Clinical consequences of gestational diabetes mellitus and maternal obesity as defined by Asian BMI thresholds in Viet Nam: a prospective, hospital-based, cohort study

Background Gestational Diabetes Mellitus (GDM) is common in South East Asia, occurring at relatively lean Body Mass Index (BMI). Outside pregnancy, cardiometabolic risks increase at lower BMI in Asian populations, justifying Asian-specific thresholds for overweight and obesity. We aimed to explore the effects of GDM and obesity on perinatal outcomes using a WHO expert consultation-recommended Asian-specific definition of obesity. Methods This is a secondary analysis of a prospective, hospital-based, cohort study in Ho Chi Minh City. Participants were recruited from antenatal clinics between 19+ 0-22+ 6 weeks gestation and followed until delivery. GDM screening occurred between 24 and 28 weeks using WHO criteria. Obesity was defined as BMI ≥ 27.5 kg/m2, based on weight and height at recruitment. We assessed associations between GDM (singly, and in combination with obesity) and perinatal outcomes. Participants were categorised into four groups: no GDM/non-obese (reference group), GDM/non-obese, no GDM/obese and GDM/obese. Outcomes included primary caesarean section, hypertensive disorders of pregnancy (HDP), large-for-gestational-age (LGA), birth weight, preterm birth, and composite adverse neonatal outcome. Logistic and linear regressions were performed with adjustment for differences in baseline characteristics. Results Among 4,970 participants, 908 (18%) developed GDM. Compared to women without GDM, GDM increased risks for preterm birth (OR: 1.40, 95% CI: 1.09–1.78), higher birthweight (birthweight z-score 0.16 versus 0.09, p = 0.027), and LGA (OR 1.14, 0.89–1.46). GDM without obesity was associated with an increased risk of preterm birth (OR 1.35, 1.04–1.74). Obese women without GDM were more likely to deliver by caesarean section and have an LGA baby (1.80, 1.33–2.44 and 2.75, 1.88–4.03). The highest risks were observed amongst women with both GDM and obesity: caesarean Sect. (2.43, 1.49–3.96), LGA (3.36, 1.94–5.80) and preterm birth (2.42, 1.32–4.44). Conclusions GDM was associated with an increased risk of ...