Pregnant women with type 1 diabetes have a higher risk of perinatal complications. Maternal hyperglycaemia is a key modifiable risk factor for perinatal complications, but it is unclear if maternal body mass index (BMI) and excessive gestational weight gain (GWG) also contribute to the risk in this population.
Objective: We assessed the association of maternal BMI and GWG with perinatal complications in women with type 1 diabetes.
Research Design and Methods: We searched MEDLINE, Embase, Scopus, Web of Science, and Cochran databases to identify studies examining the association between periconception BMI and GWG and perinatal complications (defined by a core outcome set) in women with type 1 diabetes and conducted random effects meta-analyses.
Results: We screened 209 studies and included 24 studies (11,655 pregnancies which occurred between 1978 and 2019) in the meta-analyses. Periconception BMI and excessive GWG were associated with increased odds of perinatal complications overall (OR 1.06, 95%CI 1.03-1.10 and OR 1.35, 95%CI 1.21-1.51 respectively). BMI was associated with preeclampsia (OR 1.27, 95%CI 1.11-1.45), macrosomia (OR 1.06, 95%CI 1.02-1.11), Neonatal-Intensive-Care-Unit (NICU) admission (OR 1.08, 95%CI 1.03-1.13) and congenital malformation (OR 1.22, 95%CI 1.02-1.47). Excessive GWG was associated with an increased risk of preeclampsia (OR 1.10, 95%CI 1.04-1.16), Caesarean delivery (OR 1.70, 95%CI 1.28-2.25), large-for-gestational-age (OR 1.74, 95%CI 1.38-2.18) and macrosomia (OR 1.87, 95%CI 1.26-2.79).
Conclusions: Maternal BMI and GWG are modifiable determinants of perinatal complications in type 1 diabetes. Addressing maternal BMI pre-pregnancy and preventing excessive GWG should be key clinical priorities in women with type 1 diabetes.
N. Atta: None. A. Ezeoke: None. L.C. Kusinski: None. C.L. Meek: Research Support; Dexcom, Inc.
