Pre-pregnancy obesity, gestational diabetes or gestational weight gain: Which is the strongest predictor of pregnancy outcomes?

Aims: Both obesity and gestational diabetes (GDM) are risk factors for adverse pregnancy outcomes. The aim of our study is to ascertain the independent role of prepregnancy BMI (pp-BMI), gestational weight gain (GWG), and GDM on pregnancy outcomes. Methods: We analyzed data of 1198 pregnant women, who underwent selective screening for GDM. Data on pregnancy outcomes was collected from hospital discharge records. Results: Cesarean section (CS) was comparable in GDM and NGTwomen. Prevalence of fetal macrosomia was 5.9%, with no difference between GDM and normal glucose tolerance (NGT), neonatal hyperbilirubinemia were more frequent in newborns of GDM women (63.3% vs. 52.2%; p < 0.01). Offspring of women with excessive GWG weighed more than those of women with regular GWG (3405 +/- 510 g vs. 3287 +/- 524 g; p < 0.01). On a logistic regression analysis, GWG was an independent risk factor for macrosomia (OR 1.08, 95% CI 1.02-1.13; p < 0.01) and delivery at a gestational age < 37 weeks (OR 0.29, 95% CI 0.16-0.53; p < 0.0001). GDM and pp-BMI were not independent risk factors for adverse outcomes in this cohort. Conclusions: GWG rather than GDM is associated with adverse pregnancy outcomes. These findings call for an early education and implementation of a healthy lifestyle in women planning a pregnancy. (C) 2018 Elsevier B.V. All rights reserved.