1100 Impact of gestational weight gain in women with chronic hypertension and pre-gestational diabetes

Abstract

With an aging and obese obstetric population, the co-occurrence of chronic hypertension and pre-gestational diabetes in gravidae is increasing. We sought to examine whether gestational weight gain (GWG) outside guidelines is associated with additional risks for women with both co-morbidities given their unique metabolic profile. This is a retrospective cohort study of women with both chronic hypertension and pre-gestational diabetes from a prospectively collected perinatal database at a large academic center from 2011-2020. Women were stratified by IOM classification of GWG in the following groups: insufficient, adequate, excessive. Analysis was performed with chi-square, ANOVA and logistic regression (SAS 9.4). Adjusted logistic regression was used to control for potential confounders. Odds ratios were calculated for insufficient and excessive GWG vs adequate GWG (reference). 192 of 48,204 patients met inclusion criteria. 41 (21.4%) had insufficient GWG, 42 (21.9%) had adequate, and 109 (56.8%) had excessive GWG. Women with insufficient GWG had higher pre-pregnancy BMI (38.7) than adequate (34.5) or excessive (34.3) groups (p< 0.01). Women with excessive GWG had greater than twice the odds for cesarean delivery (aOR 2.39 [95% CI 1.14-5.11]), despite adjustment for pre-pregnancy BMI. Women with insufficient GWG were more likely to have a preterm delivery than women with adequate weight gain (53.6% vs 28.5%, p=0.048, aOR 2.80, 95% CI 1.10-7.47), with average gestational age at delivery of 35.6 weeks for insufficient GWG vs 37.0 weeks for adequate GWG. Consequently, average birthweight was smaller for women with insufficient GWG (2845g vs 3217g, p< 0.01). There was no difference between groups with respect to rates of Apgar < 7 or neonatal need for ventilation. Despite additional metabolic risk factors, after adjusting for confounders, there does not appear to be additional adverse risk for women with both chronic hypertension and pre-gestational diabetes by virtue of GWG. This suggests that counseling should focus on nutrition, not weight loss nor gain.View Large Image Figure ViewerDownload Hi-res image Download (PPT)