Читать книгу Gestational Diabetes - Группа авторов - Страница 63

Obesity, as GDM, is associated with adverse pregnancy outcome, while obesity itself is a risk factor for GDM [59]; it has been suggested that obesity, rather than glucose, may have a greater RR for adverse perinatal complications than hyperglycemia [36, 37]. The risk of hyperglycemia is underestimated in the HAPO population since those with FPG >5.8 mmol/L (105 mg/dL) or those with 2-h 75-g values >11.1 mmol/L (200 mg/dL) were excluded from the study population, and this was not done for extreme BMI classes. Also, secondary analysis of HAPO data demonstrated that maternal BMI is independently associated with pregnancy complications and the combination of both is the riskiest [24, 25].

An interesting use of BMI was suggested by Kalter-Leibovici et al. [60]. They analyzed the 3,345 Israeli HAPO participants in 3 subgroups: GDM according to IADPSG criteria; GDM according to IADPSG criteria with risk stratification, or screening with BMI or FPG. They found that one-third of IADPSG-positive women were at low risk for adverse outcomes and could be managed less intensively, and this subpopulation can be identified by means of risk stratification with BMI (<33.5 kg/m²) or FPG (<88 mg/dL at 28–32 weeks), so to prevent overtreatment and reducing the number of women requiring treatment.

Both entities – diabetes and obesity – are of importance; they are not mutually exclusive and should be dealt as such.