Abstract
Aims
We aimed to explore the relationship between gestational weight gain (GWG) after Institute of Medicine (IOM) and pregnancy outcomes in women with type 1 and type 2 diabetes.
Methods
Retrospective cohort study at a tertiary medical center (1981–2011). Outcome variables: 2 maternal and 14 fetal. Main exposure variable: GWG according to IOM. We calculated crude and adjusted ORs as well as population attributable (PAF) and preventable fractions (PPF) for significant positive and negative associations, respectively.
Results
We evaluated 633 pregnant women with type 1 or type 2 diabetes. GWG was insufficient (iGWG) in 16.7% and excessive (eGWG) in 50.7%. In the adjusted analysis, GWG according to IOM was significantly associated with maternal outcomes (pregnancy-induced hypertension and cesarean delivery) and four fetal outcomes (large-for-gestational age, macrosomia, small-for-gestational age and neonatal respiratory distress). The association with large-for-gestational age newborns was negative for iGWG (0.48, CI 95% 0.25–0.94) and positive for eGWG (1.76, CI 95% 1.18–2.63). In addition, iGWG was associated with a higher risk of small-for-gestational age newborns and respiratory distress and eGWG with a higher risk of pregnancy-induced hypertension, caesarean delivery and macrosomia. PAF and PPF ranged from the 20.4% PPF of iGWG for large-for-gestational age to 56.5% PAF of eGWG for macrosomia.
Conclusion
In this cohort of women with type 1 or type 2 diabetes, inadequate GWG after IOM was associated with adverse pregnancy outcomes; associations were unfavorable for eGWG and mixed for iGWG. The attributable fractions were not moderate, pointing to the potential impact of modifying inadequate GWG.
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Data availability
Data available on request due to privacy/ethical restrictions.
References
Alexopoulos AS, Blair R, Peters AL (2019) Management of preexisting diabetes in pregnancy: a review. JAMA J Am Med Assoc 321:1811–1819. https://doi.org/10.1001/jama.2019.4981
Kitzmiller JL, Block JM, Brown FM et al (2008) Managing preexisting diabetes for pregnancy: summary of evidence and consensus recommendations for care. Diabetes Care 31:1060–1079. https://doi.org/10.2337/dc08-9020
Evers IM, De Valk HW, Visser GHA (2004) Risk of complications of pregnancy in women with type 1 diabetes: nationwide prospective study in the Netherlands. Br Med J 328:915–918. https://doi.org/10.1136/bmj.38043.583160.ee
Domanski G, Lange AE, Ittermann T et al (2018) Evaluation of neonatal and maternal morbidity in mothers with gestational diabetes: a population-based study. BMC Pregnancy Childbirth 18:367. https://doi.org/10.1186/s12884-018-2005-9
Balsells M, García-Patterson A, Gich I, Corcoy R (2009) Maternal and fetal outcome in women with type 2 versus type 1 diabetes mellitus: a systematic review and metaanalysis. J Clin Endocrinol Metab 94:4284–4291. https://doi.org/10.1210/jc.2009-1231
Maayan-Metzger A, Lubin D, Kuint J (2009) Hypoglycemia rates in the first days of life among term infants born to diabetic mothers. Neonatology 96:80–85. https://doi.org/10.1159/000203337
Bellamy L, Casas J-P, Hingorani AD, Williams D (2009) Type 2 diabetes mellitus after gestational diabetes: a systematic review and meta-analysis. Lancet 373:1773–1779. https://doi.org/10.1016/S0140-6736(09)60731-5
Black MH, Sacks DA, Xiang AH, Lawrence JM (2013) The relative contribution of prepregnancy overweight and obesity, gestational weight gain, and IADPSG-defined gestational diabetes mellitus to fetal overgrowth. Diabetes Care 36:56–62. https://doi.org/10.2337/dc12-0741
Catalano PM, McIntyre HD, Cruickshank JK et al (2012) The hyperglycemia and adverse pregnancy outcome study: associations of GDM and obesity with pregnancy outcomes. Diabetes Care 35:780–786. https://doi.org/10.2337/dc11-1790
Alberico S, Montico M, Barresi V et al (2014) The role of gestational diabetes, pre-pregnancy body mass index and gestational weight gain on the risk of newborn macrosomia : results from a prospective multicentre study. BMC pregnancy and childbirth 14(23):1–8
Farah N, Maher N, Barry S et al (2009) Maternal morbid obesity and obstetric outcomes. Obes Facts 2:352–354. https://doi.org/10.1159/000261951
Abenhaim HA, Kinch RA, Morin L et al (2007) Effect of prepregnancy body mass index categories on obstetrical and neonatal outcomes. Arch Gynecol Obstet 275:39–43. https://doi.org/10.1007/s00404-006-0219-y
Callaghan WM, Chu SY, Kim YS et al (2007) Maternal obesity and risk of gestational diabetes mellitus. Diabetes Care 30:2070–2076. https://doi.org/10.2337/dc06-2559a.The
Rasmussen KM, Yaktine AL (2009) Institute of Medicine (US) and National Research Council (US) Committee to reexamine IOM pregnancy weight guidelines. Weight gain during pregnancy: reexamining the guidelines. Washington (DC)
Secher AL, Parellada CB, Ringholm L et al (2014) Higher gestational weight gain is associated with increasing offspring birth weight independent of maternal glycemic control in women with type 1 diabetes. Diabetes Care 37:2677–2684. https://doi.org/10.2337/dc14-0896
Kawakita T, Bowers K, McWhorter K et al (2016) Characterizing gestational weight gain according to Institute of Medicine guidelines in women with type 1 diabetes mellitus: association with maternal and perinatal outcome. Am J Perinatol 33:1266–1272. https://doi.org/10.1055/s-0036-1585420
Parellada CB, Ásbjörnsdóttir B, Ringholm L et al (2014) Fetal growth in relation to gestational weight gain in women with type 2 diabetes: an observational study. Diabet Med 31:1681–1689. https://doi.org/10.1111/dme.12558
Yee LM, Cheng YW, Inturrisi M, Caughey AB (2011) Effect of gestational weight gain on perinatal outcomes in women with type 2 diabetes mellitus using the 2009 Institute of Medicine guidelines. Am J Obstet Gynecol 205:257.e1-257.e6. https://doi.org/10.1016/j.ajog.2011.06.028
National Institute for Health and Care Excellence, NICE (2014) Intrapartum care: care of healthy women and their babies during childbirth guidance and guidelines. Available at www.nice.org.uk/guidance/cg190
American College of Obstetricians and Gynecologists, ACOG (2015) Committee opinion no. 644: the Apgar score. Obstet Gynecol 126:e52-5. https://doi.org/10.1097/AOG.0000000000001108
Yeh P, Emary K, Impey L (2012) The relationship between umbilical cord arterial pH and serious adverse neonatal outcome: analysis of 51 519 consecutive validated samples. BJOG 119:824–831. https://doi.org/10.1111/j.1471-0528.2012.03335.x
Santamaria Lozano R, Verdú Martín L, Martín Caballero C, García López G (1998) Tablas españolas de pesos neonatales según edad gestacional. Barcelona Lab Menarini
Cornblath M, Schwartz R (1993) Hypoglycemia in the neonate. J Pediatr Endocrinol 6:113–129
Maisels MJ (1972) Bilirubin; on understanding and influencing its metabolism in the newborn infant. Pediatr Clin N Am 19:447–501
Edwards MO, Kotecha SJ, Kotecha S (2013) Respiratory distress of the term newborn infant. Paediatr Respir Rev 14:29–37. https://doi.org/10.1016/j.prrv.2012.02.002
Loughead JL, Mimouni F, Tsang RC (1988) Serum ionized calcium concentrations in normal neonates. Am J Dis Child 142:516–518. https://doi.org/10.1001/archpedi.1988.02150050054030
Kates EH, Kates JS (2007) Anemia and polycythemia in the newborn. Pediatr Rev 28:33–34. https://doi.org/10.1542/pir.28-1-33
Shiozaki A, Matsuda Y, Satoh S, Saito S (2011) Impact of fetal sex in pregnancy-induced hypertension and preeclampsia in Japan. J Reprod Immunol 89:133–139. https://doi.org/10.1016/j.jri.2010.12.011
Miettinen OS (1974) Proportion of disease caused or prevented by a given exposure, trait or intervention. Am J Epidemiol 99:325–332. https://doi.org/10.1093/oxfordjournals.aje.a121617
Murata T, Kyozuka H, Yamaguchi A et al (2020) Gestational weight gain and foetal acidosis in vaginal and caesarean deliveries: the Japan environment and children’s study. Sci Rep 10:1–11. https://doi.org/10.1038/s41598-020-77429-9
Xie X, Liu J, Pujol I et al (2020) Inadequate weight gain according to the Institute of Medicine 2009 guidelines in women with gestational diabetes: frequency, clinical predictors, and the association with pregnancy outcomes. J Clin Med 9:E3343. https://doi.org/10.3390/jcm9103343
Yao R, Park BY, Foster SE, Caughey AB (2017) The association between gestational weight gain and risk of stillbirth: a population-based cohort study. Ann Epidemiol 27:638-644.e1. https://doi.org/10.1016/j.annepidem.2017.09.006
Vivian Ukah U, Bayrampour H, Sabr Y et al (2019) Association between gestational weight gain and severe adverse birth outcomes in Washington State, US: a population-based retrospective cohort study, 2004–2013. PLoS Med 16:2004–2013. https://doi.org/10.1371/journal.pmed.1003009
Goldstein RF, Abell SK, Ranasinha S et al (2017) Association of gestational weight gain with maternal and infant outcomes: a systematic review and meta-analysis. JAMA J Am Med Assoc 317:2207–2225. https://doi.org/10.1001/jama.2017.3635
Viecceli C, Remonti LR, Hirakata VN et al (2017) Weight gain adequacy and pregnancy outcomes in gestational diabetes: a meta-analysis. Obes Rev 18:567–580. https://doi.org/10.1111/obr.12521
Fortner RT, Pekow P, Solomon CG et al (2009) Prepregnancy body mass index, gestational weight gain, and risk of hypertensive pregnancy among Latina women. Am J Obstet Gynecol 200:167.e1-167.e7. https://doi.org/10.1016/j.ajog.2008.08.021
Scifres CM, Feghali MN, Althouse AD et al (2014) Effect of excess gestational weight gain on pregnancy outcomes in women with type 1 diabetes. Obstet Gynecol 123:1295–1302. https://doi.org/10.1097/AOG.0000000000000271
Egan AM, Dennedy MC, Al-Ramli W et al (2014) ATLANTIC-DIP: excessive gestational weight gain and pregnancy outcomes in women with gestational or pregestational diabetes mellitus. J Clin Endocrinol Metab 99:212–219. https://doi.org/10.1210/jc.2013-2684
Bashir M, Naem E, Taha F et al (2019) Outcomes of type 1 diabetes mellitus in pregnancy; effect of excessive gestational weight gain and hyperglycaemia on fetal growth. Diabetes Metab Syndr Clin Res Rev 13:84–88. https://doi.org/10.1016/j.dsx.2018.08.030
Pécheux O, Garabedian C, Drumez E et al (2019) Maternal and neonatal outcomes according to gestational weight gain in twin pregnancies: are the Institute of Medicine guidelines associated with better outcomes? Eur J Obstet Gynecol Reprod Biol 234:190–194. https://doi.org/10.1016/j.ejogrb.2019.01.010
Wang L, Zhang X, Chen T et al (2021) Association of gestational weight gain with infant morbidity and mortality in the United States. JAMA Netw Open 4:e2141498. https://doi.org/10.1001/jamanetworkopen.2021.41498
Rm BM, Berger H, Melamed N et al (2019) Weight gain during pregnancy: does the antenatal care provider make a difference? A retrospective cohort study. Can Med Assoc Open Access J 7:283–293. https://doi.org/10.9778/cmajo.20180116
Kim SY, Sharma AJ, Sappenfield W et al (2014) Association of maternal body mass index, excessive weight gain, and gestational diabetes mellitus with large-for-gestational-age births. Obstet Gynecol 123:737–744. https://doi.org/10.1097/AOG.0000000000000177
Barquiel B, Herranz L, Hillman N et al (2016) HbA1c and gestational weight gain are factors that influence neonatal outcome in mothers with gestational diabetes. J Women’s Health 25:579–585. https://doi.org/10.1089/jwh.2015.5432
Barquiel B, Herranz L, Grande C et al (2014) Body weight, weight gain and hyperglycaemia are associated with hypertensive disorders of pregnancy in women with gestational diabetes. Diabetes Metab 40:204–210. https://doi.org/10.1016/j.diabet.2013.12.011
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XX, JL and RC contributed to formal analysis; XX, JL, AG, AC, MMS, JA, JMA and RC contributed to investigation; XX, JL, AG, AC, MMS, JA, JMA and RC contributed to data curation; writing—original draft preparation by XX, JL and RC; XX, JL, AG, AC, MMS, JA, JMA and RC contributed to writing—review and editing; RC contributed to supervision. All authors have read and agreed to the published version of the manuscript.
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Xie, X., Liu, J., García-Patterson, A. et al. Gestational weight gain and pregnancy outcomes in women with type 1 and type 2 diabetes mellitus. Acta Diabetol 60, 621–629 (2023). https://doi.org/10.1007/s00592-023-02031-0
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DOI: https://doi.org/10.1007/s00592-023-02031-0