Impact of maternal body mass index above 30 kg/m2 on adverse pregnancy outcomes in women with and without gestational diabetes mellitus in southeastern Sweden
(2025) In Acta Obstetricia et Gynecologica Scandinavica 104(11). p.2093-2101- Abstract
Introduction: Our objective was to evaluate the association of early-pregnancy body mass index (BMI) in women with gestational diabetes mellitus (GDM) with maternal, delivery, and child outcomes, and compare with pregnancies without diabetes in southeastern Sweden, including after a surge of non-European immigration. Material and Methods: A retrospective population-based observational study of all 401 singleton pregnancies with GDM in the Kronoberg and southern Kalmar regions, 2013–2018, and 377 pregnancies without diabetes, matched by date of delivery. Data were collected by chart review. Women with early-pregnancy BMI <30 kg/m2/≥30 kg/m2 were compared. Main outcomes were gestational weight gain (GWG),... (More)
Introduction: Our objective was to evaluate the association of early-pregnancy body mass index (BMI) in women with gestational diabetes mellitus (GDM) with maternal, delivery, and child outcomes, and compare with pregnancies without diabetes in southeastern Sweden, including after a surge of non-European immigration. Material and Methods: A retrospective population-based observational study of all 401 singleton pregnancies with GDM in the Kronoberg and southern Kalmar regions, 2013–2018, and 377 pregnancies without diabetes, matched by date of delivery. Data were collected by chart review. Women with early-pregnancy BMI <30 kg/m2/≥30 kg/m2 were compared. Main outcomes were gestational weight gain (GWG), continuous and dichotomized <8 kg/≥8 kg, preeclampsia, cesarean section (CS), and large-for-gestational-age (LGA). Maternal age, ethnicity, parity, smoking, physical activity, delivery type and week, birthweight, and the APGAR5min score were also registered. Results: Obese women with GDM had lower mean GWG (9.2 ± 6.8 vs. 11.7 ± 6.1 kg); fewer reached ≥8 kg (54% vs. 75%), more had preeclampsia (13% vs. 2.6%), and infants weighed 200 g less than those of nonobese women with GDM all p < 0.001 and those of obese women without GDM (11.2 ± 5.8 kg, p < 0.001; 68%, p = 0.05, 3.1%, p = 0.03). APGAR5min scores were high in all groups, 9.4–9.8. All women with GDM had a higher prevalence of LGA infants than controls without diabetes; obese 24% versus 12% (p = 0.03) and nonobese 11% versus 6% (p = 0.05). Obese women with GDM delivered more LGA infants than nonobese women with GDM, p = 0.001. The combination of GDM and obesity increased risk of LGA, OR 5.3 (2.76–10.1); preeclampsia OR 4.3 (1.83–10.23); and CS OR 1.9 (1.26–2.97) and decreased odds of GWG ≥8 kg, OR 0.25 (0.16–0.38), compared to the reference group of nonobese women without GDM. All results remained unchanged in a sensitivity analysis using the BMI obesity limit ≥27.5 kg/m2 for Asians, who were overrepresented in the group of women with GDM. Conclusions: Women with GDM and obesity, especially in combination, had a greater risk for preeclampsia, CS, and delivering LGA infants; their lower GWG and high APGAR5min scores in all groups, compared to earlier studies, suggested successful care interventions. Efforts to lower the levels of early-pregnancy obesity and strict glucose control in women with GDM are recommended to reduce adverse outcomes.
(Less)
- author
- Stogianni, Anna LU ; Jönsson, Annika ; Penna, Malin ; Lendahls, Lena ; Alvarsson, Michael ; Landin-Olsson, Mona LU ; Wanby, Pär and Thunander, Maria LU
- organization
- publishing date
- 2025-11
- type
- Contribution to journal
- publication status
- published
- subject
- keywords
- APGAR, cesarean section, ethnicity, gestational diabetes, gestational weight gain, large-for-gestational-age, obesity, preeclampsia
- in
- Acta Obstetricia et Gynecologica Scandinavica
- volume
- 104
- issue
- 11
- pages
- 9 pages
- publisher
- Wiley-Blackwell
- external identifiers
-
- scopus:105013102847
- pmid:40801460
- ISSN
- 0001-6349
- DOI
- 10.1111/aogs.70040
- language
- English
- LU publication?
- yes
- id
- b1d850d8-e4a6-43fd-a3ab-a93f2f100d6b
- date added to LUP
- 2026-01-08 08:41:54
- date last changed
- 2026-02-05 11:28:47
@article{b1d850d8-e4a6-43fd-a3ab-a93f2f100d6b,
abstract = {{<p>Introduction: Our objective was to evaluate the association of early-pregnancy body mass index (BMI) in women with gestational diabetes mellitus (GDM) with maternal, delivery, and child outcomes, and compare with pregnancies without diabetes in southeastern Sweden, including after a surge of non-European immigration. Material and Methods: A retrospective population-based observational study of all 401 singleton pregnancies with GDM in the Kronoberg and southern Kalmar regions, 2013–2018, and 377 pregnancies without diabetes, matched by date of delivery. Data were collected by chart review. Women with early-pregnancy BMI <30 kg/m<sup>2</sup>/≥30 kg/m<sup>2</sup> were compared. Main outcomes were gestational weight gain (GWG), continuous and dichotomized <8 kg/≥8 kg, preeclampsia, cesarean section (CS), and large-for-gestational-age (LGA). Maternal age, ethnicity, parity, smoking, physical activity, delivery type and week, birthweight, and the APGAR<sub>5min</sub> score were also registered. Results: Obese women with GDM had lower mean GWG (9.2 ± 6.8 vs. 11.7 ± 6.1 kg); fewer reached ≥8 kg (54% vs. 75%), more had preeclampsia (13% vs. 2.6%), and infants weighed 200 g less than those of nonobese women with GDM all p < 0.001 and those of obese women without GDM (11.2 ± 5.8 kg, p < 0.001; 68%, p = 0.05, 3.1%, p = 0.03). APGAR<sub>5min</sub> scores were high in all groups, 9.4–9.8. All women with GDM had a higher prevalence of LGA infants than controls without diabetes; obese 24% versus 12% (p = 0.03) and nonobese 11% versus 6% (p = 0.05). Obese women with GDM delivered more LGA infants than nonobese women with GDM, p = 0.001. The combination of GDM and obesity increased risk of LGA, OR 5.3 (2.76–10.1); preeclampsia OR 4.3 (1.83–10.23); and CS OR 1.9 (1.26–2.97) and decreased odds of GWG ≥8 kg, OR 0.25 (0.16–0.38), compared to the reference group of nonobese women without GDM. All results remained unchanged in a sensitivity analysis using the BMI obesity limit ≥27.5 kg/m<sup>2</sup> for Asians, who were overrepresented in the group of women with GDM. Conclusions: Women with GDM and obesity, especially in combination, had a greater risk for preeclampsia, CS, and delivering LGA infants; their lower GWG and high APGAR<sub>5min</sub> scores in all groups, compared to earlier studies, suggested successful care interventions. Efforts to lower the levels of early-pregnancy obesity and strict glucose control in women with GDM are recommended to reduce adverse outcomes.</p>}},
author = {{Stogianni, Anna and Jönsson, Annika and Penna, Malin and Lendahls, Lena and Alvarsson, Michael and Landin-Olsson, Mona and Wanby, Pär and Thunander, Maria}},
issn = {{0001-6349}},
keywords = {{APGAR; cesarean section; ethnicity; gestational diabetes; gestational weight gain; large-for-gestational-age; obesity; preeclampsia}},
language = {{eng}},
number = {{11}},
pages = {{2093--2101}},
publisher = {{Wiley-Blackwell}},
series = {{Acta Obstetricia et Gynecologica Scandinavica}},
title = {{Impact of maternal body mass index above 30 kg/m<sup>2</sup> on adverse pregnancy outcomes in women with and without gestational diabetes mellitus in southeastern Sweden}},
url = {{http://dx.doi.org/10.1111/aogs.70040}},
doi = {{10.1111/aogs.70040}},
volume = {{104}},
year = {{2025}},
}