Preventing large birth size in women with preexisting diabetes mellitus: The benefit of appropriate gestational weight gain

Abstract

Objective To estimate the percentage of infants with large birth size attributable to excess gestational weight gain (GWG), independent of prepregnancy body mass index, among mothers with preexisting diabetes mellitus (PDM). Study design We analyzed 2004–2008 Florida linked birth certificate and maternal hospital discharge data of live, term (37–41 weeks) singleton deliveries (N = 641,857). We calculated prevalence of large-for-gestational age (LGA) (birth weight-for-gestational age ≥ 90th percentile) and macrosomia (birth weight > 4500 g) by GWG categories (inadequate, appropriate, or excess). We used multivariable logistic regression to estimate the relative risk (RR) of large birth size associated with excess compared to appropriate GWG among mothers with PDM. We then estimated the population attributable fraction (PAF) of large birth size due to excess GWG among mothers with PDM (n = 4427). Results Regardless of diabetes status, half of mothers (51.2%) gained weight in excess of recommendations. Large birth size was higher in infants of mothers with PDM than in infants of mothers without diabetes (28.8% versus 9.4% for LGA, 5.8% versus 0.9% for macrosomia). Among women with PDM, the adjusted RR of having an LGA infant was 1.7 (95% CI 1.5, 1.9) for women with excess GWG compared to those with appropriate gain; the PAF was 27.7% (95% CI 22.0, 33.3). For macrosomia, the adjusted RR associated with excess GWG was 2.1 (95% CI 1.5, 2.9) and the PAF was 38.6% (95% CI 24.9, 52.4). Conclusion Preventing excess GWG may avert over one-third of macrosomic term infants of mothers with PDM. Effective strategies to prevent excess GWG are needed.

The Influence of HbA1c and Gestational Weight Gain on Pregnancy Outcomes in Pregnant Women With Gestational Diabetes Mellitus

“…Moreover, a large number of studies have shown that excessive GWG is a risk factor for various adverse maternal and infant outcomes in pregnant women with diabetes (28,29). Research by Kim et al (30) demonstrated that excessive weight gain during pregnancy is an independent predictor of the occurrence of fetal macrosomia, while appropriate GWG reduces the occurrence of fetal macrosomia in pregnant women with gestational diabetes by one-third. Xueqin Zhang et al (31) pointed out that excessive weight gain in the second trimester of pregnancy is a high-risk factor for large-for-gestationalage (LGA) infants, whereas excessive weight gain in the third trimester of pregnancy is a high-risk factor for preeclampsia and cesarean section.…”

Determining optimal gestational weight gain (GWG) in a northwest Chinese population

“…Excessive GWG has been linked to high prevalence of cesarean section and gestational hypertension, large gestational age fetals, postpartum weight retention, and child obesity. [20,32,33] On the contrary, insufficient GWG is associated with small gestational age babies, [34,35] preterm delivery, NICU admission, and stunting at 5 years. [36] Moreover, the impact due to the changes in weight and body composition during pregnancy may persist into the postpartum period and whole life of the parturients.…”

“…[16] The IOM recommendation has been widely used by various racial and ethnic groups all over the world for clinical guidance and scientific research, facilitating the comparison of international data. [11,[18][19][20] However, the recommendation may be not suitable for Asian populations because they are mainly based on the Caucasian standard. Moreover, many previous studies indicate that there may be racial differences in genetic characteristics, such as maternal height, pelvic shape.…”

Pre-gestational diabetes: Maternal body mass index and gestational weight gain are associated with augmented umbilical venous flow, fetal liver perfusion, and thus birthweight

“…Overweight and obesity add significantly to the risk of large for gestational age offspring in these pregnancies [ 7 ], and excess gestational weight gain is linked to risk for neonatal macrosomia independent of glycemic control in women with type 1 diabetes [ 8 ]. Thus, women with PGDM are advised to aim for pre-pregnancy BMI in the normal range, less gestational weight gain than women without diabetes, and strict glycemic control [ 5 , 8 , 9 ].…”