Abstract
Background/objectivesGestational weight gain (GWG) recommendations for pregnant women with gestational diabetes mellitus (GDM) in China are lacking. The present study aims to examine whether specific GWG targets for women with GDM can improve pregnancy outcomes in comparison with GWG according to the Institute of Medicine (IOM) targets.Subjects/methodsPregnant women diagnosed with GDM were selected from a retrospective cohort study of 8299 singleton pregnant women aged 18–45 years in 2012 (n = 1820). GWG ranges were calculated using a receiver operating characteristic (ROC) curve analysis (ROC targets) and the interquartile range (IR) method (the range from the 25th to 75th percentiles of the GWG among GDM women without adverse pregnancy outcomes, IR targets).ResultsThe incidences of small for gestational age (SGA) births and pregnancy hypertension among women with GDM who gained weight within the ROC targets were lower than the incidences in women who gained weight within the IOM targets (SGA, 7.5% vs. 8.6%; pregnancy hypertension, 12.6% vs. 14.1%; both P < 0.05). GWG was associated with a risk of adverse pregnancy outcomes in the total sample (estimated values ranged from −2.95 to 2.08, all P < 0.05). No statistically significant associations between GWG and adverse pregnancy outcomes were observed in subgroups of pregnant women with appropriate GWGs according to the ROC, IR, and IOM targets. The ROC targets exhibited higher negative predictive values for adverse pregnancy outcomes than the IR and IOM targets.ConclusionThe ROC targets improved pregnancy outcomes and thus represent potential special GWG guidelines for women with GDM in China.
Highlights
These authors contributed : Xiao-Tian Li and Chuan-Min YinGestational diabetes mellitus (GDM) is defined as “diabetes diagnosed in the second or third trimester of pregnancy that is not clearly overt diabetes,” and it is a risk factor for maternal and perinatal complications [1, 2]
McNemar’s chi-squared paired tests indicated a significantly lower risk of having small for gestational age (SGA) infants and pregnancy hypertension for women with appropriate Gestational weight gain (GWG) according to the receiver operating characteristic (ROC) targets than for women with appropriate GWGs based on the Institute of Medicine (IOM) targets (SGA, 7.5% vs. 8.6%; pregnancy hypertension, 12.6% vs. 14.1%, both P < 0.05)
Women with gestational diabetes mellitus (GDM) with exhibiting appropriate GWGs according to the ROC targets had a lower risk of adverse pregnancy outcomes (e.g., SGA and pregnancy hypertension) than women with appropriate GWGs according to the IOM targets, and the negative predictive values of the ROC targets were superior to the IOM targets
Summary
These authors contributed : Xiao-Tian Li and Chuan-Min YinGestational diabetes mellitus (GDM) is defined as “diabetes diagnosed in the second or third trimester of pregnancy that is not clearly overt diabetes,” and it is a risk factor for maternal and perinatal complications [1, 2]. The global prevalence of GDM is increasing in parallel with the increase in the prevalence of overweight and obesity among pregnant women, and it is correlated with physical inactivity, dietary patterns, and the sociodemographic characteristics of pregnant women (e.g., advanced maternal age and ethnicity) [3,4,5,6]. In China, the prevalence of GDM has rapidly increased since new diagnostic criteria were recommended [7,8,9]. Based on the new criteria, the prevalence of GDM is ∼10% of pregnancies in municipalities, such as Beijing and Tianjin [10, 11]. In Shanghai, more than 20% of pregnant women were diagnosed with GDM in 2012 based on our previous study of 8299 singleton pregnant women [12].
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