Gestational diabetes mellitus and interpregnancy weight change: A population-based cohort study

Abstract

BackgroundBeing overweight is an important risk factor for Gestational Diabetes Mellitus (GDM), but the underlying mechanisms are not understood. Weight change between pregnancies has been suggested to be an independent mechanism behind GDM. We assessed the risk for GDM in second pregnancy by change in Body Mass Index (BMI) from first to second pregnancy and whether BMI and gestational weight gain modified the risk.Methods and findingsIn this observational cohort, we included 24,198 mothers and their 2 first pregnancies in data from the Medical Birth Registry of Norway (2006–2014). Weight change, defined as prepregnant BMI in second pregnancy minus prepregnant BMI in first pregnancy, was divided into 6 categories by units BMI (kilo/square meter). Relative risk (RR) estimates were obtained by general linear models for the binary family and adjusted for maternal age at second delivery, country of birth, education, smoking in pregnancy, interpregnancy interval, and year of second birth. Analyses were stratified by BMI (first pregnancy) and gestational weight gain (second pregnancy). Compared to women with stable BMI (−1 to 1), women who gained weight between pregnancies had higher risk of GDM—gaining 1 to 2 units: adjusted RR 2.0 (95% CI 1.5 to 2.7), 2 to 4 units: RR 2.6 (2.0 to 3.5), and ≥4 units: RR 5.4 (4.0 to 7.4). Risk increased significantly both for women with BMI below and above 25 at first pregnancy, although it increased more for the former group. A limitation in our study was the limited data on BMI in 2 pregnancies.ConclusionsThe risk of GDM increased with increasing weight gain from first to second pregnancy, and more strongly among women with BMI < 25 in first pregnancy. Our results suggest weight change as a metabolic mechanism behind the increased risk of GDM, thus weight change should be acknowledged as an independent factor for screening GDM in clinical guidelines. Promoting healthy weight from preconception through the postpartum period should be a target.

Short interpregnancy interval and poor fetal growth: Evaluating the role of pregnancy intention

“…Our analysis is based on data collected between 1986 and 1988, which may limit the generalisability of our results to more contemporary populations. For example, the proportion of IPIs greater than or equal to 24 months is higher in our study compared to a recent populationbased Norwegian study using data from 2006 to 2014 (60% vs 37%, respectively), 23 and we found a slightly longer mean IPI compared to a population-based study from the United States using data from 2006 to 2010 (34 months vs 37 months, respectively). 7 In addition, in our cohort, 70% of pregnancies were intended, compared to 49% of pregnancies in the United States in 2008, 24 and 80% of pregnancies in a cross-sectional European study of women attending routine prenatal care between 2008 and 2010.…”

Prevention of Type 2 diabetes after gestational diabetes directed at the family context: a narrative review from the Danish Diabetes Academy symposium

“…Previous large population-based cohort studies have shown an association between an increase in interpregnancy weight gain and the risk of adverse pregnancy outcomes in the following pregnancy [41] and adverse perinatal complications even in normal or underweight women [42]. Additionally, a recent study showed that the risk of developing GDM increased with increasing weight gain from first to second pregnancy mostly in women with BMI < 25 in the first pregnancy [43]. Thus, weight retention is indeed an important aspect within the context of prevention of later diseases and complications both for the mother and the offspring.…”

“…Because previous studies have shown that breastfeeding is associated with a reduced risk of developing diabetes in mothers with previous GDM [40], increased awareness and promotion of breastfeeding may reduce the risk for diabetes later. Additionally, a recent study showed that the risk of developing GDM increased with increasing weight gain from first to second pregnancy mostly in women with BMI < 25 in the first pregnancy [43]. Previous large population-based cohort studies have shown an association between an increase in interpregnancy weight gain and the risk of adverse pregnancy outcomes in the following pregnancy [41] and adverse perinatal complications even in normal or underweight women [42].…”

“…As described earlier, studies suggest that various risk perceptions are at play among women with prior GDM; yet, limited evidence is available on what influences these risk perceptions, their trajectories, and how they may be altered. Although studies indicate that women with GDM are highly motivated for behaviour change during pregnancy due to the potential risk of hyperglycaemia on their baby, motivation tends to cease after the delivery, particularly due to factors within the family and healthcare system [30,31,43]. Given the strong motivational drive for behaviour change attached to the well-being of the offspring, focusing on how parental behaviour affects that of their children and thus their health may be a potential avenue for enhancing motivation for healthy behaviours post-partum.…”

Principle of Management of Type 2 Diabetes: From Clinical, Public Health and Research Perspectives

“…Women who had a child gains extra weight than women who remained nulliparous [71] and the second and subsequent offspring were anticipated about a decade earlier to have increased risk of in utero exposure to the maternal clinical or sub-clinical hyperglycemia due to the increased weight of mothers [56]. A recent study indeed reported increased risk of GDM with increasing weight gain from first to second pregnancy [72]. In summary, campaign and programmes for maintenance of optimal pre-pregnancy body weight as per the recommended body mass index of the respective populations along with regular physical activity and exercise during pregnancy are the essential measures available at hand to prevent the possibility of maternal hyperglycemia right from the early pregnancy and are the urgent priority to control diabetes epidemic.…”