Abstract
BackgroundBoth obesity and gestational diabetes mellitus are increasing in prevalence, being a major health problem in pregnancy with independent and additive impact on obstetrics outcomes. It is recognized that inadequate gestational weight gain is an independent risk factor for pregnancy-related morbidity. The aim of this study was to evaluate the effect of gestational weight gain on obstetric and neonatal outcomes in obese women with gestational diabetes.MethodsRetrospective multicenter study of obese women with gestational diabetes. The assessed group was divided into three categories: women who gained below (<5 kg), within (5–9 kg) and above (>9 kg) the 2009 Institute of Medicine recommendations. Maternal and neonatal outcomes were compared and adjusted odds ratios calculated controlling for confounders.ResultsOnly 35,1 % of obese women with gestational diabetes (n = 634) achieved the recommended gestational weight gain; 27,8 % (n = 502) gained below and 37,1 % (n = 670) above the recommendations. There was a positive correlation between gestational weight gain and neonatal birthweight (r = 0,225; p < 0,001). Gestational weight gain below recommendations was associated with lower odds for cesarean section, even adjusting for birthweight [aOR = 0,67 (0,54–0,85); p < 0,001]; lower odds for large for gestational age neonates [aOR = 0,39 (0,28–0,57); p < 0,001] and macrosomia [aOR = 0,34 (0,21–0,55); p < 0,001]. Excessive weight gain, even adjusting for birthweight, was associated with higher odds for cesarean section [aOR = 1,31 (1,07–1,61); p = 0,009], low Apgar score [aOR = 4,79 (1,19–19,21); p = 0,027], large for gestational age neonates [aOR = 2,32 (1,76–3,04); p < 0,001] and macrosomia [aOR = 2,39 (1,68–3,38); p < 0,001].ConclusionsIn obese women with gestational diabetes, a reduced gestational weight gain (<5 kg) is associated with better obstetric and neonatal outcomes than an excessive or even an adequate weight gain. Therefore, specific recommendations should be created since gestational weight gain could be a modifiable risk factor for adverse obstetric outcomes.
Highlights
Both obesity and gestational diabetes mellitus are increasing in prevalence, being a major health problem in pregnancy with independent and additive impact on obstetrics outcomes
Pregnant women who gained below the Institute of Medicine (IOM) limits had a higher prepregnancy Body mass index (BMI) than the rest of the study population (p < 0,01)
The rate of insulin treatment was similar in all three weight-gain groups, which suggests that glycemic control was reached during the pregnancies
Summary
Both obesity and gestational diabetes mellitus are increasing in prevalence, being a major health problem in pregnancy with independent and additive impact on obstetrics outcomes. The aim of this study was to evaluate the effect of gestational weight gain on obstetric and neonatal outcomes in obese women with gestational diabetes Both obesity and gestational diabetes mellitus (GDM) are increasing in prevalence, being a major health problem in pregnancy [1,2,3,4]. Obesity (defined as body mass index (BMI) ≥ 30 kg/m2) is a chronic illness which prepregnancy incidence is around 20 % [2,3,4,5,6] It is an independent risk factor for obstetric complications, such as congenital abnormalities, GDM, preeclampsia, large for gestational age (LGA) and GDM is one of the most common medical complications of pregnancy [11]. The obstetric complications associated are well-known: preterm labor, preeclampsia, LGA and macrosomia, growth restriction, birth trauma, cesarean section, neonatal hypoglycemia, among others. [2, 4, 5, 7, 8, 11].
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