Association between maternal obesity and gestational diabetes mellitus and their related outcomes


  • Sunanda Bharatnur Department of Obstetrics and Gynaecology, Srinivas Institute of Medical Sciences and Research Centre, Mukka, Mangalore, Karnataka, India
  • Pooja B. Acharya Department of Obstetrics and Gynaecology, Srinivas Institute of Medical Sciences and Research Centre, Mukka, Mangalore, Karnataka, India



Gestational diabetes, Insulin resistance, Maternal outcome, Neonatal outcome, Pregnancy, Obesity


Background: Gestational diabetes mellitus (GDM) has a direct correlation with maternal body mass index (BMI). Pre-pregnancy BMI is ideal for studying the outcomes of obesity in pregnancy. Unlike the west, in countries like India, pregnant women approach health facilities during first trimester making it appropriate to consider first trimester BMI, as a parameter to study outcome variables. In this study we correlate BMI and GDM in pregnancy as GDM has significant impact on mother and baby. Aim of study was to study maternal and neonatal outcomes in obese women who have conceived among two groups, GDM and non-GDM.

Methods: Observational study conducted at tertiary care teaching hospital over a one-year period (2021-2022). All pregnant women in first trimester with Body Mass Index (BMI) ≥30, calculated in first visit, was included in this study for follow-up. According to the results of GDM screening at 24-28 weeks of gestation by DIPSI method, pregnancies were divided into the GDM and non-GDM group. They were observed for risk of GDM. The obstetric and neonatal outcomes were noted and compared between the two groups. Data was analysed using SPSS software.

Results: Mean BMI (32.79±1.47) among GDM group is greater than Non GDM (31.15±1.22), with p-value 0.00005 is significant. In obstetric outcomes, GDM is associated with increased incidence of preterm deliveries (p-value=0.004), gestational hypertension (p-value=0.002). In case of perinatal outcomes, increase incidence of hyperbilirubinemia (p-value=0.002), hypoglycemia (p-value=0.048) and sepsis (p value=0.046) in neonates born to GDM is seen.

Conclusions: BMI calculation in early pregnancy is good indicator to monitor for complications in pregnancy including GDM. Therefore, identification of patients with high BMI and GDM requires regular follow up during pregnancy so that early intervention minimises complications.



Wang X, Zhang X, Zhou M, Juan J, Wang X. Association of gestational diabetes mellitus with adverse pregnancy outcomes and its interaction with maternal age in Chinese urban women. J Diab Res. 2021;2021:5516937.

Shepherd E, Gomersall JC, Tieu J, Han S, Crowther CA, Middleton P. Combined diet and exercise interventions for preventing gestational diabetes mellitus. Coch Data Syst Rev. 2017;11:CD010443.

Ferrara A. Increasing prevalence of gestational diabetes mellitus: a public health perspective. Diabetes Care. 2007;30(Suppl 2):S141-6.

Gao C, Sun X, Lu L, Liu F, Yuan J. Prevalence of gestational diabetes mellitus in mainland China: a systematic review and meta-analysis. J Diabetes Investig. 2019;10(1):154-62.

Yang X, Hsu-Hage B, Zhang H, Yu L, Dong L, Li J, et al. Gestational diabetes mellitus in women of single gravidity in Tianjin City, China. Diabetes care. 2002;25(5):847-51.

Popova PV, Klyushina AA, Vasilyeva LB, Tkachuk AS, Vasukova EA, Anopova AD, et al. Association of Common Genetic Risk Variants with Gestational Diabetes Mellitus and Their Role in GDM prediction. Front Endocrinol. 2021;12:628582.

Wu L, Han L, Zhan Y, Cui L, Chen W, Ma L, et al. Prevalence of gestational diabetes mellitus and associated risk factors in pregnant Chinese women: a cross-sectional study in Huangdao, Qingdao, China. Asia Pac J Clin Nutr. 2018;27(2):383-8.

Parrettini S, Caroli A, Torlone E. Nutrition and metabolic adaptations in physiological and complicated pregnancy: focus on obesity and gestational diabetes. Front Endocrinol. 2020;11:611929.

Goldstein RF, Abell SK, Ranasinha S, Misso M, Boyle JA, Black MH, et al. Association of gestational weight gain with maternal and infant outcomes: a systematic review and meta-analysis. JAMA. 2017;317(21):2207-25.

Yew TW, Chi C, Chan SY, van Dam RM, Whitton C, Lim CS, et al. A randomized controlled trial to evaluate the effects of a smartphone application-based lifestyle coaching program on gestational weight gain, glycemic control, and maternal and neonatal outcomes in women with gestational diabetes mellitus: the SMART-GDM study. Diab Care. 2021;44(2):456-63.

Sun Y, Shen Z, Zhan Y, Wang Y, Ma S, Zhang S, et al. Effects of pre-pregnancy body mass index and gestational weight gain on maternal and infant complications. BMC Preg Child. 2020;20(1):390.

International Diabetes Federation. Diabetes. 9th ed. ATLAS; 2019.

Cho NH, Shaw JE, Karuranga S, Huang Y, da Rocha Fernandes JD, Ohlrogge AW, et al. IDF Diabetes Atlas: global estimates of diabetes prevalence for 2017 and projections for 2045. Diabetes Res Clin Pract. 2018;138:271-81.

Jenum AK, Morkrid K, Sletner L, Vangen S, Torper JL, Nakstad B, et al.. Impact of ethnicity on gestational diabetes identified with the WHO and the modified international association of diabetes and pregnancy study groups criteria: a population-based cohort study. Eur J Endocrinol. 2012;166(2):317-24.

Kragelund Nielsen K, Andersen GS, Damm P, Andersen AN. Gestational diabetes risk in migrants. a nationwide, register-based study of all births in Denmark 2004 to 2015. J Clin Endocrinol Metab. 2020;105(3):e692-703.

Shek NW, Ngai CS, Lee CP, Chan JY, Lao TT. Lifestyle modifications in the development of diabetes mellitus and metabolic syndrome in chinese women who had gestational diabetes mellitus: a randomized interventional trial. Arch Gynecol Obstet. 2014;289(2):319-27.

Hewage SS, Koh XYH, Soh SE, Pang WW, Fok D, Cai S, et al. Breastfeeding duration and development of dysglycemia in women who had gestational diabetes mellitus: evidence from the GUSTO Cohort Study. Nutrients. 2021;13(2):408.

Heida KY, Franx A, van Rijn BB, Eijkemans MJ, Boer JM, Verschuren MW, et al. Earlier age of onset of chronic hypertension and type 2 diabetes mellitus after a hypertensive disorder of pregnancy or gestational diabetes mellitus. Hypertension. 2015;66(6):1116–22.

Forbes Forbes S, Godsland IF, Taylor-Robinson SD, Bell JD, Thomas EL, Patel N, et al. A history of previous gestational diabetes mellitus is associated with adverse changes in insulin secretion and VLDL metabolism independently of increased intrahepatocellular lipid. Diabetolog. 2013;56(9):2021-33.

Perrin MC, Terry MB, Kleinhaus K, Deutsch L, Yanetz R, Tiram E, et al. Gestational diabetes and the risk of breast cancer among women in the Jerusalem perinatal study. Breast Cancer Res Treat. 2008;108(1):129-35.

Wang L, Leng J, Liu H, Zhang S, Wang J, Li W, et al. Association between hypertensive disorders of pregnancy and the risk of postpartum hypertension: a cohort study in women with gestational diabetes. J Hum Hypertens. 2017;31(11):725–30.






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