Читать книгу Gestational Diabetes - Группа авторов - Страница 37

Congenital Malformations

Maternal obesity is associated with increased rates of congenital malformations. A recent systematic review demonstrated a positive association between increasing maternal obesity and congenital heart defects. The relation was similar for moderate and severe obesity with increases by 1.15 and 1.39 independent of diabetes mellitus status. However, for women who were overweight, there was an association (OR 1.08) but only when women with diabetes were included in the analysis [22]. An analysis of the Florida Birth Defects Registry showed an increase in prevalence of birth defects in live born infants, increasing from 3.9% in underweight women to 5.3% in obese women with BMI >40 [23]. Other studies have shown a positive dose – response relationship for most birth defects with maternal obesity, with the exception of gastroschisis [7, 23, 24]. Additionally, maternal obesity decreases the chance of detecting congenital anomalies antenatally by 23% [25].

Effects on Neonatal Complications

In addition to excess adiposity, offspring of obese women are reported to be more metabolically unhealthy at birth with higher cord blood HOMA-IR, leptin, and IL-6 [26]. Adiposity assessment using anthropometric measures and total body electrical conductivity demonstrated a marginal increase in birth weight, no change in lean body mass but a significant increase in percent body fat from 9.7 to 11.6% in neonates born to overweight/obese women [27]. The risk of LGA infants is increased with increasing maternal weight gain in obesity [28]. When adjusted for weight gain in pregnancy, the odds for LGA was increased for lean women with GDM by 1.96, by 2.63 for only obese women, and by 5.47 for obese women with GDM when compared to lean, euglycemic women [18].

Infants born to obese and morbidly obese women are at an increased risk of neonatal hypoglycemia and infants of morbidly obese women are also at an increased risk of premature delivery, admission to intensive care, and jaundice [7].