Relationship of maternal body weight and gestational diabetes mellitus with large-for-gestational-age babies at birth in Taiwan: The TMICS cohort

Hui-Ming Chen; Chia-Fang Wu; Chia-Jung Hsieh; Fu-Chen Kuo; Chien-Wen Sun; Shu-Li Wang; Mei-Lien Chen; Ming-Tsang Wu

doi:10.1016/j.tjog.2022.02.010

Relationship of maternal body weight and gestational diabetes mellitus with large-for-gestational-age babies at birth in Taiwan: The TMICS cohort

Taiwan J Obstet Gynecol. 2022 Mar;61(2):234-242. doi: 10.1016/j.tjog.2022.02.010.

Authors

Hui-Ming Chen¹, Chia-Fang Wu², Chia-Jung Hsieh³, Fu-Chen Kuo⁴, Chien-Wen Sun⁵, Shu-Li Wang⁶, Mei-Lien Chen⁷, Ming-Tsang Wu⁸

Affiliations

¹ Department of Family Medicine and Occupational Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan. Electronic address: rayne336@yahoo.com.tw.
² International Master Program of Translational Medicine, National United University, Miaoli, Taiwan; Research Center for Environmental Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan. Electronic address: chiafangwu27@gmail.com.
³ Department of Public Health, Tzu Chi University, Hualien, Taiwan. Electronic address: cjhsieh@mail.tcu.edu.tw.
⁴ Research Center for Environmental Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan; School of Medicine, College of Medicine, I-Shou University, Kaohsiung, Taiwan; Department of Obstetrics & Gynecology, E-Da Hospital, Kaohsiung, Taiwan. Electronic address: ed100418@edah.org.tw.
⁵ National Environmental Health Research Center, National Institute of Environmental Health Sciences, National Health Research Institutes, Miaoli, Taiwan. Electronic address: agnes@nhri.org.tw.
⁶ National Environmental Health Research Center, National Institute of Environmental Health Sciences, National Health Research Institutes, Miaoli, Taiwan. Electronic address: slwang@nhri.org.tw.
⁷ Institute of Environmental and Occupational Health Sciences, College of Medicine, National Yang Ming University, Taipei, Taiwan. Electronic address: mlchen@ym.edu.tw.
⁸ Research Center for Environmental Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan; PhD Program in Environmental and Occupational Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan; Department of Public Health, Kaohsiung Medical University, Kaohsiung, Taiwan; Department of Family Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan; Institute of Medical Science and Technology, National Sun Yat-Sen University, Kaohsiung, Taiwan. Electronic address: 960021@ms.kmuh.org.tw.

PMID: 35361382
DOI: 10.1016/j.tjog.2022.02.010

Abstract

Objective: To determine if both gestational diabetes mellitus (GDM) and maternal overweight/obesity are independently associated with delivery of large-for-gestational-age (LGA) babies in Taiwan.

Materials and methods: Anthropometric parameters were measured and 75-g oral glucose-tolerance tests were administered to a cohort of 1428 pregnant women at 24-28 weeks gestation at nine hospitals in Taiwan. GDM was diagnosed based on the International Association of Diabetes and Pregnancy Study Groups criteria. Reported pre-pregnancy BMI and measured BMI during pregnancy were recorded at the late stage of the second trimester and the third trimester. Neonatal anthropometrics were measured at delivery. Primary outcome was LGA, defined in this study as having a birth weight ≥90th percentile for gestational age defined by WHO or a Chinese growth reference, taking into consideration the racial/ethnic and environmental differences in growth around the world. Multiple logistic regression was used to examine associations of GDM and maternal overweight/obesity with outcomes.

Results: Based on WHO growth reference definition of LGA, subjects with pre-pregnancy BMI ≥24 and pregnancy BMI >28.4 were found to be 2.46 times (0.76-7.97) and 3.28 times (1.01-10.60), respectively, more likely to deliver LGA babies than subjects with normal pre-pregnancy and pregnancy BMIs. Compared to those without GDM, subjects with GDM were 7.55 (1.62-35.25) times more likely to deliver LGA babies. The odds ratios for delivering a baby with a birth weight ≥90th percentile were 11.40 (1.65-78.75) for those with GDM alone, 4.10 (1.07-15.65) for those with overweight/obesity alone and 15.75 (1.30-190.40) for those with both GDM and overweight/obesity, compared to those with no GDM and no overweightness. Women with both pre-pregnancy and pregnancy overweightness/obesity were 3.64 (1.07-12.34) times more likely to deliver LGA. The above results remained similar when analyzing data based on Chinese growth reference definition of LGA.

Conclusion: Maternal overweightness/obesity and GDM are independently associated with LGA. Their combination had a greater impact than either one alone.

Keywords: Gestational diabetes mellitus; Large-for-gestational-age babies; Maternal body weight; TMICS.

MeSH terms

Birth Weight
Body Mass Index
Diabetes, Gestational*
Female
Humans
Infant, Newborn
Pregnancy
Taiwan / epidemiology
Weight Gain