Excessive gestational weight gain and gestational diabetes: importance of the first weeks of pregnancy

Abstract

Gestational diabetes mellitus (GDM) is associated with many adverse neonatal and maternal outcomes and prevention of this condition is considered a key strategy for breaking the intergenerational cycle of obesity and diabetes. Whether prevention of excessive gestational weight gain in the first weeks of pregnancy is associated with a reduced risk for GDM is currently unclear. In this issue of Diabetologia, Brunner et al (DOI: 10.1007/s00125-015-3686-5) address this possible association by conducting a systematic review and a meta-analysis. The results of their study provide evidence that excessive gestational weight gain prior to a GDM screening test is associated with an increased risk of GDM compared with non-excessive gestational weight gain. These results emphasise the need for appropriate preconception care and for better prevention of early excessive gestational weight gain and GDM. Keywords Gestational diabetes mellitus (GDM) . Gestational weight gain . PregnancyAbbreviations GDM Gestational diabetes mellitus GWG Gestational weight gain IOM Institute of Medicine Gestational diabetes mellitus (GDM) is defined as glucose intolerance with onset or first recognition during pregnancy and is associated with many adverse neonatal and maternal outcomes [1]. Although treatment of this condition has been shown to be successful in preventing major perinatal and maternal complications [2], prevention of GDM is considered a key strategy for breaking the intergenerational cycle of obesity and diabetes [3]. Avoidance of excessive gestational weight gain (GWG) could be a potential preventative measure given that higher GWGs lead to greater fat deposition, which may impair insulin sensitivity [4,5]. In 2009, the Institute of Medicine (IOM) published new guidelines for the management of GWG [6]. These revised guidelines include a specific recommendation for obese women and rates of GWG per week of pregnancy from the second trimester [6]. Data have indicated that since the publication of the revised 2009 IOM guidelines, approximately 50% of women have experienced excessive GWG [7]. Although excessive GWG has been associated with a number of perinatal and maternal outcomes, studies have failed to demonstrate a clear association between total GWG and the risk of GDM. This may be partly explained by intensive management of GDM, which has been proven to be successful in limiting GWG in late pregnancy, resulting in similar total GWG between women with a pregnancy complicated by GDM and women without GDM [8]. Given that screening for GDM usually occurs during the second trimester, depending on the criteria used, and given that excessive GWG may impair insulin sensitivity, the focus has now shifted to the study of the association between early GWG or GWG before screening for GDM and the subsequent risk for GDM. However, it remains unclear if excessive GWG in the first weeks of pregnancy is associated with an increased risk for GDM.In this issue of Diabetologia, Brunner et al [9] investigated this possible association by c...

An evaluation of whether a gestational weight gain of 5 to 9 kg for obese women optimizes maternal and neonatal health risks

“…As predicted, studies evaluating the effect of GWG on GDM has been shown risks to be both increased [23] and decreased [24] The Committee also accurately predicted that treatment for the condition would alter the pattern of weight gain after diagnosis [25, 26]. More recent studies have evaluated GWG prior to early screening and shown that early in pregnancy, increased GWG does precede the diagnosis of GWG [27–29].…”

Gestational weight gain and gestational diabetes among Emirati and Arab women in the United Arab Emirates: results from the MISC cohort

“…The association between a higher pre-pregnancy BMI and GDM might be explained by the fact that obese women, due to greater fat deposition, have lower insulin sensitivity as compared normal weight women [56]. Prevention of GDM is considered a key strategy for breaking the intergenerational cycle of obesity and diabetes [57]. Thus, strategies aiming at preventing obesity in young women and keeping appropriate preconception weight in pre-pregnant women are essential for the prevention of GDM.…”

The association between gestational diabetes mellitus and postpartum depressive symptomatology: A prospective cohort study

“…Furthermore, obesity at the beginning of pregnancy has been suggested to increase the likelihood of PPD (Molyneaux et al, 2014), and PPD has been suggested to be a preface to a chronic depressive disorder (Vliegen et al, 2014). In turn, high pre-pregnancy BMI and excessive weight gain during early pregnancy are associated with a significantly increased risk of GDM (Morisset et al, 2010;Robitaille, 2015). Women with GDM are also at greater risk of developing type 2 diabetes mellitus later in life (Bellamy et al, 2009).…”