.  Present study showed an increased incidence of pre-eclampsia in patients with high BMI (28% as compared to 8% of the normal BMI) and a higher incidence of Gestational diabetes mellitus among women with high BMI with a value of 27.5 % compared to a value of 7.5% in women with normal BMI. Caesarean delivery was found in 54.5% of the high BMI mothers compared to 31.5% in normal BMI mothers. Postoperatively, wound gaping was found with an incidence of 4.5% in high BMI mothers. IUGR was found in 10% of babies of women with high BMI and still birth occurred in 2.5% of deliveries of high BMI mothers compared to 0.5% in mothers of normal BMI group.Conclusions: The obstetrician needs to be well versed with dietary advice and life style pattern advice to the women of the reproductive age group in order to prevent the complications of high Body mass index in pregnancy. Its imperative to counsel these women about the pre-pregnancy loss of weight, healthy food and exercise, and healthy life style pattern during pregnancy in order to have a healthy outcome