Estimating the impact of change in pre-pregnancy body mass index on development of Gestational Diabetes Mellitus: An Australian population-based cohort

Abstract

BackgroundInternational studies examining maternal overweight and obesity have found GDM risk increases with increasing weight gain between pregnancies. AimThe study aimed to estimate the association between pre-pregnancy maternal body mass index (BMI), change in BMI between pregnancies and Gestational Diabetes Mellitus (GDM) amongst women with consecutive births in an Australian cohort. MethodsWe used a population cohort of women who had at least two consecutive singleton births between 2010 and 2017 in one NSW health district to investigate the risk of GDM in the pregnancy after the index pregnancy, BMI change between pregnancies and the impact of BMI change on risk of GDM. FindingsOf 10,074 women 1987 (16.7%) had no GDM in the index pregnancy but GDM in the subsequent one while 823 (8.2%) had GDM in both pregnancies. No change in BMI between pregnancies occurred in 47% of women, while 12% had a decrease and 41% an increase. After adjusting for socio-demographic characteristics and selected maternal and perinatal confounders, a reduction in BMI between births in women without GDM in the index pregnancy was associated with a 36% lower risk in GDM (aRR: 0.64; 95% CI: 0.49−0.85), while an increase in BMI was associated with increased risk of GDM with the greatest risk amongst those who gained 4+ kg/m² (aRR 2.27; 95%CI: 1.88–2.75). ConclusionInterpregnancy weight change is an important modifiable risk factor for the risk of GDM in a subsequent pregnancy. Clinical guidelines and health messages about interpregnancy weight change are important for all women.