CC BY-NC-ND 4.0 · Geburtshilfe Frauenheilkd 2018; 78(04): 400-406
DOI: 10.1055/a-0589-2833
GebFra Science
Original Article
Georg Thieme Verlag KG Stuttgart · New York

The Influence of Maternal Obesity on Pregnancy Complications and Neonatal Outcomes in Diabetic and Nondiabetic Women

Der Einfluss mütterlicher Adipositas auf Schwangerschaftskomplikationen und neonatale Ergebnisse bei Frauen mit und ohne Diabetes
Burcu Budak Timur
1   Zekai Tahir Burak Womenʼs Health Education and Research Hospital, Obstetrics and Gynecology Department, Ankara, Turkey
,
Hakan Timur
2   Zekai Tahir Burak Womenʼs Health Education and Research Hospital, Perinatology Department, Ankara, Turkey
,
Aytekin Tokmak
1   Zekai Tahir Burak Womenʼs Health Education and Research Hospital, Obstetrics and Gynecology Department, Ankara, Turkey
,
Hatice Isik
3   Memorial Hospital, Obstetrics and Gynecology Department, Ankara,Turkey
,
Elif Gul Yapar Eyi
2   Zekai Tahir Burak Womenʼs Health Education and Research Hospital, Perinatology Department, Ankara, Turkey
› Author Affiliations
Further Information

Publication History

received 23 December 2017
revised 11 March 2018

accepted 12 March 2018

Publication Date:
26 April 2018 (online)

Abstract

Introduction This study aimed to investigate the influence of obesity on pregnancy complications and neonatal outcomes in diabetic and nondiabetic women.

Materials and Methods This retrospective case control study was conducted on 1193 pregnant women and their neonates at a tertiary level maternity hospital between March 2007 and 2011. The pregnant women were classified into 2 groups according to the presence of diabetes mellitus. Six hundred and seven patients with gestational diabetes or pregestational diabetes formed the diabetic group (study group) and 586 patients were in the nondiabetic group (control group). Demographic characteristics, body mass index, gestational weight gain, obstetric history, smoking status, type of delivery, gestational ages, pregnancy complications, neonatal outcomes were recorded for each patient. Multivariable logistic regression analysis was performed to evaluate the effect of obesity and diabetes on the pregnancy complications and neonatal outcomes.

Results The mean age and pre-pregnancy body mass indices of women with diabetes mellitus were significantly higher than the control groupʼs (p < 0.001). Gestational weight gain and number of smokers were similar among the groups. Multiparity and obesity were more prevalent in the diabetic group compared to controls (both p < 0.001). Although gestational age at birth was earlier in the diabetic group, birth weights were higher in this group than in the control group (both p < 0.001). Cesarean delivery rates, the incidence of macrosomia, and neonatal intensive care unit admission rates were significantly higher in the diabetes group both with normal and increased body mass index (all p < 0.001). However, adverse pregnancy outcomes were comparable between the groups (p = 0.279). Multivariable logistic regression analysis showed that obesity is a significant risk factor for pregnancy complications (OR = 1.772 [95% CI, 1.283 – 2.449], p = 0.001) but not for adverse neonatal outcomes (OR = 1.068 [95% CI, 0.683 – 1.669], p = 0.773).

Conclusion While obesity increases risk of developing a pregnancy complication, diabetes worsens neonatal outcomes.

Zusammenfassung

Einleitung Ziel dieser Studie war es, den Einfluss von mütterlicher Adipositas auf Schwangerschaftskomplikationen sowie Neugeborenen-Outcomes bei Frauen mit und ohne Diabetes zu untersuchen.

Material und Methode Diese retrospektive Fallkontrollstudie wurde an 1193 schwangeren Frauen und ihren neugeborenen Kinder durchgeführt, die zwischen März 2007 und 2011 in einer Geburtsklinik der Regelversorgung betreut wurden. Die schwangeren Frauen wurden in 2 Gruppen eingeteilt, abhängig davon, ob sie Diabetes hatten oder nicht. 607 Patientinnen mit Gestations- oder Prägestationsdiabetes bildeten die Diabetesgruppe (Untersuchungsgruppe), die 586 Patientinnen in der Gruppe ohne Diabetes fungierten als Kontrollgruppe. Demografische Merkmale, Body-Mass-Index (BMI), Gewichtszunahme während der Schwangerschaft, geburtshilfliche Anamnese, Raucherstatus, Art der Entbindung, Schwangerschaftsalter, Schwangerschaftskomplikationen und neonatales Outcome wurden für jede Patientin erfasst. Eine multivariable Regressionsanalyse wurde durchgeführt, um die Auswirkung von Adipositas und Diabetes auf Schwangerschaftskomplikationen und neonatales Outcome zu bewerten.

Ergebnisse Das Durchschnittsalter und der BMI vor der Schwangerschaft waren deutlich höher bei den Frauen mit Diabetes mellitus als in der Kontrollgruppe (p < 0,001). Die Gewichtszunahme während der Schwangerschaft und die Anzahl der Raucherinnen waren in beiden Gruppen ähnlich. Es gab mehr Frauen mit Übergewicht und mehr Mehrgebärende in der Diabetesgruppe verglichen mit der Kontrollgruppe (beide jeweils p < 0,001). Obwohl die Neugeborenen der Diabetesgruppe ein jüngeres Schwangerschaftsalter hatten bei der Geburt, war das Geburtsgewicht bei den Neugeborenen der Diabetesgruppe höher verglichen mit der Kontrollgruppe (beide jeweils p < 0,001). Die Kaiserschnittraten, die Häufigkeit von Makrosomie und die Einweisungsrate in die Neugeborenen-Intensivstation waren deutlich höher für die Diabetesgruppe, sowohl für Frauen mit normalem BMI als auch für Frauen mit hohem BMI (jeweils p < 0,001). Die unerwünschten Schwangerschaftsausgänge waren aber in beiden Gruppen vergleichbar (p = 0,279). Die multivariable Regressionsanalyse zeigte, dass Übergewicht einen wesentlichen Risikofaktor für Schwangerschaftskomplikationen darstellt (OR = 1,772 [95%-KI 1,283 – 2,449], p = 0,001), aber nicht für ungünstige neonatale Ergebnisse (OR = 1,068 [95%-KI 0,683 – 1,669], p = 0,773).

Schlussfolgerung Während Adipositas das Risiko von Schwangerschaftskomplikationen erhöht, verschlechtert Diabetes das neonatale Outcome.

 
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