Abstract
Excess gestational weight gain (GWG) is associated with the development of gestational diabetes mellitus (GDM). Lifestyle trials have not achieved much GWG limitation, and have largely failed to prevent GDM. We compared the effect of substantial GWG limitation on maternal GDM risk. Pregnant women with a body mass index (BMI) ≥29 kg/m2 <20 weeks gestation without GDM (n = 436) were randomized, in a multicenter trial, to usual care (UC), healthy eating (HE), physical activity (PA), or HE and PA lifestyle interventions. GWG over the median was associated with higher homeostasis model assessment insulin resistance (HOMA-IR) and insulin secretion (Stumvoll phases 1 and 2), a higher fasting plasma glucose (FPG) at 24–28 weeks (4.66 ± 0.43 vs. 4.61 ± 0.40 mmol/L, p < 0.01), and a higher rate of caesarean section (38% vs. 27% p < 0.05). The GWG over the median at 35–37 weeks was associated with a higher rate of macrosomia (25% vs. 16%, p < 0.05). A post hoc comparison among women from the five sites with a GWG difference >3 kg showed no significance difference in glycaemia or insulin resistance between HE and PA, and UC. We conclude that preventing even substantial increases in GWG after the first trimester has little effect on maternal glycaemia. We recommend randomized controlled trials of effective lifestyle interventions, starting in or before the first trimester.
Highlights
The risk of gestational diabetes mellitus (GDM) increases with both obesity and gestational weight gain (GWG) [1] GDM, excess GWG, and overweight/obesity are all independently associated with an increased risk of macrosomia, operative delivery, and other adverse perinatal outcomes, including shoulder dystocia [1]
The women with the greatest GWG commenced at a lower weight and body mass index (BMI), and were more likely to be smokers and nulliparous (35–37 weeks group only)
We have shown that GWG above the median is associated with increased fasting glucose, insulin resistance, and insulin secretion
Summary
The risk of gestational diabetes mellitus (GDM) increases with both obesity and gestational weight gain (GWG) [1] GDM, excess GWG, and overweight/obesity are all independently associated with an increased risk of macrosomia, operative delivery, and other adverse perinatal outcomes, including shoulder dystocia [1]. +3.5 kg in a meta-analysis in 2012, with a mean of −2.21 kg and no significant reduction in GDM rates [3]. A recent meta-analysis of the individual participant data from randomized trials estimated a GWG reduction of 0.7 kg overall, with no overall reduction in GDM (unless data from studies without individual data were included) [4]. The most recent Cochrane review (2017) showed no reduction in GDM or in adverse obstetric outcomes with lifestyle interventions [5]. Another recent meta-analysis showed a reduction in GDM if intervention commenced in the first, but not the second trimester [6]
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