Obesity and Diabetes Independently Linked to Adverse Pregnancy Outcomes

Pre-pregnancy weight above 149 pounds was tied to increased risks of preeclampsia in all ethnic groups. In the combined analysis, increased body weight raised the risk of primary cesarean delivery, but was tied to reduced risk of low birthweight.

A large population-based study shows that obesity and diabetes are independent risk factors for a number of adverse pregnancy outcomes, such as primary cesarean delivery and low birth weight. The magnitude of the effect, however, varies by ethnic group.

As reported in the American Journal of Public Health for September, Dr. Terry J. Rosenberg, from the Medical Health and Research Association of New York City, and colleagues analyzed data from 329,988 singleton births to determine the impact of obesity and diabetes on pregnancy outcomes and the effect, if any, of race.

The researchers found that diabetes, whether gestational or chronic, raised the risk of primary cesarean delivery in all ethnic groups. The relative risks ranged from 1.23 for whites with gestational diabetes to 2.86 for Hispanics with chronic diabetes.

Similarly, diabetes was tied to elevated risks of preterm birth in all ethnic groups. In this case, the relative risks ranged from 1.20 for whites with gestational diabetes to 3.43 for Hispanics with chronic diabetes.

Regarding low birthweight, the effect of diabetes was less clear. Chronic diabetes was always associated with an increased risk of low birthweight, regardless of ethnicity. In contrast, gestational diabetes had no significant effect on this outcome in whites or Asians and was tied a significantly reduced risk in blacks and Hispanics.

Prepregnancy weight above 149 pounds was tied to increased risks of preeclampsia in all ethnic groups. In the combined analysis, increased body weight raised the risk of primary cesarean delivery, but was tied to reduced risk of low birthweight.

"Although careful monitoring of diabetes during pregnancy can improve pregnancy outcomes for diabetic women," the authors conclude, "the longer-term public health approach should be to prevent type 2 diabetes and gestational diabetes by controlling women’s weight over their lifetimes."
Am J Public Health 2005;95:1545-1551.

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