{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,11,17]],"date-time":"2025-11-17T23:36:56Z","timestamp":1763422616106,"version":"3.45.0"},"reference-count":15,"publisher":"Georg Thieme Verlag KG","issue":"16","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Am J Perinatol"],"published-print":{"date-parts":[[2025,12]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>Obesity, gestational diabetes mellitus (GDM), and excessive gestational weight gain (EGWG) are associated with adverse outcomes. It is unclear which carries the greatest risk. In this study, the relationship of obesity, GDM, and EGWG independently and concomitantly was analyzed to determine if one is a greater risk factor than the other.<\/jats:p>\n                  <jats:p>A retrospective cohort study of singleton gestations at Geisinger from October 2007 to March 2023 was performed. Exclusion criteria were pregravid body mass index (BMI) &lt;18\u2009kg\/m2, gestational age (GA) &lt;34 weeks, pregestational diabetes or chronic hypertension, prior cesarean delivery (CD) or contraindication to vaginal delivery. Patients were grouped by BMI class, and the order of groups within each BMI for the test for trend were no GDM\/no EGWG, GDM\/no EGWG, no GDM\/EGWG, and GDM\/EGWG. The rates of hypertensive disorders of pregnancy (HDP), severe HDP, CD, large for gestational age (LGA), shoulder dystocia, and neonatal intensive care unit (NICU) admission at \u226535 weeks were evaluated. A test for trend and odds ratios with 95% CIs were reported. p-values were reported across the GDM\/EGWG groups per BMI category.<\/jats:p>\n                  <jats:p>A total of 42,627 pregnancies were included. At each BMI category, HDP, severe HDP, CD, LGA, and shoulder dystocia generally increased from patients with no GDM\/no EGWG to those with GDM\/no EGWG to those with no GDM\/EGWG to those with GDM\/EGWG. NICU admission at \u226535 weeks did not follow this progression.<\/jats:p>\n                  <jats:p>EGWG poses a greater risk than GDM regardless of pregravid BMI for HDP, severe HDP, CD, LGA, and shoulder dystocia. Attention should be given to determine the optimal strategy to manage pregnancies experiencing EGWG.<\/jats:p>","DOI":"10.1055\/a-2568-6317","type":"journal-article","created":{"date-parts":[[2025,3,31]],"date-time":"2025-03-31T19:52:09Z","timestamp":1743450729000},"page":"2162-2168","source":"Crossref","is-referenced-by-count":1,"title":["The Association of Adverse Perinatal Outcomes in Pregnancies with Gestational Diabetes and Excessive Gestational Weight Gain According to Obesity Status"],"prefix":"10.1055","volume":"42","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7772-5865","authenticated-orcid":false,"given":"Henry","family":"Lesser","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Geisinger Medical Center, Danville, Pennsylvania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Vani","family":"Movva","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Essentia Health Maternal-Fetal Medicine, Duluth, Minnesota"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Amanda","family":"Young","sequence":"additional","affiliation":[{"name":"Biostatistics Core, Department of Population Health Sciences, Geisinger Medical Center, Danville, Pennsylvania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Celia","family":"Gray","sequence":"additional","affiliation":[{"name":"Department of Population Health Sciences, Phenomic Analytics and Clinical Data Core Geisinger, Danville, Pennsylvania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"A Dhanya","family":"Mackeen","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Geisinger Medical Center, Danville, Pennsylvania"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"194","published-online":{"date-parts":[[2025,4,30]]},"reference":[{"issue":"01","key":"ref1","doi-asserted-by":"crossref","first-page":"e18","DOI":"10.1097\/AOG.0000000000003606","article-title":"Macrosomia: ACOG Practice Bulletin, number 216","volume":"135","author":"American College of Obstetricians and Gynecologists","year":"2020","journal-title":"Obstet Gynecol"},{"issue":"01","key":"ref2","doi-asserted-by":"crossref","first-page":"210","DOI":"10.1097\/01.AOG.0000425668.87506.4c","article-title":"ACOG Committee Opinion No. 548: Weight gain during pregnancy","volume":"121","author":"American College of Obstetricians and Gynecologists","year":"2013","journal-title":"Obstet Gynecol"},{"issue":"06","key":"ref3","doi-asserted-by":"crossref","first-page":"e128","DOI":"10.1097\/AOG.0000000000004395","article-title":"Obesity in pregnancy: ACOG practice bulletin, number 230","volume":"137","author":"American College of Obstetricians and Gynecologists","year":"2021","journal-title":"Obstet Gynecol"},{"issue":"21","key":"ref4","doi-asserted-by":"crossref","first-page":"2207","DOI":"10.1001\/jama.2017.3635","article-title":"Association of gestational weight gain with maternal and infant outcomes: A systematic review and meta-analysis","volume":"317","author":"R F Goldstein","year":"2017","journal-title":"JAMA"},{"issue":"08","key":"ref5","doi-asserted-by":"crossref","first-page":"e0221549","DOI":"10.1371\/journal.pone.0221549","article-title":"Independent and concomitant associations of gestational diabetes and maternal obesity to perinatal outcome: A register-based study","volume":"14","author":"H Ij\u00e4s","year":"2019","journal-title":"PLoS ONE"},{"issue":"02","key":"ref6","doi-asserted-by":"crossref","first-page":"186","DOI":"10.3109\/14767058.2014.995084","article-title":"Obesity or diabetes: which is more hazardous to the health of the offspring?","volume":"29","author":"O Langer","year":"2016","journal-title":"J Matern Fetal Neonatal Med"},{"key":"ref7","doi-asserted-by":"crossref","first-page":"47","DOI":"10.1186\/1472-6823-14-47","article-title":"The independent effects of maternal obesity and gestational diabetes on the pregnancy outcomes","volume":"14","author":"H A Wahabi","year":"2014","journal-title":"BMC Endocr Disord"},{"issue":"02","key":"ref8","doi-asserted-by":"crossref","first-page":"106","DOI":"10.1001\/jamainternmed.2021.6373","article-title":"Association of antenatal diet and physical activity-based interventions with gestational weight gain and pregnancy outcomes: A systematic review and meta-analysis","volume":"182","author":"H J Teede","year":"2022","journal-title":"JAMA Intern Med"},{"issue":"03","key":"ref9","doi-asserted-by":"crossref","first-page":"261","DOI":"10.1002\/osp4.565","article-title":"Encouraging appropriate gestational weight gain in high-risk gravida: A randomized controlled trial","volume":"8","author":"A D Mackeen","year":"2021","journal-title":"Obes Sci Pract"},{"issue":"01","key":"ref10","doi-asserted-by":"crossref","first-page":"10","DOI":"10.1038\/s41372-022-01496-1","article-title":"Retrospective application of algorithms to improve identification of pregnancy outcomes from the electronic health record","volume":"43","author":"K Angras","year":"2023","journal-title":"J Perinatol"},{"issue":"06","key":"ref12","doi-asserted-by":"crossref","first-page":"e237","DOI":"10.1097\/AOG.0000000000003891","article-title":"Gestational hypertension and preeclampsia: ACOG practice bulletin, number 222","volume":"135","author":"American College of Obstetricians and Gynecologists","year":"2020","journal-title":"Obstet Gynecol"},{"issue":"02","key":"ref13","doi-asserted-by":"crossref","first-page":"e49","DOI":"10.1097\/AOG.0000000000002501","article-title":"ACOG Practice Bulletin No. 190: Gestational diabetes mellitus","volume":"131","author":"American College of Obstetricians and Gynecologists","year":"2018","journal-title":"Obstet Gynecol"},{"issue":"02","key":"ref14","doi-asserted-by":"crossref","first-page":"559","DOI":"10.1097\/00003081-198006000-00024","article-title":"Management of shoulder girdle dystocia","volume":"23","author":"R Resnik","year":"1980","journal-title":"Clin Obstet Gynecol"},{"issue":"01","key":"ref15","doi-asserted-by":"crossref","first-page":"195","DOI":"10.1186\/s12884-022-04533-1","article-title":"Clinical consequences of gestational diabetes mellitus and maternal obesity as defined by asian BMI thresholds in Viet Nam: a prospective, hospital-based, cohort study","volume":"22","author":"S Yue","year":"2022","journal-title":"BMC Pregnancy Childbirth"},{"key":"ref16","doi-asserted-by":"crossref","first-page":"754406","DOI":"10.3389\/fendo.2021.754406","article-title":"Maternal pre-pregnancy obesity combined with abnormal glucose metabolism further increases adverse pregnancy outcomes in chinese pregnant women","volume":"12","author":"M F Li","year":"2022","journal-title":"Front Endocrinol (Lausanne)"}],"container-title":["American Journal of 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