Normal Gestational Weight Gain Protects From Large-for-Gestational-Age Birth Among Women With Obesity and Gestational Diabetes.

Sanna Mustaniemi,Eero Kajantie,Johan G Eriksson,Hannele Laivuori,Marja Vääräsmäki,Mika Gissler,Anneli Pouta,Hilkka Nikkinen,Aini Bloigu,Risto Kaaja

doi:10.3389/fpubh.2021.550860

Abstract

Background: Pre-pregnancy obesity, excess gestational weight gain (GWG), and gestational diabetes (GDM) increase fetal growth. Our aim was to assess whether normal GWG is associated with lower risk for a large-for-gestational-age (LGA; over the 90th percentile of birth weight for sex and gestational age) infant and lower birth weight standard deviation (SD) score in the presence of GDM and maternal obesity.Methods: This multicenter case-control study is part of the Finnish Gestational Diabetes (FinnGeDi) Study and includes singleton pregnancies of 1,055 women with GDM and 1,032 non-diabetic controls. Women were divided into 12 subgroups according to their GDM status, pre-pregnancy body mass index (BMI; kg/m2), and GWG. Non-diabetic women with normal BMI and normal GWG (according to Institute of Medicine recommendations) served as a reference group.Results: The prevalence of LGA birth was 12.2% among women with GDM and 6.2% among non-diabetic women (p < 0.001). Among all women, normal GWG was associated with lower odds of LGA [odds ratio (OR) 0.57, 95% CI: 0.41–0.78]. Among women with both obesity and GDM, the odds for giving birth to a LGA infant was 2.25-fold (95% CI: 1.04–4.85) among those with normal GWG and 7.63-fold (95% CI: 4.25–13.7) among those with excess GWG compared with the reference group. Compared with excess GWG, normal GWG was associated with 0.71 SD (95% CI: 0.47–0.97) lower birth weight SD score among women with GDM and obesity. Newborns of normal weight women with GDM and normal GWG had 0.28 SD (95% CI: 0.05–0.51) lower birth weight SD scores compared with their counterparts with excess GWG. In addition, in the group of normal weight non-diabetic women, normal GWG was associated with 0.46 SD (95% CI: 0.30–0.61) lower birth weight SD scores compared with excess GWG.Conclusion: GDM, obesity, and excess GWG are associated with higher risk for LGA infants. Interventions aiming at normal GWG have the potential to lower LGA rate and birth weight SD scores even when GDM and obesity are present.

Highlights

Gestational diabetes (GDM) affects 10–25% of all pregnancies depending on diagnostic criteria, screening strategies, and study populations [1, 2]
gestational weight gain (GWG) was normal in 50.6% of the women in the gestational diabetes (GDM) group and in 54.4% of the women in the non-diabetic group (Table 1)
In women with overweight or obesity, GWG below the Institute of Medicine (IOM) guidelines was more common in the GDM group, 16.0 vs. 7.2%, respectively (p < 0.001)

Summary

Introduction

Gestational diabetes (GDM) affects 10–25% of all pregnancies depending on diagnostic criteria, screening strategies, and study populations [1, 2]. GDM, pre-pregnancy obesity, and excess GWG are all independent risk factors for having a large-for-gestational-age (LGA) infant [4,5,6,7]. Previous studies assessing the association of GWG with LGA in relation to GDM and pre-pregnancy obesity are inconsistent. Other studies including only women with GDM reported an increased risk for LGA in women with excess GWG [6, 9,10,11]. Pre-pregnancy obesity, excess gestational weight gain (GWG), and gestational diabetes (GDM) increase fetal growth. Our aim was to assess whether normal GWG is associated with lower risk for a large-for-gestational-age (LGA; over the 90th percentile of birth weight for sex and gestational age) infant and lower birth weight standard deviation (SD) score in the presence of GDM and maternal obesity

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Conclusion