Pre-pregnancy weight and excess weight gain are risk factors for macrosomia in women with gestational diabetes

Abstract

Objective: To determine whether women with gestational diabetes mellitus (GDM) whose weight gain exceeded the 2009 Institute of Medicine (IOM) recommendations were more likely to have macrosomia.Study Design: Retrospective cohort study of the association of weight gain in women with Class A1 GDM, with term (X37 weeks) singleton liveborns and macrosomia (birthweight X4000 g). Multivariate logistic regression models were used to adjust for covariates and test for interactions.Result: Of 1502 women studied, pre-pregnancy body mass index (BMI) categories were: normal (39.6%), overweight (28.5%) and obese (31.9%). The mean ( ± standard deviation ) weight gain (lbs) for these groups was: 27.6±10.9, 24.2±13.0 and 18.8±16.3 (P<0.0001), whereas the occurrence of macrosomia was 7.4, 11.4 and 19.0%, respectively. Women with an obese BMI were twice as likely to have a macrosomic infant compared with women in the normal BMI group (odds ratio, OR 2.0; 95% CI 1.4-3.0; P ¼ 0.0005). Independently, women who exceeded the IOM guidelines were three times more likely to have a macrosomic infant (OR 3.0, 95% CI 2.2-4.2, P<0.0001).Conclusion: Maternal pre-pregnancy weight and weight gain during pregnancy appear to be significant and independent risk factors for macrosomia in women with GDM.

Pregnancy adverse outcomes related to pregravid body mass index and gestational weight gain, according to the presence or not of gestational diabetes mellitus: A retrospective observational study

“…As the partial population attributable fraction of GDM, BMI and GWG was < 50%, other factors may be important contributors to LGA infants. Similar to the findings of others, our data indicate that, while ethnicity [15,16], a familial history of diabetes and personal history of a child with macrosomia [15,29] suggest genetic causes of macrosomia, smoking habits [6], multiparity and preeclampsia [31] are also possible, non-genetic causes of macrosomia. All these factors may play a role through epigenetic mechanisms, with fetal epigenetic programming of adipokines involved when considering BMI and GWG [32].…”

“…[7], in which 13.7% had a BMI ≥ 33 kg/m 2 at inclusion. However, obesity is still far less than reported in recent US reports, which ranged from 20.0% [28] to 31.9% [29]. Indeed, as in the US [15], our study shows that race/ethnicity is a determinant of overweight/obesity.…”

Racial and ethnic disparities in extremes of fetal growth after gestational diabetes mellitus

“…The investigation of racial/ethnic disparities in fetal growth associated with GDM is potentially confounded by maternal obesity and gestational weight gain, since both are important risk factors for fetal growth independent of GDM [21][22][23][24], and both may vary by race/ethnicity even among women with GDM pregnancies. The purposes of this study were to estimate LGA/SGA risks and assess variation in LGA and SGA risks among women from ten racial/ethnic groups with pregnancies complicated by GDM, where LGA and SGA were identified using racial/ethnic-sex-specific standards adjusted for gestational age at delivery.…”

Gestational diabetes, pre-pregnancy obesity and pregnancy weight gain in relation to excess fetal growth: variations by race/ethnicity

“…Maternal obesity before pregnancy and excessive weight gain during pregnancy are additional, potentially modifiable, independent risk factors of excessive fetal growth [10] and often occur in conjunction with GDM or hyperglycaemia in pregnancy. It is therefore important to evaluate the association of pre-pregnancy obesity and weight gain during pregnancy in the context of the two other major risk factors for excess fetal growth.…”