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Metabolic syndrome in pregnancy and risk for adverse pregnancy outcomes: A prospective cohort of nulliparous women

PLoS medicine, 2018-12, Vol.15 (12), p.e1002710-e1002710 [Peer Reviewed Journal]

COPYRIGHT 2018 Public Library of Science ;COPYRIGHT 2018 Public Library of Science ;2018 Grieger et al. This is an open access article distributed under the terms of the Creative Commons Attribution License: http://creativecommons.org/licenses/by/4.0/ (the “License”), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License. ;2018 Grieger et al 2018 Grieger et al ;ISSN: 1549-1676 ;ISSN: 1549-1277 ;EISSN: 1549-1676 ;DOI: 10.1371/journal.pmed.1002710 ;PMID: 30513077

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Title:
Metabolic syndrome in pregnancy and risk for adverse pregnancy outcomes: A prospective cohort of nulliparous women
Author: Grieger, Jessica A ; Bianco-Miotto, Tina ; Grzeskowiak, Luke E ; Leemaqz, Shalem Y ; Poston, Lucilla ; McCowan, Lesley M ; Kenny, Louise C ; Myers, Jenny E ; Walker, James J ; Dekker, Gus A ; Roberts, Claire T
Langenberg, Claudia
Subjects: Adult ; Australia - epidemiology ; Biology and Life Sciences ; Blood pressure ; Body mass ; Cardiovascular diseases ; Cholesterol ; Chronic illnesses ; Cohort Studies ; Demographic variables ; Demographics ; Diabetes mellitus ; Diabetes mellitus (non-insulin dependent) ; Diagnosis ; Female ; Fetuses ; Gestation ; Gestational age ; Health risk assessment ; Health risks ; Humans ; Insulin resistance ; Internationality ; Ireland - epidemiology ; Medicine and Health Sciences ; Metabolic diseases ; Metabolic disorders ; Metabolic syndrome ; Metabolic Syndrome - blood ; Metabolic Syndrome - diagnosis ; Metabolic Syndrome - epidemiology ; Minority & ethnic groups ; New Zealand - epidemiology ; Obesity ; Parity - physiology ; Physical activity ; Physical Sciences ; Pre-eclampsia ; Pregnancy ; Pregnancy complications ; Pregnancy Complications - blood ; Pregnancy Complications - diagnosis ; Pregnancy Complications - epidemiology ; Pregnancy Outcome - epidemiology ; Pregnancy, Complications of ; Premature birth ; Prospective Studies ; Risk assessment ; Risk Factors ; Small for gestational age ; Smoking ; United Kingdom - epidemiology ; Women ; Womens health
Is Part Of: PLoS medicine, 2018-12, Vol.15 (12), p.e1002710-e1002710
Description: Obesity increases the risk for developing gestational diabetes mellitus (GDM) and preeclampsia (PE), which both associate with increased risk for type 2 diabetes mellitus (T2DM) and cardiovascular disease (CVD) in women in later life. In the general population, metabolic syndrome (MetS) associates with T2DM and CVD. The impact of maternal MetS on pregnancy outcomes, in nulliparous pregnant women, has not been investigated. Low-risk, nulliparous women were recruited to the multi-centre, international prospective Screening for Pregnancy Endpoints (SCOPE) cohort between 11 November 2004 and 28 February 2011. Women were assessed for a range of demographic, lifestyle, and metabolic health variables at 15 ± 1 weeks' gestation. MetS was defined according to International Diabetes Federation (IDF) criteria for adults: waist circumference ≥80 cm, along with any 2 of the following: raised trigycerides (≥1.70 mmol/l [≥150 mg/dl]), reduced high-density lipoprotein cholesterol (<1.29 mmol/l [<50 mg/dl]), raised blood pressure (BP) (i.e., systolic BP ≥130 mm Hg or diastolic BP ≥85 mm Hg), or raised plasma glucose (≥5.6 mmol/l). Log-binomial regression analyses were used to examine the risk for each pregnancy outcome (GDM, PE, large for gestational age [LGA], small for gestational age [SGA], and spontaneous preterm birth [sPTB]) with each of the 5 individual components for MetS and as a composite measure (i.e., MetS, as defined by the IDF). The relative risks, adjusted for maternal BMI, age, study centre, ethnicity, socioeconomic index, physical activity, smoking status, depression status, and fetal sex, are reported. A total of 5,530 women were included, and 12.3% (n = 684) had MetS. Women with MetS were at an increased risk for PE by a factor of 1.63 (95% CI 1.23 to 2.15) and for GDM by 3.71 (95% CI 2.42 to 5.67). In absolute terms, for PE, women with MetS had an adjusted excess risk of 2.52% (95% CI 1.51% to 4.11%) and, for GDM, had an adjusted excess risk of 8.66% (95% CI 5.38% to 13.94%). Diagnosis of MetS was not associated with increased risk for LGA, SGA, or sPTB. Increasing BMI in combination with MetS increased the estimated probability for GDM and decreased the probability of an uncomplicated pregnancy. Limitations of this study are that there are several different definitions for MetS in the adult population, and as there are none for pregnancy, we cannot be sure that the IDF criteria are the most appropriate definition for pregnancy. Furthermore, MetS was assessed in the first trimester and may not reflect pre-pregnancy metabolic health status. We did not compare the impact of individual metabolic components with that of MetS as a composite, and therefore cannot conclude that MetS is better at identifying women at risk. However, more than half of the women who had MetS in early pregnancy developed a pregnancy complication compared with just over a third of women who did not have MetS. Furthermore, while increasing BMI increases the probability of GDM, the addition of MetS exacerbates this probability. Further studies are required to determine if individual MetS components act synergistically or independently.
Publisher: United States: Public Library of Science
Language: English
Identifier: ISSN: 1549-1676
ISSN: 1549-1277
EISSN: 1549-1676
DOI: 10.1371/journal.pmed.1002710
PMID: 30513077
Source: GFMER Free Medical Journals
MEDLINE
PubMed Central
Public Library of Science (PLoS)
ProQuest Central
DOAJ Directory of Open Access Journals

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Metabolic syndrome in pregnancy and risk for adverse pregnancy outcomes: A prospective cohort of nulliparous women

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