Maternal Anthropometric Indices and Gestational Diabetes

Chapter

Abstract

The prevalence of gestational diabetes (GDM) has been on the rise worldwide. GDM is glucose intolerance first detected in pregnancy and heightens the risk of caesarian section, ­prematurity and neonatal mortality, to name a few of its consequences. Greater prepregnancy BMI is a strong risk factor for GDM with evidence that overweight doubles its risk and obesity triples it. Other anthropometric risk factors of GDM reviewed in this chapter include low birth weight, short stature or leg length, increased abdominal adiposity (by waist circumference or waist-to-hip ratio), excessive total adiposity by skinfolds, greater gestational weight gain, and postpartum weight retention. Due to the strong association between prepregnancy BMI and the risk of GDM, these other anthropometric risk factors were also evaluated for whether there is evidence that they can delineate risks apart from that related to BMI; that is, whether they have clinical relevance independent of pregravid BMI. Scarce evidence was given that measures of total adiposity by skinfolds add to discriminating participants at risk for GDM that may not have been determined by prepregnancy BMI. Measures of central adiposity by waist and hip circumferences may have added information. Difficulties in measurement may preclude their use in clinical practice as they require some technical­ training to obtain valid and reliable values. Short stature or leg length and low birth weight, were factors that remained associated with increased risk of GDM independent of BMI but these associations were weak. Investigations of these associations, however, support the developmental origins of human disease hypothesis and generate evidence that early life risk factors may be important for future health. Gestational weight gain has been regarded as not to be a determinant of GDM by the Institute of Medicine, and review of the studies to date supports their conclusion, although there is some evidence that it is still relevant for development of less severe forms of hyperglycemia in pregnancy. Lastly, post-partum weight retention may increase the risk of GDM in subsequent pregnancies but this is through the mechanism of BMI. In conclusion, anthropometry does play a significant role in the development of GDM and investigations of its measures may bring about greater understanding of the etiology of the disease, even if not all measures are suitable for clinical use.

Keywords

Obesity Europe Hyperglycemia Preeclampsia Gluteal Muscle 

Abbreviations

ADA

American Diabetes Association

BIA

Bioelectrical impedance analysis

BMI

Body mass index

CI

Confidence interval

CT

Computer tomography

CVD

Cardiovascular disease

Dx

Diagnosis

DXA

Dual energy x-ray absorptiometry

GDM

Gestational diabetes

GH

Growth hormone

GWG

Gestational weight gain

HOMA-IR

Homeostasis model of insulin resistance

ICC

Intra-class correlation coefficient

ICD-9

International Classification of Diseases, 9th edition

IGF-1

Insulin-like growth factor-1

IGT

Impaired glucose tolerance

IOM

Institute of Medicine

MRI

Magnetic resonance imaging

NDDG

National Diabetes Data Group

NHANES

National Health and Nutrition Examination Survey

NGT

Normal glucose tolerance

NHSII

Nurses’ Health Study II

OGTT

Oral glucose tolerance test

OR

Odds ratio

PE

Preeclampsia

PNSS

Pregnancy Nutrition Surveillance System

ROC

receiver operating characteristic

RR

Relative risk

SCAT

Subcutaneous adipose tissue

SD

Standard deviation

T2D

Type 2 diabetes

TSF

Total skinfolds

US

United States

VAT

Visceral adipose tissue

WC

Waist circumference

WHO

World Health Organization

WHR

Waist to hip ratio

References

  1. ADA (2004) Gestational diabetes mellitus. Diabetes Care 27 Suppl 1: S88–S90CrossRefGoogle Scholar
  2. ADA (2009) Diagnosis and classification of diabetes mellitus. Diabetes Care 32 Suppl 1: S62–S67CrossRefGoogle Scholar
  3. Anastasiou, E, Alevizaki, M, Grigorakis, SJ, Philippou, G, Kyprianou, M, Souvatzoglou, A (1998) Decreased stature in gestational diabetes mellitus. Diabetologia 41: 997–1001PubMedCrossRefGoogle Scholar
  4. Barker, DJ (2005) The developmental origins of insulin resistance. Horm. Res. 64 Suppl 3: 2–7PubMedCrossRefGoogle Scholar
  5. Bellamy, L, Casas, JP, Hingorani, AD, Williams, D (2009) Type 2 diabetes mellitus after gestational diabetes: a systematic review and meta-analysis. Lancet 373: 1773–1779PubMedCrossRefGoogle Scholar
  6. Ben-Haroush, A, Yogev, Y, Hod, M (2004) Epidemiology of gestational diabetes mellitus and its association with Type 2 diabetes. Diabet. Med. 21: 103–113PubMedCrossRefGoogle Scholar
  7. Berg, AH, Scherer, PE (2005) Adipose tissue, inflammation, and cardiovascular disease. Circ. Res. 96: 939–949PubMedCrossRefGoogle Scholar
  8. Branchtein, L, Schmidt, MI, Matos, MC, Yamashita, T, Pousada, JM, Duncan, BB (2000) Short stature and gestational diabetes in Brazil. Brazilian Gestational Diabetes Study Group. Diabetologia 43: 848–851PubMedCrossRefGoogle Scholar
  9. Branchtein, L, Schmidt, MI, Mengue, SS, Reichelt, AJ, Matos, MC, Duncan, BB (1997) Waist circumference and waist-to-hip ratio are related to gestational glucose tolerance. Diabetes Care 20: 509–511PubMedCrossRefGoogle Scholar
  10. Brennand, EA, Dannenbaum, D, Willows, ND (2005) Pregnancy outcomes of First Nations women in relation to pregravid weight and pregnancy weight gain. J. Obstet. Gynaecol. Can. 27: 936–944PubMedGoogle Scholar
  11. Buchanan, TA (2001) Pancreatic B-cell defects in gestational diabetes: implications for the pathogenesis and prevention of type 2 diabetes. J. Clin. Endocrinol. Metab 86: 989–993PubMedCrossRefGoogle Scholar
  12. Buchanan, TA, Xiang, AH (2005) Gestational diabetes mellitus. J. Clin. Invest 115: 485–491PubMedGoogle Scholar
  13. Carpenter, MW, Coustan, DR (1982) Criteria for screening tests for gestational diabetes. Am. J. Obstet. Gynecol. 144: 768–773PubMedGoogle Scholar
  14. Chen, Y, Quick, WW, Yang, W, Zhang, Y, Baldwin, A, Moran, J, Moore, V, Sahai, N, Dall, TM (2009) Cost of gestational diabetes mellitus in the United States in 2007. Popul. Health Manag. 12: 165–174PubMedGoogle Scholar
  15. Dabelea, D, Snell-Bergeon, JK, Hartsfield, CL, Bischoff, KJ, Hamman, RF, McDuffie, RS (2005) Increasing prevalence of gestational diabetes mellitus (GDM) over time and by birth cohort: Kaiser Permanente of Colorado GDM Screening Program. Diabetes Care 28: 579–584PubMedCrossRefGoogle Scholar
  16. Di, CG, Volpe, L, Lencioni, C, Miccoli, R, Cuccuru, I, Ghio, A, Chatzianagnostou, K, Bottone, P, Teti, G, Del, PS, Benzi, L (2003) Prevalence and risk factors for gestational diabetes assessed by universal screening. Diabetes Res. Clin. Pract. 62: 131–137CrossRefGoogle Scholar
  17. Egeland, GM, Skjaerven, R, Irgens, LM (2000) Birth characteristics of women who develop gestational diabetes: population based study. BMJ 321: 546–547PubMedCrossRefGoogle Scholar
  18. Ehrenberg, HM, Huston-Presley, L, Catalano, PM (2003) The influence of obesity and gestational diabetes mellitus on accretion and the distribution of adipose tissue in pregnancy. Am. J. Obstet. Gynecol. 189: 944–948PubMedCrossRefGoogle Scholar
  19. Eriksson, JG, Forsen, T, Tuomilehto, J, Osmond, C, Barker, DJ (2003) Early adiposity rebound in childhood and risk of Type 2 diabetes in adult life. Diabetologia 46: 190–194PubMedGoogle Scholar
  20. Forsum, E, Sadurskis, A, Wager, J (1989) Estimation of body fat in healthy Swedish women during pregnancy and lactation. Am. J. Clin. Nutr. 50: 465–473PubMedGoogle Scholar
  21. Glazer, NL, Hendrickson, AF, Schellenbaum, GD, Mueller, BA (2004) Weight change and the risk of gestational diabetes in obese women. Epidemiology 15: 733–737PubMedCrossRefGoogle Scholar
  22. Goran, MI, Gower, BA (2001) Longitudinal study on pubertal insulin resistance. Diabetes 50: 2444–2450PubMedCrossRefGoogle Scholar
  23. Guelinckx, I, Devlieger, R, Vansant, G (2009) Reproductive outcome after bariatric surgery: a critical review. Hum. Reprod. Update. 15: 189–201PubMedCrossRefGoogle Scholar
  24. Gunderson, EP (2009) Childbearing and obesity in women: weight before, during, and after pregnancy. Obstet. Gynecol. Clin. North Am. 36: 317–32, ixPubMedCrossRefGoogle Scholar
  25. Gunderson, EP, Sternfeld, B, Wellons, MF, Whitmer, RA, Chiang, V, Quesenberry, CP, Jr., Lewis, CE, Sidney, S (2008) Childbearing may increase visceral adipose tissue independent of overall increase in body fat. Obesity. (Silver. Spring) 16: 1078–1084CrossRefGoogle Scholar
  26. Herring, SJ, Oken, E, Rifas-Shiman, SL, Rich-Edwards, JW, Stuebe, AM, Kleinman, KP, Gillman, MW (2009) Weight gain in pregnancy and risk of maternal hyperglycemia. Am. J. Obstet. Gynecol. 201: 61–67PubMedCrossRefGoogle Scholar
  27. Ibrahim, MM (2009) Subcutaneous and visceral adipose tissue: structural and functional differences. Obes. Rev. 11: 11–8Google Scholar
  28. Innes, KE, Byers, TE, Marshall, JA, Baron, A, Orleans, M, Hamman, RF (2002) Association of a woman’s own birth weight with subsequent risk for gestational diabetes. JAMA 287: 2534–2541PubMedCrossRefGoogle Scholar
  29. Institute of Medicine (2009) Weight Gain During Pregnancy: Reexamining the Guidelines.Google Scholar
  30. Jang, HC, Min, HK, Lee, HK, Cho, NH, Metzger, BE (1998) Short stature in Korean women: a contribution to the multifactorial predisposition to gestational diabetes mellitus. Diabetologia 41: 778–783PubMedCrossRefGoogle Scholar
  31. Kale, SD, Kulkarni, SR, Lubree, HG, Meenakumari, K, Deshpande, VU, Rege, SS, Deshpande, J, Coyaji, KJ, Yajnik, CS (2005) Characteristics of gestational diabetic mothers and their babies in an Indian diabetes clinic. J. Assoc. Physicians India 53: 857–863PubMedGoogle Scholar
  32. Keppel, KG, Taffel, SM (1993) Pregnancy-related weight gain and retention: implications of the 1990 Institute of Medicine guidelines. Am. J. Public Health 83: 1100–1103PubMedCrossRefGoogle Scholar
  33. Kieffer, EC, Carman, WJ, Gillespie, BW, Nolan, GH, Worley, SE, Guzman, JR (2001) Obesity and gestational diabetes among African-American women and Latinas in Detroit: implications for disparities in women’s health. J. Am. Med. Womens Assoc. 56: 181–7, 196PubMedGoogle Scholar
  34. Kim, C, Cheng, YJ, Beckles, GL (2008) Cardiovascular disease risk profiles in women with histories of gestational diabetes but without current diabetes. Obstet. Gynecol. 112: 875–883PubMedCrossRefGoogle Scholar
  35. Kim, C, Newton, KM, Knopp, RH (2002) Gestational diabetes and the incidence of type 2 diabetes: a systematic review. Diabetes Care 25: 1862–1868PubMedCrossRefGoogle Scholar
  36. Kousta, E, Lawrence, NJ, Penny, A, Millauer, BA, Robinson, S, Johnston, DG, McCarthy, MI (2000) Women with a history of gestational diabetes of European and South Asian origin are shorter than women with normal glucose tolerance in pregnancy. Diabet. Med. 17: 792–797PubMedCrossRefGoogle Scholar
  37. Ma, RM, Lao, TT, Ma, CL, Liao, SJ, Lu, YF, Du, MY, Xiao, H, Zhang, L, Yang, MH, Xiao, X (2007) Relationship between leg length and gestational diabetes mellitus in Chinese pregnant women. Diabetes Care 30: 2960–2961PubMedCrossRefGoogle Scholar
  38. Madhavan, A, Beena, KR, Sanal, MG (2008) A pilot study on the usefulness of body mass index and waist hip ratio as a predictive tool for gestational diabetes in Asian Indians. Gynecol. Endocrinol. 24: 701–707PubMedCrossRefGoogle Scholar
  39. McCarthy, EA, Strauss, BJ, Walker, SP, Permezel, M (2004) Determination of maternal body composition in pregnancy and its relevance to perinatal outcomes. Obstet. Gynecol. Surv. 59: 731–742PubMedCrossRefGoogle Scholar
  40. Metzger, BE, Buchanan, TA, Coustan, DR, de, LA, Dunger, DB, Hadden, DR, Hod, M, Kitzmiller, JL, Kjos, SL, Oats, JN, Pettitt, DJ, Sacks, DA, Zoupas, C (2007) Summary and recommendations of the Fifth International Workshop-Conference on Gestational Diabetes Mellitus. Diabetes Care 30 Suppl 2: S251–S260PubMedCrossRefGoogle Scholar
  41. Moses, RG, Mackay, MT (2004) Gestational diabetes: Is there a relationship between leg length and glucose tolerance? Diabetes Care 27: 1033–1035PubMedCrossRefGoogle Scholar
  42. NDDG (1979) Classification and diagnosis of diabetes mellitus and other categories of glucose intolerance. National Diabetes Data Group. Diabetes 28: 1039–1057Google Scholar
  43. Nicholson, WK, Asao, K, Brancati, F, Coresh, J, Pankow, JS, Powe, NR (2006) Parity and risk of type 2 diabetes: the Atherosclerosis Risk in Communities Study. Diabetes Care 29: 2349–2354PubMedCrossRefGoogle Scholar
  44. Nohr, EA, Vaeth, M, Baker, JL, Sorensen, TI, Olsen, J, Rasmussen, KM (2008) Combined associations of prepregnancy body mass index and gestational weight gain with the outcome of pregnancy. Am. J. Clin. Nutr. 87: 1750–1759PubMedGoogle Scholar
  45. Parker, ED, Pereira, MA, Stevens, J, Folsom, AR (2009) Association of hip circumference with incident diabetes and coronary heart disease: the Atherosclerosis Risk in Communities study. Am. J. Epidemiol. 169: 837–847PubMedCrossRefGoogle Scholar
  46. Pettitt, DJ, Jovanovic, L (2007) Low birth weight as a risk factor for gestational diabetes, diabetes, and impaired glucose tolerance during pregnancy. Diabetes Care 30 Suppl 2: S147–S149PubMedCrossRefGoogle Scholar
  47. Radesky, JS, Oken, E, Rifas-Shiman, SL, Kleinman, KP, Rich-Edwards, JW, Gillman, MW (2008) Diet during early pregnancy and development of gestational diabetes. Paediatr. Perinat. Epidemiol. 22: 47–59PubMedCrossRefGoogle Scholar
  48. Ratner, RE, Hamner, LH, III, Isada, NB (1991) Effects of gestational weight gain in morbidly obese women: I. Maternal morbidity. Am. J. Perinatol. 8: 21–24PubMedCrossRefGoogle Scholar
  49. Reece, EA, Leguizamon, G, Wiznitzer, A (2009) Gestational diabetes: the need for a common ground. Lancet 373: 1789–1797PubMedCrossRefGoogle Scholar
  50. Ross R, Berentzen T, Bradshaw AJ, Janssen I, Kahn HS, Katzmarzyk PT, Kuk JL, Seidell JC, Snijder MB, Sorensen TI, Despres JP. (2008) Does the relationship between waist circumference, morbidity and mortality depend on measurement protocol for waist circumference? Obes Rev. 9: 312–25PubMedCrossRefGoogle Scholar
  51. Rudra, CB, Sorensen, TK, Leisenring, WM, Dashow, E, Williams, MA (2007) Weight characteristics and height in relation to risk of gestational diabetes mellitus. Am. J. Epidemiol. 165: 302–308PubMedCrossRefGoogle Scholar
  52. Saldana, TM, Siega-Riz, AM, Adair, LS, Suchindran, C (2006) The relationship between pregnancy weight gain and glucose tolerance status among black and white women in central North Carolina. Am. J. Obstet. Gynecol. 195: 1629–1635PubMedCrossRefGoogle Scholar
  53. Sidebottom, AC, Brown, JE, Jacobs, DR, Jr. (2001) Pregnancy-related changes in body fat. Eur. J. Obstet. Gynecol. Reprod. Biol. 94: 216–223PubMedCrossRefGoogle Scholar
  54. Solomon, CG, Willett, WC, Carey, VJ, Rich-Edwards, J, Hunter, DJ, Colditz, GA, Stampfer, MJ, Speizer, FE, Spiegelman, D, Manson, JE (1997) A prospective study of pregravid determinants of gestational diabetes mellitus. JAMA 278: 1078–1083PubMedCrossRefGoogle Scholar
  55. Sonnenschein, EG, Kim, MY, Pasternack, BS, Toniolo, PG (1993) Sources of variability in waist and hip measurements in middle-aged women. Am. J. Epidemiol. 138: 301–309PubMedGoogle Scholar
  56. Stevens-Simon, C, McAnarney, ER, Roghmann, KJ, Forbes, GB (1997) Composition of gestational weight gain in adolescent pregnancy. J. Matern. Fetal Med. 6: 79–86PubMedCrossRefGoogle Scholar
  57. Suntio, K, Saarelainen, H, Laitinen, T, Valtonen, P, Heiskanen, N, Lyyra-Laitinen, T, Vanninen, E, Heinonen, S (2009) Women With Hypertensive Pregnancies Have Difficulties in Regaining Pre-pregnancy Weight and Show Metabolic Disturbances. Obesity. (Silver. Spring)CrossRefGoogle Scholar
  58. Tabak, AG, Kerenyi, Z, Nagy, E, Bosnyak, Z, Madarasz, E, Tamas, G (2002) Height and gestational diabetes mellitus. Diabet. Med. 19: 344–345PubMedCrossRefGoogle Scholar
  59. Taggart, NR, Holliday, RM, Billewicz, WZ, Hytten, FE, Thomson, AM (1967) Changes in skinfolds during pregnancy. Br. J. Nutr. 21: 439–451PubMedCrossRefGoogle Scholar
  60. Torloni, MR, Betran, AP, Horta, BL, Nakamura, MU, Atallah, AN, Moron, AF, Valente, O (2009) Prepregnancy BMI and the risk of gestational diabetes: a systematic review of the literature with meta-analysis. Obes. Rev. 10: 194–203PubMedCrossRefGoogle Scholar
  61. Tovar, A, Must, A, Bermudez, OI, Hyatt, RR, Chasan-Taber, L (2009) The impact of gestational weight gain and diet on abnormal glucose tolerance during pregnancy in Hispanic women. Matern. Child Health J. 13: 520–530PubMedCrossRefGoogle Scholar
  62. Wadsworth, ME, Hardy, RJ, Paul, AA, Marshall, SF, Cole, TJ (2002) Leg and trunk length at 43 years in relation to childhood health, diet and family circumstances; evidence from the 1946 national birth cohort. Int. J. Epidemiol. 31: 383–390PubMedCrossRefGoogle Scholar
  63. Wendland, EM, Duncan, BB, Mengue, SS, Nucci, LB, Schmidt, MI (2007) Waist circumference in the prediction of obesity-related adverse pregnancy outcomes. Cad. Saude Publica 23: 391–398PubMedCrossRefGoogle Scholar
  64. WHO/IDF (2006) Definition and diagnosis of diabetes mellitus and intermediate hyperglycemia: report of a WHO/IDF consultationGoogle Scholar
  65. Wolf, M, Sandler, L, Hsu, K, Vossen-Smirnakis, K, Ecker, JL, Thadhani, R (2003) First-trimester C-reactive protein and subsequent gestational diabetes. Diabetes Care 26: 819–824PubMedCrossRefGoogle Scholar
  66. Wolff, S, Legarth, J, Vangsgaard, K, Toubro, S, Astrup, A (2008) A randomized trial of the effects of dietary counseling on gestational weight gain and glucose metabolism in obese pregnant women. Int. J. Obes. (Lond) 32: 495–501CrossRefGoogle Scholar
  67. Yang, X, Hsu-Hage, B, Zhang, H, Yu, L, Dong, L, Li, J, Shao, P, Zhang, C (2002) Gestational diabetes mellitus in women of single gravidity in Tianjin City, China. Diabetes Care 25: 847–851PubMedCrossRefGoogle Scholar
  68. Yeung, EH, Hu, FB, Solomon, CG, Chen, L, Louis, GM, Schisterman, E, Willett, WC, Zhang, C (2009) Life-course weight characteristics and the risk of gestational diabetes. Diabetologia 53: 668–78PubMedCrossRefGoogle Scholar
  69. Yilmaz, O, Kucuk, M, Ilgin, A, Dagdelen, M (2009) Assessment of insulin sensitivity/resistance and their relations with leptin concentrations and anthropometric measures in a pregnant population with and without gestational diabetes mellitus. J. Diabetes Complications 24:109–14PubMedCrossRefGoogle Scholar
  70. Zhang, S, Folsom, AR, Flack, JM, Liu, K (1995) Body fat distribution before pregnancy and gestational diabetes: findings from coronary artery risk development in young adults (CARDIA) study. BMJ 311: 1139–1140PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2012

Authors and Affiliations

  1. 1.Epidemiology Branch, Division of Epidemiology, Statistics, and Prevention ResearchEunice Kennedy Shriver National Institute of Child Health and Human DevelopmentBethesdaUSA

Personalised recommendations