Gestational Weight Gain in Patients With Obesity and Diabetes: A Comparison of 2009 Institute of Medicine Versus 2019 JAMA Recommendations [A270

Abstract

INTRODUCTION: Excessive gestational weight gain (GWG) is associated with adverse maternal and neonatal outcomes. Current guidelines established by the United States' Institute of Medicine (IOM) in 2009 recommend GWG of 11–20 lb for all obese patients. In 2019, a JAMA meta-analysis proposed recommending less weight gain in obesity (0–13 lb), not accounting for pre-existing maternal co-morbidities. We aim to ascertain whether, in obese diabetic pregnancies, GWG within the updated JAMA guidelines is associated with better outcomes. METHODS: IRB approval was obtained. Using a large urban hospital's de-identified obstetric database, obese diabetic patients from 2011 to 2020 were categorized into two groups: IOM and JAMA, depending on their GWG. Diagnosis codes were used to assess outcomes. Chi-square test, independent samples T-test, and Wilcoxon rank-sum test were used. RESULTS: Of 240 patients with obesity and diabetes, 135 fell within IOM weight gain guidelines and 65 within JAMA. The groups were not significantly different in age, BMI, A1C, or proportion with prior cesarean delivery. For maternal outcomes, chronic hypertension was independently associated with weight gain within the JAMA guidelines versus IOM (55% vs. 36%, P=.0082). There were no significant differences in rates of cesarean delivery (P=.73) or pre-eclampsia (P=.92). For neonatal outcomes, no differences were noted in NICU admission (P=.73), macrosomia (P=.72), or preterm delivery (P=.21) rates. CONCLUSION: For women with obesity and diabetes, chronic hypertension was associated with marginally less weight gain. Further research may be needed before clinicians advise the stricter GWG recommendations in the new JAMA guidelines rather than the current standard of IOM guidelines.