Higher Gestational Weight Gain Is Associated With Increasing Offspring Birth Weight Independent of Maternal Glycemic Control in Women With Type 1 Diabetes

Abstract

OBJECTIVEWe evaluate the association between gestational weight gain and offspring birth weight in singleton term pregnancies of women with type 1 diabetes. RESEARCH DESIGN AND METHODSOne hundred fifteen consecutive women referred at <14 weeks were retrospectively classified as underweight (prepregnancy BMI <18.5 kg/m 2 ; n = 1), normal weight (18.5-24.9; n = 65), overweight (25.0-29.9; n = 39), or obese ( ‡30.0; n = 10). Gestational weight gain was categorized as excessive, appropriate, or insufficient according to the Institute of Medicine recommendations for each BMI class. Women with nephropathy, preeclampsia, and/or preterm delivery were excluded because of restrictive impact on fetal growth and limited time for total weight gain. RESULTSHbA 1c was comparable at ∼6.6% (49 mmol/mol) at 8 weeks and ∼6.0% (42 mmol/mol) at 36 weeks between women with excessive (n = 62), appropriate (n = 37), and insufficient (n = 16) gestational weight gain. Diabetes duration was comparable, and median prepregnancy BMI was 25.3 (range 18-41) vs. 23.5 (18-31) vs. 22.7 (20-30) kg/m 2 (P = 0.05) in the three weight gain groups. Offspring birth weight and birth weight SD score decreased across the groups (3,681 [2,374-4,500] vs. 3,395 [2,910-4,322] vs. 3,295 [2,766-4,340] CONCLUSIONSHigher gestational weight gain in women with type 1 diabetes was associated with increasing offspring birth weight independent of glycemic control and prepregnancy BMI.

Pregnancy Outcomes in Women With Diabetes—Lessons Learned From Clinical Research: The 2015 Norbert Freinkel Award Lecture

“…In a cohort of women with type 1 diabetes, an independent association between maternal gestational weight gain and fetal overgrowth after adjustment for HbA 1c in late pregnancy was demonstrated (57). Similar associations between maternal excessive gestational weight gain and fetal overgrowth in women with diabetes have also been described by others (58).…”

Vitamin D insufficiency, preterm delivery and preeclampsia in women with type 1 diabetes – an observational study

“…Gestational age was estimated based on an early ultrasound scan. The total gestational weight gain (kg) was calculated as the difference between the last weight measured before delivery and the self-reported prepregnancy weight (26). Preeclampsia was defined as blood pressure ≥140/90 mmHg accompanied by proteinuria defined as ≥1+ on a sterile urinary dipstick or urinary proteinuria excretion ≥300 mg/24 h or albumin-to-creatinine ratio >190 mg/24 h (proteinuria of 300 mg/24 h approximates urinary albuminuria excretion of 190 mg/24 h) after 20 weeks (20,21,27).…”

Diastolic blood pressure is a potentially modifiable risk factor for preeclampsia in women with pre-existing diabetes

“…The women attended obstetric visits at 8,12,20,27,33,36 gestational weeks where weight, office BP and HbA1c were registered and a sterile urine dipstick was screened for protein [19]. The women consulted a diabetes specialist approximately every 1-2 weeks throughout pregnancy, either at our Center or at their local diabetes clinic.…”

“…At the first antenatal visit, all women received a one-hour dietary consultation with individual dietary planning. A low glycemic index diet was recommended according to national guidelines on diabetes diet with focus on gestational weight gain defined as the difference between the weight at last antenatal visit and the self-reported pre-pregnancy weight [20]. The following gestational weight gain targets were recommended [19]: women with pre-pregnancy BMI < 30 kg/m 2 were recommended to gain 10-15 kg, whereas women with pre-pregnancy BMI ≥ 30 kg/m 2 were advised to limit their gestational weight gain to 0-5 kg, according to local guidelines [21].…”