Influence of maternal weight gain on birth weight: a gestational diabetes cohort.

Livia S Mastella,Angela J Reichelt,Vânia N Hirakata,Maria Lúcia R Oppermann,Sandra P Silveiro,Letícia S Weinert,Vanessa Gnielka

doi:10.20945/2359-3997000000009

Abstract

Objective Our objective was to evaluate gestational weight gain (GWG) patterns and their relation to birth weight. Subjects and methods We prospectively enrolled 474 women with gestational diabetes mellitus (GDM) at a university hospital (Porto Alegre, Brazil, November 2009-May 2015). GWG was categorized according to the 2009 Institute of Medicine guidelines; birth weight was classified as large (LGA) or small (SGA) for gestational age. Adjusted relative risks (aRRs) and 95% confidence intervals (95% CIs) were determined. Results Adequate GWG occurred in 121 women [25.5%, 95% CI: 22, 30%]; excessive, in 180 [38.0%, 95% CI: 34, 43%]; and insufficient, in 173 [36.5%, 95% CI: 32, 41%]. In women with normal body mass index (BMI), the prevalence of SGA was higher in those with insufficient compared to adequate GWG (30% vs. 0%, p < 0.001). In women with BMI ≥ 25 kg/m2, excessive GWG increased the prevalence of LGA [aRR 2.58, 95% CI: 1.06, 6.29] and protected from SGA [aRR 0.25, 95% CI: 0.10, 0.64]. Insufficient vs. adequate GWG did not influence the prevalence of SGA [aRR 0.61, 95% CI: 0.31, 1.22]; insufficient vs. excessive GWG protected from LGA [aRR 0.46, 95% CI: 0.23, 0.91]. Conclusions One quarter of this cohort achieved adequate GWG, indicating that specific ranges have to be tailored for GDM. To prevent inadequate birth weight, excessive GWG in women with higher BMI and less than recommended GWG in normal BMI women should be avoided; less than recommended GWG may be suitable for overweight and obese women.

Highlights

Gestational diabetes mellitus (GDM) is typically diagnosed approximately 24-28 weeks using an oral glucose tolerance test [1]
We studied a cohort of 508 women with GDM with singleton pregnancies, with at least one prenatal appointment, who delivered at Hospital de Clínicas de Porto Alegre (HCPA), a university hospital
The main differences were observed for a family history of diabetes (54.3% vs. 42.6%, p = 0.011), pregestational body mass index (BMI) (29.4 ± 6.5 vs. 30.7 ± 7.0 kg/m2, p = 0.046); the 2-hour glucose in the diagnostic oral glucose tolerance test (OGTT) (170.7 ± 29.1 vs. 148.5 ± 37.1 mg/dL, p < 0.001); the baseline A1C value (5.7% ± 0.8% vs. 5.4% ± 0.6%, p < 0.001), the latter measurement being within the range of laboratory references (6.0%); and weight at delivery (84.0 ± 17.3 vs. 89.1 ± 18.5 kg, p = 0.002)

Summary

Introduction

Gestational diabetes mellitus (GDM) is typically diagnosed approximately 24-28 weeks using an oral glucose tolerance test [1]. IADPSG: International Association of Diabetes in Pregnancy Study Groups; GDM: gestational diabetes mellitus; BMI: body mass index; BP: blood pressure; OGTT: oral glucose tolerance test; SGA: small for gestational age; AGA: adequate for gestational age; LGA: large for gestational age.

Results

Conclusion