The Catalano lab published three new papers recently, adding to the literature of adverse outcomes of maternal obesity and diagnostic criteria for gestational diabetes mellitus. Key points of the papers are below. See Patrick Catalano for more information about Dr. Catalano's lab.
- Cringe AA, Catalano PM, Bateman BT. Obesity in Pregnancy, N Engle J Med. 2022; 387:248-59. https://www.nejm.org/doi/10.1056/NEJMra1801040?url_ver=Z39.88-2003&rfr_id=ori%3Arid%3Acrossref.org&rfr_dat=cr_pub++0pubmed
Summary: Obesity is the most common health problem in women of reproductive age. Not only does obesity pose clinically significant health risks to women during pregnancy and after delivery, but it also has long-term health implications that require recognition and treatment. Maternal obesity can adversely affect fetal, neonatal, and infant outcomes, with lifelong consequences for the offspring. Evidence-based options for nutritional, behavioral, and surgical management of maternal obesity are available. Ideally, such management approaches should be instituted before pregnancy and should be continued after delivery and as part of long-term care, to ensure the best possible maternal and fetal outcomes and to prevent severe complications. This review provides an overview of conditions and factors associated with obesity in prepregnancy, as well as key management considerations for obese persons who are pregnant or have given birth. This information is relevant not only to obstetricians but to all clinicians caring for women of reproductive age, since prevention of long-term complications associated with obesity in pregnancy requires a lifecourse approach.
- Rojas-Rodriquez R, Price l, Somogie J, Hauguel-de Mouzon S, Kalhan SC, Catalano PM. Maternal Lipid Metabolism Is Associated With Neonatal Adiposity: A Longitudinal Study. The Journal of Clinical Endocrinology & Metabolism. 2022, XX, 1–10. Read summary below:
Objective: Because higher maternal prepregnancy BMI is strongly associated with both hyperlipidemia and neonatal adiposity, we aimed to examine the longitudinal changes in basal and clamp maternal lipid metabolism as contributors to neonatal adiposity.
Results: Basal free-fatty acids decreased with advancing gestation (p=0.0210), however, basal GLYTO and nonoxidative lipid metabolism increased over time (p=0.0046; p=0.0052, respectively). Further, clamp GLYTO and lipid oxidation increased longitudinally over time (p=0.0004; p=0.0238, respectively). There was a median 50% increase and significant positive correlation during both basal and clamp GLYTO from prepregnancy through late gestation. Neonatal adiposity correlated with late pregnancy basal and clamp GLYTO (r=0.6515, p=0.0217 and r=0.6051, p=0.0371).
Conclusions: Maternal prepregnancy and late pregnancy measures of basal and clamp lipid metabolism are highly correlated. Late pregnancy basal and clamp GLYTO are significantly associated with neonatal adiposity and account for ~40% of the variance in neonatal adiposity. These data emphasize the importance of lipid metabolism relating to fetal fat accrual.
- He Y, Ma, RC, McIntyre HD, Sacks DA, Lowe J, Catalano PM, Tam WH. Comparing IADPSG and NICE Diagnostic Criteria for GDM in Predicting Adverse Pregnancy Outcomes. Diabetes Care 2022; 45:1–9. Read summary below:
Objective: To compare the performance of diagnostic criteria for gestational diabetes mellitus (GDM) proposed by the International Association of the Diabetes and Pregnancy Study Groups (IADPSG) with those endorsed by the National Institute for Health and Care Excellence (NICE) in predicting adverse pregnancy outcomes.
Results: Among all, IADPSG criteria diagnosed 267 (4.1%) more women with GDM, but predicted primary caesarean section (CS) and large for gestational age (LGA) and neonatal adiposity better than did NICE criteria after adjustment for potential confounders. Among Whites, IADPSG criteria diagnosed 65 (2.5%) more subjects with GDM and predicted LGA and neonatal adiposity better, but predicted hypertensive disorders, primary CS and clinical neonatal hypoglycemia worse. Among Hispanics, the IADPSG criteria diagnosed 203 (12.1%) more with GDM but performed better in predicting hypertensive disorders, LGA, neonatal adiposity, and hyperinsulinemia. Among Asians, the IADPSG criteria diagnosed 34 (2.0%) fewer subjects with GDM but predicted hypertensive disorders better in the unadjusted model. In Blacks, IADPSG criteria diagnosed 34 (10.5%) more women with GDM.
Conclusions: IADPSG criteria appear to be more favorable than NICE for identification of adverse pregnancy outcomes among Hispanic and Asian women, while they are comparable to NICE among White women.