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Gestational weight gain and pregnancy outcomes in women with type 1 and type 2 diabetes mellitus

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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.


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.


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.


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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This research received no specific grant from any funding agency in the public, commercial or not-for-profit sectors. The authors do not report any potential conflict of interest.

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Authors and Affiliations



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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Correspondence to Rosa Corcoy.

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The authors report no conflicts of interest.

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The study protocol was approved by the Ethics Committee of the Institut d’Investigació Biomèdica Sant Pau (IIB Sant Pau) (reference number IIBSP-IPE-2020-44).

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The Ethics Committee waived the requirement for informed consent.

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This article belongs to the topical collection Pregnancy and Diabetes, managed by Antonio Secchi and Marina Scavini

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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).

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