PMID- 30513077 OWN - NLM STAT- MEDLINE DCOM- 20190501 LR - 20220129 IS - 1549-1676 (Electronic) IS - 1549-1277 (Print) IS - 1549-1277 (Linking) VI - 15 IP - 12 DP - 2018 Dec TI - Metabolic syndrome in pregnancy and risk for adverse pregnancy outcomes: A prospective cohort of nulliparous women. PG - e1002710 LID - 10.1371/journal.pmed.1002710 [doi] LID - e1002710 AB - BACKGROUND: Obesity increases the risk for developing gestational diabetes mellitus (GDM) and preeclampsia (PE), which both associate with increased risk for type 2 diabetes mellitus (T2DM) and cardiovascular disease (CVD) in women in later life. In the general population, metabolic syndrome (MetS) associates with T2DM and CVD. The impact of maternal MetS on pregnancy outcomes, in nulliparous pregnant women, has not been investigated. METHODS AND FINDINGS: Low-risk, nulliparous women were recruited to the multi-centre, international prospective Screening for Pregnancy Endpoints (SCOPE) cohort between 11 November 2004 and 28 February 2011. Women were assessed for a range of demographic, lifestyle, and metabolic health variables at 15 +/- 1 weeks' gestation. MetS was defined according to International Diabetes Federation (IDF) criteria for adults: waist circumference >/=80 cm, along with any 2 of the following: raised trigycerides (>/=1.70 mmol/l [>/=150 mg/dl]), reduced high-density lipoprotein cholesterol (<1.29 mmol/l [<50 mg/dl]), raised blood pressure (BP) (i.e., systolic BP >/=130 mm Hg or diastolic BP >/=85 mm Hg), or raised plasma glucose (>/=5.6 mmol/l). Log-binomial regression analyses were used to examine the risk for each pregnancy outcome (GDM, PE, large for gestational age [LGA], small for gestational age [SGA], and spontaneous preterm birth [sPTB]) with each of the 5 individual components for MetS and as a composite measure (i.e., MetS, as defined by the IDF). The relative risks, adjusted for maternal BMI, age, study centre, ethnicity, socioeconomic index, physical activity, smoking status, depression status, and fetal sex, are reported. A total of 5,530 women were included, and 12.3% (n = 684) had MetS. Women with MetS were at an increased risk for PE by a factor of 1.63 (95% CI 1.23 to 2.15) and for GDM by 3.71 (95% CI 2.42 to 5.67). In absolute terms, for PE, women with MetS had an adjusted excess risk of 2.52% (95% CI 1.51% to 4.11%) and, for GDM, had an adjusted excess risk of 8.66% (95% CI 5.38% to 13.94%). Diagnosis of MetS was not associated with increased risk for LGA, SGA, or sPTB. Increasing BMI in combination with MetS increased the estimated probability for GDM and decreased the probability of an uncomplicated pregnancy. Limitations of this study are that there are several different definitions for MetS in the adult population, and as there are none for pregnancy, we cannot be sure that the IDF criteria are the most appropriate definition for pregnancy. Furthermore, MetS was assessed in the first trimester and may not reflect pre-pregnancy metabolic health status. CONCLUSIONS: We did not compare the impact of individual metabolic components with that of MetS as a composite, and therefore cannot conclude that MetS is better at identifying women at risk. However, more than half of the women who had MetS in early pregnancy developed a pregnancy complication compared with just over a third of women who did not have MetS. Furthermore, while increasing BMI increases the probability of GDM, the addition of MetS exacerbates this probability. Further studies are required to determine if individual MetS components act synergistically or independently. FAU - Grieger, Jessica A AU - Grieger JA AD - Robinson Research Institute, University of Adelaide, Adelaide, Australia. AD - Adelaide Medical School, University of Adelaide, Adelaide, Australia. FAU - Bianco-Miotto, Tina AU - Bianco-Miotto T AD - Robinson Research Institute, University of Adelaide, Adelaide, Australia. AD - Waite Research Institute, School of Agriculture, Food and Wine, University of Adelaide, Adelaide, Australia. FAU - Grzeskowiak, Luke E AU - Grzeskowiak LE AUID- ORCID: 0000-0001-8554-4696 AD - Robinson Research Institute, University of Adelaide, Adelaide, Australia. AD - Adelaide Medical School, University of Adelaide, Adelaide, Australia. FAU - Leemaqz, Shalem Y AU - Leemaqz SY AD - Robinson Research Institute, University of Adelaide, Adelaide, Australia. AD - Adelaide Medical School, University of Adelaide, Adelaide, Australia. FAU - Poston, Lucilla AU - Poston L AD - Department of Women and Children's Health, King's College London, St. Thomas' Hospital, London, United Kingdom. FAU - McCowan, Lesley M AU - McCowan LM AUID- ORCID: 0000-0001-9915-7873 AD - Department of Obstetrics and Gynaecology, University of Auckland, Auckland, New Zealand. FAU - Kenny, Louise C AU - Kenny LC AD - Faculty of Health & Life Sciences, University of Liverpool, Liverpool, United Kingdom. FAU - Myers, Jenny E AU - Myers JE AD - Maternal and Fetal Health Research Centre, University of Manchester, Manchester, United Kingdom. FAU - Walker, James J AU - Walker JJ AUID- ORCID: 0000-0002-8922-083X AD - Obstetrics and Gynaecology Section, Leeds Institute of Biomedical and Clinical Sciences, University of Leeds, Leeds, United Kingdom. FAU - Dekker, Gus A AU - Dekker GA AD - Robinson Research Institute, University of Adelaide, Adelaide, Australia. AD - Adelaide Medical School, University of Adelaide, Adelaide, Australia. AD - Women and Children's Division, Lyell McEwin Hospital, Adelaide, Australia. FAU - Roberts, Claire T AU - Roberts CT AD - Robinson Research Institute, University of Adelaide, Adelaide, Australia. AD - Adelaide Medical School, University of Adelaide, Adelaide, Australia. LA - eng GR - NIHR-CS-011-020/DH_/Department of Health/United Kingdom PT - Journal Article PT - Multicenter Study DEP - 20181204 PL - United States TA - PLoS Med JT - PLoS medicine JID - 101231360 SB - IM MH - Adult MH - Australia/epidemiology MH - Cohort Studies MH - Female MH - Humans MH - Internationality MH - Ireland/epidemiology MH - Metabolic Syndrome/blood/*diagnosis/*epidemiology MH - New Zealand/epidemiology MH - Parity/*physiology MH - Pregnancy MH - Pregnancy Complications/blood/*diagnosis/*epidemiology MH - Pregnancy Outcome/*epidemiology MH - Prospective Studies MH - Risk Factors MH - United Kingdom/epidemiology PMC - PMC6279018 COIS- I have read the journal's policy and the authors of this manuscript have the following competing interests: LCK is a minority shareholder in Metabolomic Diagnostics, an SME which has licensed IP pertaining to biomarkers predictive of pre-eclampsia which LCK invented. JEM receives a stipend as a specialty consulting editor for PLOS Medicine and serves on the journal's editorial board. EDAT- 2018/12/05 06:00 MHDA- 2019/05/02 06:00 PMCR- 2018/12/04 CRDT- 2018/12/05 06:00 PHST- 2017/12/23 00:00 [received] PHST- 2018/11/02 00:00 [accepted] PHST- 2018/12/05 06:00 [entrez] PHST- 2018/12/05 06:00 [pubmed] PHST- 2019/05/02 06:00 [medline] PHST- 2018/12/04 00:00 [pmc-release] AID - PMEDICINE-D-17-04510 [pii] AID - 10.1371/journal.pmed.1002710 [doi] PST - epublish SO - PLoS Med. 2018 Dec 4;15(12):e1002710. doi: 10.1371/journal.pmed.1002710. eCollection 2018 Dec.