OBJECTIVE The increased risk of pregnancy complications in type 1 diabetes is mainly attributed to maternal hyperglycemia. However, it is unclear whether other potentially modifiable factors also contribute to risk in this population. We sought to assess whether high BMI and excessive gestational weight gain (GWG) are associated with perinatal complications in type 1 diabetes. RESEARCH DESIGN AND METHODS We searched Medline, Embase, PubMed, Scopus, Web of Science, and Cochrane databases to January 2024. Studies examining associations between periconception BMI or GWG and perinatal complications in type 1 diabetes were included. We used a predesigned data extraction template to extract study data including year, country, sample size, participants’ characteristics, exposure, and outcomes. We included 29 studies (18,965 pregnancies; 1978–2019) in the meta-analysis. RESULTS A 1 kg/m2/1 kg increase in preconception BMI or GWG was associated with a 3% and 11% increase, respectively, in perinatal complications (BMI odds ratio [OR] 1.03 [95% CI 1.01–1.06]; GWG OR 1.11 [95% CI 1.04–1.18]). Preconception BMI ≥ 25 kg/m2 or excessive GWG was associated with a 22% and 50% increase, respectively, in perinatal complications (BMI OR 1.22 [95% CI 1.11–1.34]; GWG OR 1.50 [95% CI 1.31–1.73]). BMI was associated with congenital malformation, preeclampsia, and neonatal intensive care unit admission. Excessive GWG was associated with preeclampsia, cesarean delivery, large for gestational age, and macrosomia. CONCLUSIONS Addressing maternal BMI prepregnancy and preventing excessive GWG should be key clinical priorities to improve outcomes in pregnant women with type 1 diabetes.

中文翻译：

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高 BMI 和妊娠期体重过度增加与 1 型糖尿病女性妊娠结局的关联：系统评价和荟萃分析


目的 1 型糖尿病妊娠并发症风险增加主要归因于产妇高血糖。然而，目前尚不清楚其他可能可改变的因素是否也会导致该人群的风险。我们试图评估高 BMI 和妊娠期体重过度增加 （GWG） 是否与 1 型糖尿病的围产期并发症相关。研究设计和方法 我们检索了截至 2024 年 1 月的 Medline、Embase、PubMed、Scopus、Web of Science 和 Cochrane 数据库。纳入了检查围孕期 BMI 或 GWG 与 1 型糖尿病围产期并发症之间关联的研究。我们使用预先设计的数据提取模板来提取研究数据，包括年份、国家、样本量、参与者的特征、暴露和结局。我们在荟萃分析中纳入了 29 项研究 （18,965 例妊娠;1978-2019 年）。结果 孕前 BMI 或 GWG 增加 1 kg/m2/1 kg 与围产期并发症分别增加 3% 和 11% 相关 （BMI 比值比 [OR] 1.03 [95% CI 1.01-1.06];GWG OR 1.11 [95% CI 1.04–1.18]）。孕前 BMI ≥ 25 kg/m2 或超标 GWG 分别与围产期并发症增加 22% 和 50% 相关 （BMI OR 1.22 [95% CI 1.11-1.34];GWG OR 1.50 [95% CI 1.31–1.73]）。BMI 与先天性畸形、子痫前期和新生儿重症监护病房收治相关。过高的 GWG 与子痫前期、剖宫产、大于胎龄儿和巨大儿有关。结论解决孕前孕产妇 BMI 和预防过高 GWG 应该是改善 1 型糖尿病孕妇预后的关键临床重点。