The Association of Gestational Weight Gain and Adverse Pregnancy Outcomes in Women with Gestational Diabetes Mellitus |
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| Institution: | 1. From the Department of Endocrinology, Drum Tower Hospital Affiliated to Nanjing University Medical School, Nanjing, China.;1. From Department of Endocrinology, Zhongda Hospital, Institute of Diabetes, School of medicine, Southeast University, Nanjing, China;2. Department of Psychosomatics and Psychiatry, Zhongda Hospital, Institute of Psychosomatics, School of medicine, Southeast University, Nanjing, China.;1. From the Key Laboratory of Endocrinology, Ministry of Health, Department of Endocrinology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China;2. Department of Orthopaedic Surgery, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China.;1. From the Department of Pharmacy Practice & Science, The University of Arizona College of Pharmacy, Tucson, Arizona;2. Prince Sattam Bin Abdulaziz University College of Pharmacy, Alkharj, Saudi Arabia;3. School of Pharmacy, University of Sydney, Royal Prince Alfred Hospital, Camperdown Campus, Sydney, New South Wales, Australia;4. King Faisal University College of Clinical Pharmacy, Al-ahsa, Saudi Arabia;5. Department of Medicine, The University of Arizona College of Medicine, Tucson, Arizona.;1. From the Department of Nuclear Medicine, Tianjin Medical University General Hospital, Tianjin, P.R. China;2. Senior Lecturer in Statistics, Hull York Medical School, University of Hull, Hull, United Kingdom;3. Department of Cardiology, Tianjin Medical University General Hospital, Tianjin, P.R. China;4. Department of Endocrinology and Metabolism, Tianjin Medical University General Hospital, Tianjin, P.R. China;5. Department of Health Management, Tianjin Medical University General Hospital, Tianjin, P.R. China;6. Tianjin Key Laboratory of Lung Cancer Metastasis and Tumor Microenvironment, Tianjin Lung Cancer Institute, Tianjin Medical University General Hospital, Tianjin, P.R. China;7. Department of Biochemistry and Molecular Biology, School of Basic Medical Sciences, Tianjin Medical University, Tianjin, P.R. China. |
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| Abstract: | Objective: To explore the association of excessive gestational weight gain (GWG) defined by the Institute of Medicine (IOM) targets and adverse perinatal outcomes in gestational diabetes mellitus (GDM) pregnancies, and whether a modified target might be related to a lower rate of adverse perinatal outcomes for GDM.Methods: This retrospective cohort study involved 1,138 women of normal glucose tolerance (NGT) and 1,200 women with GDM. Based on the IOM target, pregnancies were classified to appropriate GWG (aGWG), inadequate GWG, and excessive GWG (eGWG). Modified GWG targets included: upper limit of IOM target minus 1 kg (IOM-1) or 2 kg (IOM-2), both upper and lower targets minus 1 kg (IOM-1-1) or 2 kg (IOM-2-2).Results: The proportions of women achieving eGWG were 26.3% in NGT and 31.2% in GDM (P = .036); in comparison, for aGWG NGT, the risks of large for gestational age (LGA) were significantly higher in eGWG NGT (adjusted odds ratio [OR] 1.47; 95% confidence interval [CI] 1.02 to 2.13), aGWG GDM (adjusted OR 1.42; 95% CI 1.03 to 1.95), and eGWG GDM (adjusted OR 2.70; 95% CI 1.92 to 3.70). GDM pregnancies gaining aGWG based on the modified GWG targets (IOM-2, IOM-1-1, and IOM-2-2) had a lower prevalence of LGA and macrosomia delivery than that for similar pregnancies using the original IOM target (all P<.05).Conclusion: For aGWG GDM according to the IOM target, adhering to a more stringent weight control was associated with decreased adverse outcomes. A tighter IOM target might help to reduce the prevalence of adverse pregnancy outcomes.Abbreviations: aGWG = appropriate gestational weight gain; BG = blood glucose; BMI = body mass index; CI = confidence interval; eGWG = excessive gestational weight gain; GDM = gestational diabetes mellitus; GW = gestational weeks; GWG = gestational weight gain; HbA1c = hemoglobin A1c; iGWG = inadequate gestational weight gain; IOM = Institute of Medicine; LGA = large for gestational age; NGT = normal glucose tolerance; NICU = neonatal intensive care unit; OGTT = oral glucose tolerance test; OR = odds ratio; PARp = partial population attributable risks; SGA = small for gestational age |
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