What is the role of maternal obesity in gestational diabetes mellitus (GDM) and fetal morbidity?

Updated: Apr 29, 2020
  • Author: Thomas R Moore, MD; Chief Editor: George T Griffing, MD  more...
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Excessive body fat stores, stimulated by excessive glucose delivery during diabetic pregnancy, often extends into childhood and adult life. Maternal obesity, common in type 2 diabetes, appears to significantly accelerate the risk of infants being large for gestational age (LGA). Approximately 30% of fetuses of women with diabetes mellitus in pregnancy are LGA. In preexisting diabetes mellitus, this incidence appears to be slightly higher (38%). [18]

In women with gestational diabetes, weight gain during pregnancy that exceeds Institute of Medicine (IOM) weight-gain guidelines increases the risk of preterm delivery, of having a newborn who is LGA, and of requiring a cesarean delivery. [35] The chance that a newborn would be small for gestational age (SGA) was greater among women with gestational diabetes whose weight gain was below the IOM guidelines.

Plotting of serial ultrasonographic examination findings from diabetic fetuses shows that the growth velocity of the abdominal circumference is often well above the growth percentiles seen in nondiabetic fetuses, and it is higher than the fetal head and femur percentiles. The growth of the abdominal circumference begins to rise significantly above normal after 24 weeks.

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