Abstract
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Introduction: We sought to examine the association between body mass index (BMI) and fetal anomalies (FA) in women with pre-existing diabetes, gestational diabetes, and without diabetes.
Methods: This is a retrospective cohort study of women with singleton, term pregnancies between 2007 and 2011 using linked vital statistics and discharge data. Chi-square tests were used to compare rates of FA in diabetic and non-diabetic women categorized by BMI. Pre-pregnancy BMI was categorized into underweight, normal weight, overweight, obesity, and morbid obesity. Multivariable logistic regression was used to examine the association of BMI with FA by diabetes classification, controlling for maternal race/ethnicity, age, parity, education, and insurance status.
Results: The cohort of 1,993,905 consisted of 392,008 (19.7%) obese pregnant women. Higher BMI was found to be associated with increased odds of FA, independent of diabetes status. Underweight pre-pregnancy BMI was associated with decreased odds of FA compared to normal-weight. Women with gestational and pre-existing diabetes have significantly increased odds of FA (aOR 1.17, 95% CI 1.14-1.19; aOR 1.82 95% CI 1.74-1.90, respectively). A significant association was demonstrated between BMI category and FA for women with pre-existing diabetes and no diabetes but this relationship was not found with gestational diabetes.
Conclusion/Implications: Diabetes status and higher BMI were found to be individually associated with increased odds of FA. This study also demonstrated the compounding effect of diabetes status and obesity on the incidence of FA. Obstetrical education for these women should emphasize the increased potential of this pregnancy complication and the role of prenatal screening for FA.
Methods: This is a retrospective cohort study of women with singleton, term pregnancies between 2007 and 2011 using linked vital statistics and discharge data. Chi-square tests were used to compare rates of FA in diabetic and non-diabetic women categorized by BMI. Pre-pregnancy BMI was categorized into underweight, normal weight, overweight, obesity, and morbid obesity. Multivariable logistic regression was used to examine the association of BMI with FA by diabetes classification, controlling for maternal race/ethnicity, age, parity, education, and insurance status.
Results: The cohort of 1,993,905 consisted of 392,008 (19.7%) obese pregnant women. Higher BMI was found to be associated with increased odds of FA, independent of diabetes status. Underweight pre-pregnancy BMI was associated with decreased odds of FA compared to normal-weight. Women with gestational and pre-existing diabetes have significantly increased odds of FA (aOR 1.17, 95% CI 1.14-1.19; aOR 1.82 95% CI 1.74-1.90, respectively). A significant association was demonstrated between BMI category and FA for women with pre-existing diabetes and no diabetes but this relationship was not found with gestational diabetes.
Conclusion/Implications: Diabetes status and higher BMI were found to be individually associated with increased odds of FA. This study also demonstrated the compounding effect of diabetes status and obesity on the incidence of FA. Obstetrical education for these women should emphasize the increased potential of this pregnancy complication and the role of prenatal screening for FA.
Introduction: We sought to examine the association between body mass index (BMI) and fetal anomalies (FA) in women with pre-existing diabetes, gestational diabetes, and without diabetes.
Methods: This is a retrospective cohort study of women with singleton, term pregnancies between 2007 and 2011 using linked vital statistics and discharge data. Chi-square tests were used to compare rates of FA in diabetic and non-diabetic women categorized by BMI. Pre-pregnancy BMI was categorized into underweight, normal weight, overweight, obesity, and morbid obesity. Multivariable logistic regression was used to examine the association of BMI with FA by diabetes classification, controlling for maternal race/ethnicity, age, parity, education, and insurance status.
Results: The cohort of 1,993,905 consisted of 392,008 (19.7%) obese pregnant women. Higher BMI was found to be associated with increased odds of FA, independent of diabetes status. Underweight pre-pregnancy BMI was associated with decreased odds of FA compared to normal-weight. Women with gestational and pre-existing diabetes have significantly increased odds of FA (aOR 1.17, 95% CI 1.14-1.19; aOR 1.82 95% CI 1.74-1.90, respectively). A significant association was demonstrated between BMI category and FA for women with pre-existing diabetes and no diabetes but this relationship was not found with gestational diabetes.
Conclusion/Implications: Diabetes status and higher BMI were found to be individually associated with increased odds of FA. This study also demonstrated the compounding effect of diabetes status and obesity on the incidence of FA. Obstetrical education for these women should emphasize the increased potential of this pregnancy complication and the role of prenatal screening for FA.
Methods: This is a retrospective cohort study of women with singleton, term pregnancies between 2007 and 2011 using linked vital statistics and discharge data. Chi-square tests were used to compare rates of FA in diabetic and non-diabetic women categorized by BMI. Pre-pregnancy BMI was categorized into underweight, normal weight, overweight, obesity, and morbid obesity. Multivariable logistic regression was used to examine the association of BMI with FA by diabetes classification, controlling for maternal race/ethnicity, age, parity, education, and insurance status.
Results: The cohort of 1,993,905 consisted of 392,008 (19.7%) obese pregnant women. Higher BMI was found to be associated with increased odds of FA, independent of diabetes status. Underweight pre-pregnancy BMI was associated with decreased odds of FA compared to normal-weight. Women with gestational and pre-existing diabetes have significantly increased odds of FA (aOR 1.17, 95% CI 1.14-1.19; aOR 1.82 95% CI 1.74-1.90, respectively). A significant association was demonstrated between BMI category and FA for women with pre-existing diabetes and no diabetes but this relationship was not found with gestational diabetes.
Conclusion/Implications: Diabetes status and higher BMI were found to be individually associated with increased odds of FA. This study also demonstrated the compounding effect of diabetes status and obesity on the incidence of FA. Obstetrical education for these women should emphasize the increased potential of this pregnancy complication and the role of prenatal screening for FA.
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