Research Article
BibTex RIS Cite

The amplifying effect of maternal obesity on perinatal outcomes in gestational diabetes mellitus

Year 2025, Volume: 7 Issue: 5, 551 - 558, 15.09.2025

Erkan Sağlam

https://doi.org/10.38053/acmj.1720706

Abstract

Aims: This study aimed to evaluate the impact of maternal body-mass index (BMI) in the first trimester on perinatal outcomes in pregnant women diagnosed with gestational diabetes mellitus (GDM).
Methods: This retrospective cohort study included 210 women with GDM, categorized into three groups based on firsttrimester BMI: normal weight (BMI<25.0 kg/m²), overweight (BMI 25.0–29.9 kg/m²), and obese (BMI≥30.0 kg/m²). Perinatal outcomes such as preterm birth, low birth weight, macrosomia, NICU admission, and Apgar scores were compared across groups. Multivariate logistic regression analyses were conducted to evaluate the independent association between obesity and adverse perinatal outcomes.
Results: The rates of preterm birth <37 weeks (35.7%, p<0.001) and <34 weeks (11.4%, p=0.016) were significantly higher in the obese group. Although low birth weight (<2500 g) was observed in 10.0% of obese women, this difference was not statistically significant (p=0.211). Macrosomia (≥4000 g) was more frequent in the obese group (11.4%) but did not reach statistical significance (p=0.261). NICU admission rates were higher in obese women (22.9%, p=0.089). In adjusted analyses, obesity was independently associated with increased odds of preterm birth <34 weeks (adjusted OR: 6.01, p=0.012) and low birth weight (adjusted OR: 4.68, p=0.026). Additionally, Spearman correlation analysis revealed a weak, non-significant positive correlation between gestational weight gain and gestational age at birth (r=0.122, p=0.077).
Conclusion: In pregnant women with GDM, first-trimester maternal obesity is associated with an increased risk of early preterm birth and low birth weight. These findings underscore the importance of assessing and managing maternal BMI early in pregnancy to improve perinatal outcomes.

Keywords

Gestational diabetes mellitus maternal obesity perinatal outcomes preterm birth

References

  • Wendland EM, Torloni MR, Falavigna M, et al. Gestational diabetes and pregnancy outcomes--a systematic review of the World Health Organization (WHO) and the International Association of Diabetes in Pregnancy Study Groups (IADPSG) diagnostic criteria. BMC Pregnancy Childbirth. 2012;12(1):23. doi:10.1186/1471-2393-12-23
  • Wang H, Li N, Chivese T, et al. IDF diabetes atlas: estimation of global and regional gestational diabetes mellitus prevalence for 2021 by international association of diabetes in pregnancy study group’s criteria. Diabetes Res Clin Pract. 2022;183:109050. doi:10.1016/j.diabres.2021. 109050
  • Gao C, Sun X, Lu L, et al. Prevalence of gestational diabetes mellitus in mainland China: a systematic review and meta- analysis. J Diabetes Investig. 2019;10(1):154-162. doi:10.1111/jdi.12854
  • Yen IW, Lee CN, Lin MW, et al. Overweight and obesity are associated with clustering of metabolic risk factors in early pregnancy and the risk of GDM. PLoS One. 2019;14(12):e0225978. doi:10.1371/journal.pone. 0225978
  • Pantham P, Aye IL, Powell TL. Inflammation in maternal obesity and gestational diabetes mellitus. Placenta. 2015;36(7):709-715. doi:10.1016/j.placenta.2015.04.006
  • Šimják P, Cinkajzlová A, Anderlová K, et al. The role of obesity and adipose tissue dysfunction in gestational diabetes mellitus. J Endocrinol. 2018;238(2):R63-77. doi:10.1530/JOE-18-0032
  • Catalano PM, McIntyre HD, Cruickshank JK, et al. The hyperglycemia and adverse pregnancy outcome study: associations of GDM and obesity with pregnancy outcomes. Diabetes Care. 2012;35(4):780-786. doi:10.2337/dc11-1790
  • Wahabi HA, Fayed AA, Alzeidan RA, Mandil AA. The independent effects of maternal obesity and gestational diabetes on the pregnancy outcomes. BMC Endocr Disord. 2014;14(1):47. doi:10.1186/1472-6823-14-47
  • Martin KE, Grivell RM, Yelland LN, Dodd JM. The influence of maternal BMI and gestational diabetes on pregnancy outcome. Diabetes Res Clin Pract. 2015;108(3):508-513. doi:10.1016/j.diabres.2014.12.015
  • Ijäs H, Koivunen S, Raudaskoski T, Kajantie E, Gissler M, Vääräsmäki M. Independent and concomitant associations of gestational diabetes and maternal obesity to perinatal outcome: a register-based study. PLoS One. 2019;14(8):e0221549. doi:10.1371/journal.pone.0221549
  • Weschenfelder F, Hein F, Lehmann T, Schleußner E, Groten T. Clinical medicine contributing factors to perinatal outcome in pregnancies with gestational diabetes: what matters most? A retrospective analysis. J Clin Med. 2021;10(2):348. doi:10.3390/jcm10020348
  • Whiteman VE, Salemi JL, Mejia De Grubb MC, et al. Additive effects of pre-pregnancy body-mass index and gestational diabetes on health outcomes and costs. Obesity (Silver Spring). 2015;23(11):2299-308. doi: 10.1002/oby.21222
  • Hartling L, Dryden DM, Guthrie A, et al. Screening and diagnosing gestational diabetes mellitus. Evid Rep Technol Assess (Full Rep). 2012; (210):1-327.
  • Kominiarek MA, Saade G, Mele L, et al. Association between gestational weight gain and perinatal outcomes. Obstet Gynecol. 2018;132(4):875-881. doi:10.1097/AOG.0000000000002854
  • Sun Y, Shen Z, Zhan Y, et al. Effects of pre-pregnancy body-mass index and gestational weight gain on maternal and infant compli cations. BMC Pregnancy Childbirth. 2020;20(1):390. doi:10.1186/s12884-020-03071-y
  • Zhu Y, Zheng Q, Pan Y, et al. Association between prepregnancy body mass index or gestational weight gain and adverse pregnancy outcomes among Chinese women with gestational diabetes mellitus: a systematic review and meta-analysis. BMJ Open. 2024;14(2):e075226. doi:10.1136/bmjopen-2023-075226
  • Su WJ, Chen YL, Huang PY, et al. Effects of prepregnancy body mass index, weight gain, and gestational diabetes mellitus on pregnancy outcomes: a population-based study in Xiamen, China, 2011-2018. Ann Nutr Metab. 2019;75(1):31-38. doi:10.1159/000501710
  • Liu K, Chen Y, Tong J, Yin A, Wu L, Niu J. Association of maternal obesity with preterm birth phenotype and mediation effects of gestational diabetes mellitus and preeclampsia: a prospective cohort study. BMC Pregnancy Childbirth. 2022;22(1):459. doi:10.1186/s12884-022-04780-2
  • Smith GC, Shah I, Pell JP, Crossley JA, Dobbie R. Maternal obesity in early pregnancy and risk of spontaneous and elective preterm deliveries: a retrospective cohort study. Am J Public Health. 2007;97(1):157-162. doi: 10.2105/AJPH.2005.074294
  • Lewandowska M, Sajdak S, Więckowska B, Manevska N, Lubiński J. The influence of maternal BMI on adverse pregnancy outcomes in older women. Nutrients. 2020;12(9):2838. doi:10.3390/nu12092838
  • Liu P, Xu L, Wang Y, et al. Association between perinatal outcomes and maternal pre-pregnancy body-mass index. Obes Rev. 2016;17(11):1091-1102. doi:10.1111/obr.12455
  • Kominiarek MA, Vanveldhuisen P, Hibbard J, et al. Consortium on safe labor. The maternal body mass index: a strong association with delivery route. Am J Obstet Gynecol. 2010;203(3):264.e1-267. doi:10.1016/j.ajog. 2010.06.024
  • Sebire NJ, Jolly M, Harris JP, et al. Maternal obesity and pregnancy outcome: a study of 287,213 pregnancies in London. Int J Obes Relat Metab Disord. 2001;25(8):1175-1182. doi:10.1038/sj.ijo.0801670
  • Bogaerts A, Van den Bergh B, Nuyts E, Martens E, Witters I, Devlieger R. Socio-demographic and obstetrical correlates of pre-pregnancy body-mass index and gestational weight gain. Clin Obes. 2012;2(5-6):150-159. doi:10.1111/cob.12004
  • Ray JG, Vermeulen MJ, Shapiro JL, Kenshole AB. Maternal and neonatal outcomes in pregestational and gestational diabetes mellitus, and the influence of maternal obesity and weight gain: the DEPOSIT study. Diabetes endocrine pregnancy outcome study in Toronto. QJM. 2001; 94(7):347-356. doi:10.1093/qjmed/94.7.347
  • Ke JF, Liu S, Ge RL, Ma L, Li MF. Associations of maternal pre-pregnancy BMI and gestational weight gain with the risks of adverse pregnancy outcomes in Chinese women with gestational diabetes mellitus. BMC Pregnancy Childbirth. 2023;23(1):414. doi:10.1186/s12884-023-05657-8
  • Takele WW, Vesco KK, Josefson J, et al. Effective interventions in preventing gestational diabetes mellitus: a systematic review and meta-analysis. Commun Med (Lond). 2024;4(1):75. doi:10.1038/s43856-024-00491-1
  • Esin S, Okuyan E, Gunakan E, Zengin HY, Hayran M, Tohma YA. A novel technique for prediction of preterm birth: fetal nasal flow Doppler. J Perinat Med. 2020;49(3):319-325. doi:10.1515/jpm-2020-0276
  • Zhu Y, Hedderson MM, Sridhar S, Xu F, Feng J, Ferrara A. Poor diet quality in pregnancy is associated with increased risk of excess fetal growth: a prospective multi-racial/ethnic cohort study. Int J Epidemiol. 2019;48(2):423-432. doi:10.1093/ije/dyy285

The amplifying effect of maternal obesity on perinatal outcomes in gestational diabetes mellitus

Year 2025, Volume: 7 Issue: 5, 551 - 558, 15.09.2025

Erkan Sağlam

https://doi.org/10.38053/acmj.1720706

Abstract

Aims: This study aimed to evaluate the impact of maternal body-mass index (BMI) in the first trimester on perinatal outcomes in pregnant women diagnosed with gestational diabetes mellitus (GDM).
Methods: This retrospective cohort study included 210 women with GDM, categorized into three groups based on firsttrimester BMI: normal weight (BMI<25.0 kg/m²), overweight (BMI 25.0–29.9 kg/m²), and obese (BMI≥30.0 kg/m²). Perinatal outcomes such as preterm birth, low birth weight, macrosomia, NICU admission, and Apgar scores were compared across groups. Multivariate logistic regression analyses were conducted to evaluate the independent association between obesity and adverse perinatal outcomes.
Results: The rates of preterm birth <37 weeks (35.7%, p<0.001) and <34 weeks (11.4%, p=0.016) were significantly higher in the obese group. Although low birth weight (<2500 g) was observed in 10.0% of obese women, this difference was not statistically significant (p=0.211). Macrosomia (≥4000 g) was more frequent in the obese group (11.4%) but did not reach statistical significance (p=0.261). NICU admission rates were higher in obese women (22.9%, p=0.089). In adjusted analyses, obesity was independently associated with increased odds of preterm birth <34 weeks (adjusted OR: 6.01, p=0.012) and low birth weight (adjusted OR: 4.68, p=0.026). Additionally, Spearman correlation analysis revealed a weak, non-significant positive correlation between gestational weight gain and gestational age at birth (r=0.122, p=0.077).
Conclusion: In pregnant women with GDM, first-trimester maternal obesity is associated with an increased risk of early preterm birth and low birth weight. These findings underscore the importance of assessing and managing maternal BMI early in pregnancy to improve perinatal outcomes.

Keywords

Gestational diabetes mellitus maternal obesity perinatal outcomes preterm birth

References

  • Wendland EM, Torloni MR, Falavigna M, et al. Gestational diabetes and pregnancy outcomes--a systematic review of the World Health Organization (WHO) and the International Association of Diabetes in Pregnancy Study Groups (IADPSG) diagnostic criteria. BMC Pregnancy Childbirth. 2012;12(1):23. doi:10.1186/1471-2393-12-23
  • Wang H, Li N, Chivese T, et al. IDF diabetes atlas: estimation of global and regional gestational diabetes mellitus prevalence for 2021 by international association of diabetes in pregnancy study group’s criteria. Diabetes Res Clin Pract. 2022;183:109050. doi:10.1016/j.diabres.2021. 109050
  • Gao C, Sun X, Lu L, et al. Prevalence of gestational diabetes mellitus in mainland China: a systematic review and meta- analysis. J Diabetes Investig. 2019;10(1):154-162. doi:10.1111/jdi.12854
  • Yen IW, Lee CN, Lin MW, et al. Overweight and obesity are associated with clustering of metabolic risk factors in early pregnancy and the risk of GDM. PLoS One. 2019;14(12):e0225978. doi:10.1371/journal.pone. 0225978
  • Pantham P, Aye IL, Powell TL. Inflammation in maternal obesity and gestational diabetes mellitus. Placenta. 2015;36(7):709-715. doi:10.1016/j.placenta.2015.04.006
  • Šimják P, Cinkajzlová A, Anderlová K, et al. The role of obesity and adipose tissue dysfunction in gestational diabetes mellitus. J Endocrinol. 2018;238(2):R63-77. doi:10.1530/JOE-18-0032
  • Catalano PM, McIntyre HD, Cruickshank JK, et al. The hyperglycemia and adverse pregnancy outcome study: associations of GDM and obesity with pregnancy outcomes. Diabetes Care. 2012;35(4):780-786. doi:10.2337/dc11-1790
  • Wahabi HA, Fayed AA, Alzeidan RA, Mandil AA. The independent effects of maternal obesity and gestational diabetes on the pregnancy outcomes. BMC Endocr Disord. 2014;14(1):47. doi:10.1186/1472-6823-14-47
  • Martin KE, Grivell RM, Yelland LN, Dodd JM. The influence of maternal BMI and gestational diabetes on pregnancy outcome. Diabetes Res Clin Pract. 2015;108(3):508-513. doi:10.1016/j.diabres.2014.12.015
  • Ijäs H, Koivunen S, Raudaskoski T, Kajantie E, Gissler M, Vääräsmäki M. Independent and concomitant associations of gestational diabetes and maternal obesity to perinatal outcome: a register-based study. PLoS One. 2019;14(8):e0221549. doi:10.1371/journal.pone.0221549
  • Weschenfelder F, Hein F, Lehmann T, Schleußner E, Groten T. Clinical medicine contributing factors to perinatal outcome in pregnancies with gestational diabetes: what matters most? A retrospective analysis. J Clin Med. 2021;10(2):348. doi:10.3390/jcm10020348
  • Whiteman VE, Salemi JL, Mejia De Grubb MC, et al. Additive effects of pre-pregnancy body-mass index and gestational diabetes on health outcomes and costs. Obesity (Silver Spring). 2015;23(11):2299-308. doi: 10.1002/oby.21222
  • Hartling L, Dryden DM, Guthrie A, et al. Screening and diagnosing gestational diabetes mellitus. Evid Rep Technol Assess (Full Rep). 2012; (210):1-327.
  • Kominiarek MA, Saade G, Mele L, et al. Association between gestational weight gain and perinatal outcomes. Obstet Gynecol. 2018;132(4):875-881. doi:10.1097/AOG.0000000000002854
  • Sun Y, Shen Z, Zhan Y, et al. Effects of pre-pregnancy body-mass index and gestational weight gain on maternal and infant compli cations. BMC Pregnancy Childbirth. 2020;20(1):390. doi:10.1186/s12884-020-03071-y
  • Zhu Y, Zheng Q, Pan Y, et al. Association between prepregnancy body mass index or gestational weight gain and adverse pregnancy outcomes among Chinese women with gestational diabetes mellitus: a systematic review and meta-analysis. BMJ Open. 2024;14(2):e075226. doi:10.1136/bmjopen-2023-075226
  • Su WJ, Chen YL, Huang PY, et al. Effects of prepregnancy body mass index, weight gain, and gestational diabetes mellitus on pregnancy outcomes: a population-based study in Xiamen, China, 2011-2018. Ann Nutr Metab. 2019;75(1):31-38. doi:10.1159/000501710
  • Liu K, Chen Y, Tong J, Yin A, Wu L, Niu J. Association of maternal obesity with preterm birth phenotype and mediation effects of gestational diabetes mellitus and preeclampsia: a prospective cohort study. BMC Pregnancy Childbirth. 2022;22(1):459. doi:10.1186/s12884-022-04780-2
  • Smith GC, Shah I, Pell JP, Crossley JA, Dobbie R. Maternal obesity in early pregnancy and risk of spontaneous and elective preterm deliveries: a retrospective cohort study. Am J Public Health. 2007;97(1):157-162. doi: 10.2105/AJPH.2005.074294
  • Lewandowska M, Sajdak S, Więckowska B, Manevska N, Lubiński J. The influence of maternal BMI on adverse pregnancy outcomes in older women. Nutrients. 2020;12(9):2838. doi:10.3390/nu12092838
  • Liu P, Xu L, Wang Y, et al. Association between perinatal outcomes and maternal pre-pregnancy body-mass index. Obes Rev. 2016;17(11):1091-1102. doi:10.1111/obr.12455
  • Kominiarek MA, Vanveldhuisen P, Hibbard J, et al. Consortium on safe labor. The maternal body mass index: a strong association with delivery route. Am J Obstet Gynecol. 2010;203(3):264.e1-267. doi:10.1016/j.ajog. 2010.06.024
  • Sebire NJ, Jolly M, Harris JP, et al. Maternal obesity and pregnancy outcome: a study of 287,213 pregnancies in London. Int J Obes Relat Metab Disord. 2001;25(8):1175-1182. doi:10.1038/sj.ijo.0801670
  • Bogaerts A, Van den Bergh B, Nuyts E, Martens E, Witters I, Devlieger R. Socio-demographic and obstetrical correlates of pre-pregnancy body-mass index and gestational weight gain. Clin Obes. 2012;2(5-6):150-159. doi:10.1111/cob.12004
  • Ray JG, Vermeulen MJ, Shapiro JL, Kenshole AB. Maternal and neonatal outcomes in pregestational and gestational diabetes mellitus, and the influence of maternal obesity and weight gain: the DEPOSIT study. Diabetes endocrine pregnancy outcome study in Toronto. QJM. 2001; 94(7):347-356. doi:10.1093/qjmed/94.7.347
  • Ke JF, Liu S, Ge RL, Ma L, Li MF. Associations of maternal pre-pregnancy BMI and gestational weight gain with the risks of adverse pregnancy outcomes in Chinese women with gestational diabetes mellitus. BMC Pregnancy Childbirth. 2023;23(1):414. doi:10.1186/s12884-023-05657-8
  • Takele WW, Vesco KK, Josefson J, et al. Effective interventions in preventing gestational diabetes mellitus: a systematic review and meta-analysis. Commun Med (Lond). 2024;4(1):75. doi:10.1038/s43856-024-00491-1
  • Esin S, Okuyan E, Gunakan E, Zengin HY, Hayran M, Tohma YA. A novel technique for prediction of preterm birth: fetal nasal flow Doppler. J Perinat Med. 2020;49(3):319-325. doi:10.1515/jpm-2020-0276
  • Zhu Y, Hedderson MM, Sridhar S, Xu F, Feng J, Ferrara A. Poor diet quality in pregnancy is associated with increased risk of excess fetal growth: a prospective multi-racial/ethnic cohort study. Int J Epidemiol. 2019;48(2):423-432. doi:10.1093/ije/dyy285
There are 29 citations in total.

Details

Primary Language English
Subjects Obstetrics and Gynaecology
Journal Section Research Articles
Authors

Erkan Sağlam 0000-0001-5600-5597

Publication Date September 15, 2025
Submission Date June 16, 2025
Acceptance Date July 22, 2025
Published in Issue Year 2025 Volume: 7 Issue: 5

Cite

AMA Sağlam E. The amplifying effect of maternal obesity on perinatal outcomes in gestational diabetes mellitus. Anatolian Curr Med J / ACMJ / acmj. September 2025;7(5):551-558. doi:10.38053/acmj.1720706
 Download Cover Image

TR DİZİN ULAKBİM and International Indexes (1b)

Interuniversity Board (UAK) Equivalency:  Article published in Ulakbim TR Index journal [10 POINTS], and Article published in other (excuding 1a, b, c) international indexed journal (1d) [5 POINTS]

Note: Our journal is not WOS indexed and therefore is not classified as Q.

You can download Council of Higher Education (CoHG) [Yüksek Öğretim Kurumu (YÖK)] Criteria) decisions about predatory/questionable journals and the author's clarification text and journal charge policy from your browser. https://dergipark.org.tr/tr/journal/3449/file/4924/show

Journal Indexes and Platforms: 

TR Dizin ULAKBİM, Google Scholar, Crossref, Worldcat (OCLC), DRJI, EuroPub, OpenAIRE, Turkiye Citation Index, Turk Medline, ROAD, ICI World of Journal's, Index Copernicus, ASOS Index, General Impact Factor, Scilit.


The indexes of the journal's are;

18596


asos-index.png

f9ab67f.png

WorldCat_Logo_H_Color.png

      logo-large-explore.png

images?q=tbn:ANd9GcQgDnBwx0yUPRKuetgIurtELxYERFv20CPAUcPe4jYrrJiwXzac8rGXlzd57gl8iikb1Tk&usqp=CAU

index_copernicus.jpg


84039476_619085835534619_7808805634291269632_n.jpg





The platforms of the journal's are;

COPE.jpg

images?q=tbn:ANd9GcTbq2FM8NTdXECzlOUCeKQ1dvrISFL-LhxhC7zy1ZQeJk-GGKSx2XkWQvrsHxcfhtfHWxM&usqp=CAUicmje_1_orig.png


ncbi.png

ORCID_logo.pngimages?q=tbn:ANd9GcQlwX77nfpy3Bu9mpMBZa0miWT2sRt2zjAPJKg2V69ODTrjZM1nT1BbhWzTVPsTNKJMZzQ&usqp=CAU


images?q=tbn:ANd9GcTaWSousoprPWGwE-qxwxGH2y0ByZ_zdLMN-Oq93MsZpBVFOTfxi9uXV7tdr39qvyE-U0I&usqp=CAU






The indexes/platforms of the journal are;

TR Dizin Ulakbim, Crossref (DOI), Google Scholar, EuroPub, Directory of Research Journal İndexing (DRJI), Worldcat (OCLC), OpenAIRE, ASOS Index, ROAD, Turkiye Citation Index, ICI World of Journal's, Index Copernicus, Turk Medline, General Impact Factor, Scilit 


Journal articles are evaluated as "Double-Blind Peer Review"

All articles published in this journal are licensed under a Creative Commons Attribution 4.0 International License (CC BY NC ND)