Hyperglycaemia and Adverse Pregnancy Outcome (HAPO) Study: associations with maternal body mass index
Open accessAbstract
Please cite this paper as: HAPO Study Cooperative Research Group. Hyperglycaemia and Adverse Pregnancy Outcome (HAPO) Study: associations with maternal body mass index. BJOG 2010;117:575–584. Objective To determine whether higher maternal body mass index (BMI), independent of maternal glycaemia, is associated with adverse pregnancy outcomes. Design Observational cohort study. Setting Fifteen centres in nine countries. Population Eligible pregnant women. Methods A 75‐g 2‐hour oral glucose tolerance test (OGTT) was performed between 24 and 32 weeks of gestation in all participants. Maternal BMI was calculated from height and weight measured at the OGTT. Fetal adiposity was assessed using skinfold measurements and percentage of body fat was calculated. Associations between maternal BMI and pregnancy outcomes were assessed using multiple logistic regression analyses, with adjustment for potential confounders. Main outcome measures Predefined primary outcomes were birthweight >90th percentile, primary caesarean section, clinical neonatal hypoglycaemia and cord serum C‐peptide >90th percentile. Secondary outcomes included pre‐eclampsia, preterm delivery (before 37 weeks) and percentage of body fat >90th percentile. Results Among 23 316 blinded participants, with control for maternal glycaemia and other potential confounders, higher maternal BMI was associated (odds ratio [95% confidence interval] for highest {≥42.0 kg/m 2} versus lowest {<22.6 kg/m 2} BMI categories) with increased frequency of birthweight >90th percentile (3.52 [2.48–5.00]) and percentage of body fat >90th percentile (3.28 [2.28–4.71]), caesarean section (2.23 [1.66–2.99]), cord C‐peptide >90th percentile (2.33 [1.58–3.43]) and pre‐eclampsia (14.14 [9.44–21.17]). Preterm delivery was less frequent with higher BMI (0.48 [0.31–0.74]). Associations with fetal size tended to plateau in the highest maternal BMI categories. Conclusion Higher maternal BMI, independent of maternal glycaemia, is strongly associated with increased frequency of pregnancy complications, in particular those related to excess fetal growth and adiposity and to pre‐eclampsia.
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“More recent post hoc analyses of the HAPO study using the IADPSG criteria for GDM identified both maternal GDM and obesity at pregnancy week 28 (week 24–32) as independent risk factors for birth weight >90 percentile [31,32].”
MethodWeight control before and during pregnancy for patients with gestational diabetes mellitus
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- Authors
- HAPO Study Cooperative Research Group
- Corresponding author
- HAPO Study Cooperative Research Group
- Venue
- BJOG: An International Journal of Obstetrics & Gynaecology
- Publisher
- Wiley
- Published
- 2010-03-08
- Volume
- 117
- Issue
- 5
- Pages
- 575-584
- ISSN
- 0306-5456 (ISSN-L)
- 1470-0328
- 1471-0528
- OpenAlex
- W204391295
- Cited by
- 395
- References
- 34
- Citations by year
- 2026: 13 · 2025: 10 · 2024: 15 · 2023: 22 · 2022: 17 · 2021: 21 · 2020: 35 · 2019: 22 · 2018: 26 · 2017: 20 · 2016: 27 · 2015: 25 · 2014: 26 · 2013: 32 · 2012: 47
- FWCI
- 50.59
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- BJOG An International Journal of Obstetrics & Gynaecology (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Center for Research Resources (M01RR000080, M01 RR00048, M01RR00080, M01RR000048)
- Eunice Kennedy Shriver National Institute of Child Health and Human Development (R01-HD-34243, R01-HD-34242, R01HD034242, R01HD034243)
- Topics
- Health Sciences › Medicine › Obstetrics and Gynecology › Gestational Diabetes Research and Management
- Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Birth, Development, and Health
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes, Cardiovascular Risks, and Lipoproteins
- Keywords
- maternal body mass index, maternal obesity, adverse pregnancy outcomes, fetal growth, birth weight, fetal adiposity, preeclampsia, cesarean section, preterm birth, neonatal hypoglycemia, HAPO study
- MeSH terms
- Adult, Cesarean Section, Female, Fetal Growth Retardation, Humans, Hyperglycemia, Obesity, Pre-Eclampsia, Pregnancy, Pregnancy Complications, Pregnancy Outcome, Prenatal Diagnosis, Body Mass Index, Adiposity, Young Adult
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