Excessive Gestational Weight Gain and Pregnancy Outcomes in Gestational and Pre-gestational Diabetes

Abstract

Background and aims: Women with diabetes mellitus (DM) during pregnancy are at higher risk of adverse maternal and neonatal outcomes. Excessive gestational weight gain (GWG) is a potential risk factor for these adverse results. In 2009 the Institute of Medicine (IOM) established recommendations for appropriate GWG in non-diabetic women. We try to examine if excessive GWG, using IOM recommendations, in pregnancies with pregestational diabetes mellitus (PGDM) or gestational diabetes(GDM) is associated with higher adverse pregnancy outcomes. Materials and methods: We performed a retrospective study of 2773 singleton pregnancies in women with DM [[259 PGDM (176 type 1 DM, 83 type 2 DM), 2514 GDM]. Maternal weight and body mass index (BMI) had been recorded pre-pregnancy and at the time of delivery. GWG was calculated and compared with IOM guidelines to assess if the upper limit per BMI category was breached. Examined maternal outcomes included pre-eclampsia, gestational hypertension and cesarean delivery. Fetal outcomes included large for gestational age (LGA), macrosomia and neonatal morbidity. Multivariate analyses were performed and odds ratio calculated using a logistic regression analysis adjusted with age, parity, ethnicity, pre-pregnancy BMI, and neonatal sex. Results: 1. Women with PGDM: 46,2% demonstrated excessive GWG. In the excessive GWG group a higher percentage were overweight (60,2%) or obese (56,2%, p< 0,01). There were no significant differences in GWG between type 1 and type 2 DM. Excessive GWG was associated with higher odds for LGA (OR 2,5 , CI 1,4-4,7 p<0,01), macrosomia (OR 6,4 , CI 2,2-20 p<0,01) and cesarean delivery (OR 2,1, CI 1,1-3,9 p<0,05). 2. Women with GDM: 18,3% demonstrated excessive GWG. A higher percentage in the group with excessive GWG were overweight (40,2%) or obese (35,2%, p< 0,01). Insulinization was more frequent in the excessive GWG group (43,0% vs 52,6%, p< 0,01). Excessive GWG was associated with higher odds for LGA (OR 2,3 , CI 1,7-3,1 p<0,01), macrosomia (OR 2,2 , CI 1,5-3,3 p<0,01) and cesarean delivery (OR 1,6, CI 1,3-2,0 p<0,05). Conclusion: Excessive GWG confers an additional risk for LGA, macrosomia and cesarean delivery of both GDM and PGDM. Multidisciplinary lifestyle intervention programs must be implemented to achieve weight control in all women with diabetes during pregnancy.