Impact of gestational weight gain on obstetric and neonatal outcomes in obese diabetic women

Abstract

BackgroundBoth obesity and gestational diabetes mellitus are increasing in prevalence, being a major health problem in pregnancy with independent and additive impact on obstetrics outcomes. It is recognized that inadequate gestational weight gain is an independent risk factor for pregnancy-related morbidity. The aim of this study was to evaluate the effect of gestational weight gain on obstetric and neonatal outcomes in obese women with gestational diabetes.MethodsRetrospective multicenter study of obese women with gestational diabetes. The assessed group was divided into three categories: women who gained below (<5 kg), within (5–9 kg) and above (>9 kg) the 2009 Institute of Medicine recommendations. Maternal and neonatal outcomes were compared and adjusted odds ratios calculated controlling for confounders.ResultsOnly 35,1 % of obese women with gestational diabetes (n = 634) achieved the recommended gestational weight gain; 27,8 % (n = 502) gained below and 37,1 % (n = 670) above the recommendations. There was a positive correlation between gestational weight gain and neonatal birthweight (r = 0,225; p < 0,001). Gestational weight gain below recommendations was associated with lower odds for cesarean section, even adjusting for birthweight [aOR = 0,67 (0,54–0,85); p < 0,001]; lower odds for large for gestational age neonates [aOR = 0,39 (0,28–0,57); p < 0,001] and macrosomia [aOR = 0,34 (0,21–0,55); p < 0,001]. Excessive weight gain, even adjusting for birthweight, was associated with higher odds for cesarean section [aOR = 1,31 (1,07–1,61); p = 0,009], low Apgar score [aOR = 4,79 (1,19–19,21); p = 0,027], large for gestational age neonates [aOR = 2,32 (1,76–3,04); p < 0,001] and macrosomia [aOR = 2,39 (1,68–3,38); p < 0,001].ConclusionsIn obese women with gestational diabetes, a reduced gestational weight gain (<5 kg) is associated with better obstetric and neonatal outcomes than an excessive or even an adequate weight gain. Therefore, specific recommendations should be created since gestational weight gain could be a modifiable risk factor for adverse obstetric outcomes.

Association of pre-pregnancy body mass index, gestational weight gain with cesarean section in term deliveries of China

“…As BMI has been considered by some studies to be a better indicator of body fat than weight alone8, we also classified pregnancy weight gain according to net change in BMI, and similarly, excessive BMI gain during pregnancy was shown to be associated with elevated odds of cesarean section. Excessive weight gain during pregnancy might increase the risk of several adverse outcomes such as fetal distress, low birth Apgar score and large for gestational age births1819, which may result in cesarean delivery. Furthermore, as excessive GWG may be associated with increased adipose tissue and cholesterol deposits in the myometrium, which may in turn inhibit the myometrial contractility, thereby potentially impeding the labour process, complicating vaginal delivery1420, and increasing the need for cesarean delivery.…”

Use of a clinical‐laboratory score to guide treatment of gestational diabetes

“…Also, ensuring appropriate weight gain during pregnancy could improve perinatal outcomes. Gante et al . observed a higher frequency of SGA newborns among obese pregnant women with diabetes and below‐recommended weight gain; by contrast, the prevalences of macrosomia, LGA newborns, a low Apgar score, and cesarean delivery were higher among obese pregnant women with diabetes and above‐recommended weight gain.…”

Is the Risk for Gestational Diabetes Higher with Lower Weight Gain During Pregnancy?

“…Gebelik sırasında fazla kilo alımının, fetal ağırlıkta artışı ve makrozomik yenidoğan riskini artırdığı bildirilmiştir. 1 Gonçalves ve ark., gebelikte hipertansiyon ve diyabet riskinin, BKİ ve kilo alımı ile ilişkisi olmadığını, ancak bu faktörlerin sezaryen ile doğum ve fetal makrozomi gelişme olasılığını artırdığını belirtmişlerdir. 28 Bu çalışmada, vücut ağırlığı artışı 11-20 kg arasında veya >20 kg olan gebe kadınlara göre, vücut ağırlığı artışı <11 kg olan gebe kadınlardaki GDM oranı anlamlı derecede yüksek bulundu.…”

“…1 Sadece gebelik döneminde sı-nırlı kalmayıp ileri yaşlarda da annede Tip 2 diyabet riskini artırmaktadır. 2 Ailede diabetes mellitus (DM) öyküsü, gebelik öncesi fazla kilolu olma veya gebelik boyunca fazla kilo alımı GDM için risk faktörleridir.…”

“…5 Obezite, modern toplumlardaki en önemli sağ-lık sorunlarından biri hâline gelmiştir ve buna bağlı olarak, GDM ve GBGI görülme sıklığı artmıştır. 1 İl-ginç olarak, gebeliğin başlangıcındaki vücut ağır-lığı düşük olan veya gebelik süresince kilo alımı az olan kadınlarda da GDM ve GBGI riskinin fazla olabileceği öne sürülmüştür. 6 Bu çalışmada, İstanbul bölgesinde özel bir hastanede gebelik takiplerini yaptıran olgular geriye dönük olarak incelenmiş ve gebelikteki kilo alımı ile GDM arasında ilişki olup olmadığı araştırılmış-tır.…”