Abstract
We have investigated the prospective association between excess gestational weight gain (GWG) and development of diabetes by 21 years post-partum using a community-based large prospective cohort study in Brisbane, Australia. There were 3386 mothers for whom complete data were available on GWG, pre-pregnancy BMI and self-reported diabetes 21 years post-partum. We used The Institute of Medicine (IOM) definition to categorize GWG as inadequate, adequate and excessive. We found 839 (25.78%) mothers gained inadequate weight, 1,353 (39.96%) had adequate weight gain and 1,194 (35.26%) had gained excessive weight during pregnancy. At 21 years post-partum, 8.40% of mothers self-reported a diagnosis of diabetes made by their doctor. In the age adjusted model, we found mothers who gained excess weight during pregnancy were 1.47(1.11,1.94) times more likely to experience diabetes at 21 years post-partum compared to the mothers who gained adequate weight. This association was not explained by the potential confounders including maternal age, parity, education, race, smoking, TV watching and exercise. However, this association was mediated by the current BMI. There was no association for the women who had normal BMI before pregnancy and gained excess weight during pregnancy. The findings of this study suggest that women who gain excess weight during pregnancy are at greater risk of being diagnosed with diabetes in later life. This relationship is likely mediated through the pathway of post-partum weight-retention and obesity. This study adds evidence to the argument that excessive GWG during pregnancy for overweight mothers has long term maternal health implications.
Highlights
While weight gain has long been associated with the development of diabetes relatively little has been written about the possibility that gestational weight gain (GWG) may be an independent predictor of diabetes onset in later life
Using a large community based pregnancy cohort study we found that women who gained excess weight during pregnancy have had 1.47 times greater risk of experiencing diabetes mellitus by 21 years post-partum compared to women who gained Institute of Medicine (IOM) recommended weight during pregnancy
The findings of this study suggest that women who gain excess weight during pregnancy are at greater risk of diabetes in later life, and that this relationship appears to be mediated through the pathway of weight gain prior to pregnancy, post-partum weight-retention and obesity
Summary
While weight gain has long been associated with the development of diabetes relatively little has been written about the possibility that gestational weight gain (GWG) may be an independent predictor of diabetes onset in later life. The institute of Medicine (IOM) [1] defined GWG as inadequate, adequate and excessive, with appropriate GWG dependent on pre-pregnancy body mass index (BMI). This has been a commonly used indicator to predict post partum weight retention (PPWR) in the short and long- term [2,3,4]. Overweight and obesity during midlife, among women, are strong independent predictors of cardiovascular disease, metabolic syndrome, diabetes and early mortality [7,8,9] It is unknown whether GWG independently contributes to the burden of diabetes. 1 2 3 or more Missing Race Caucasian Asian Aboriginal-Islander Missing TV watched a day before pregnancy Less than 1 hour 1 to ,3 hour 3 to ,5 hour 5 or more hours Missing How often physical exercise? Often Sometime Never Missing Maternal depression during pregnancy Not depressed Depressed Missing IOM Inadequate Adequate Excess Missing Age at first clinic visit, mean(SD) Pre-pregnancy BMI kg/m2, mean (SD)
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