340: The impact of inadequate gestational weight gain (GWG) in obese diabetic women

Abstract

The Institute of Medicine recommends obese women gain 11-20 lbs during pregnancy; however, it is less clear how these targets apply to women with diabetes. Altering their standard diet and adhering to low glycemic diets may result in less GWG in this population. The objective of our study was to evaluate the maternal and neonatal impact of inadequate GWG in obese diabetic women receiving prenatal care. A retrospective cohort study of women with a pre-pregnancy BMI≥30 and gestational diabetes, Type 2 diabetes or Type 1 diabetes who received prenatal care at the University of California, San Diego from 2011-2012 was conducted. Data were collected by review of the medical record. Women received nutrition counseling and weekly monitoring of blood glucose values by a certified diabetic educator. For term patients, women were stratified into GWG groups of inadequate (<11 lbs), adequate (11-20 lbs), or excessive (>20 lbs). The primary outcome was low birth weight (LBW) (<2500 grams). Secondary outcomes included maternal and neonatal complications, gestational age (GA) at delivery, mode of delivery, Apgar scores, and birth weights. Univariate and multivariate analyses evaluated the association between GWG and maternal and neonatal outcomes. 211 diabetic obese women were identified, with 36.5% having inadequate GWG, 25.1% with adequate GWG, and 38.4% with excessive GWG. Maternal demographic characteristics were similar among the groups. Our results are listed in Table 1. Although women who had inadequate GWG had lower mean birth weights, there was no difference in rates of LBW infants between the groups. Diabetic obese women with inadequate GWG had lower rates of Cesarean delivery compared to those with adequate and excessive GWG (36%, 51%, 59%; P=0.015). These findings persisted on multivariate analysis. Obese diabetic women who gain <11 lbs during pregnancy do not have higher rates of LBW infants. Inadequate GWG is, however, associated with a lower risk of Cesarean delivery.