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Prevalence of Clinical and Pre-Clinical Obesity at Six Months Postpartum
24 Pages Posted: 7 May 2025
More...Abstract
Background: A Lancet Diabetes and Endocrinology Commission redefined obesity as ‘clinical’, if excess adiposity affects organ function, and ‘pre-clinical’ if it does not. In this prospective observational study, we examined this clinical framework postpartum.
Methods: At King’s College Hospital, London, UK, we invited for review by six months postpartum, consecutive women with GDM (N=1244, September/2023-March/2025) and without GDM (N=372, January/2025-April/2025). Those with excess adiposity (BMI ≥30kg/m2 and waist-to-height ratio >0·5) were assessed for clinical obesity, according to organ dysfunction diagnostic criteria from the Commission: anovulation, metabolism or renal clusters, raised blood pressure, or elevated end-diastolic left ventricular filling pressure. Multiple regression determined predictors of clinical obesity, the prevalence of which was calculated as a range (highest estimate: absolute organ dysfunction prevalence; lowest estimate: obesity-adjusted, as highest estimate minus prevalence in women without obesity).
Findings: Of those invited for review, 937/1244=75·3% GDM and 324/372=87·1% non-GDM women attended, at median 5·8 months after birth (interquartile range 4·8-6·7). Obesity was observed in 336/937=35·9% GDM and 46/324=14·2% non-GDM women, among whom organ dysfunction was seen in 59·8% GDM (201/336), 54·3% non-GDM (25/46), and 59·2% (226/382) overall. 38·9% (339/872) of women without obesity had organ dysfunction. The clinical obesity estimate was 20·3% (59·2-38·9%) to 59·2%; predictors (older maternal age, pre-eclampsia/gestational hypertension, postnatal BMI ≥35·0kg/m2) did not include GDM.
Interpretation: Clinical obesity may affect 20-59% of postpartum women with excess adiposity. GDM was not associated with a higher prevalence of clinical obesity.
Keywords: Clinical obesity, preclinical obesity, gestational diabetes, postpartum follow-up, pregnancy
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