The Hyperglycemia and Adverse Pregnancy Outcome Study

Associations of GDM and obesity with pregnancy outcomes

  1. for the HAPO Study Cooperative Research Group
  1. 1Reproductive Biology, Case Western Reserve University at MetroHealth Medical Center, Cleveland, Ohio
  2. 2Endocrinology and Obstetric Medicine, Mater Medical Research Institute, University of Queensland, Brisbane, Australia
  3. 3Diabetes and Clinical Endocrinology, University of Manchester and Royal Infirmary, Manchester, U.K.
  4. 4Regional Centre for Endocrinology and Diabetes, Royal Victoria Hospital, Belfast, Northern Ireland, U.K.
  5. 5Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
  6. 6Division of Endocrinology, Metabolism and Molecular Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
  7. 7Department of Clinical Biochemistry, Queen’s University Belfast, Belfast, Northern Ireland, U.K.
  8. 8Division of Maternal Fetal Medicine, Women & Infants’ Hospital of Rhode Island, Warren Alpert Medical School of Brown University, Providence, Rhode Island
  9. 9Department of Pediatrics, Karolinska Institute, Stockholm, Sweden
  10. 10Department of Obstetrics and Gynecology, Helen Schneider Hospital for Women, Rabin Medical Center-Sackler Faculty of Medicine, Tel-Aviv University, Petah-Tiqva, Israel
  11. 11Obstetric Medicine, Mater Misericordiae Mothers’ Hospital-University of Queensland, Brisbane, Australia
  1. Corresponding author: Boyd E. Metzger, bem{at}


OBJECTIVE To determine associations of gestational diabetes mellitus (GDM) and obesity with adverse pregnancy outcomes in the Hyperglycemia and Adverse Pregnancy Outcome (HAPO) Study.

RESEARCH DESIGN AND METHODS Participants underwent a 75-g oral glucose tolerance test (OGTT) between 24 and 32 weeks. GDM was diagnosed post hoc using International Association of Diabetes and Pregnancy Study Groups criteria. Neonatal anthropometrics and cord serum C-peptide were measured. Adverse pregnancy outcomes included birth weight, newborn percent body fat, and cord C-peptide >90th percentiles, primary cesarean delivery, preeclampsia, and shoulder dystocia/birth injury. BMI was determined at the OGTT. Multiple logistic regression was used to examine associations of GDM and obesity with outcomes.

RESULTS Mean maternal BMI was 27.7, 13.7% were obese (BMI ≥33.0 kg/m2), and GDM was diagnosed in 16.1%. Relative to non-GDM and nonobese women, odds ratio for birth weight >90th percentile for GDM alone was 2.19 (1.93–2.47), for obesity alone 1.73 (1.50–2.00), and for both GDM and obesity 3.62 (3.04–4.32). Results for primary cesarean delivery and preeclampsia and for cord C-peptide and newborn percent body fat >90th percentiles were similar. Odds for birth weight >90th percentile were progressively greater with both higher OGTT glucose and higher maternal BMI. There was a 339-g difference in birth weight for babies of obese GDM women, compared with babies of normal/underweight women (64.2% of all women) with normal glucose based on a composite OGTT measure of fasting plasma glucose and 1- and 2-h plasma glucose values (61.8% of all women).

CONCLUSIONS Both maternal GDM and obesity are independently associated with adverse pregnancy outcomes. Their combination has a greater impact than either one alone.


  • Received September 14, 2011.
  • Accepted January 4, 2012.

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  1. Diabetes Care vol. 35 no. 4 780-786
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