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Maternofetal outcomes in early-onset gestational diabetes: does weight gain matter?

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Abstract

Aim

Women with early-onset gestational diabetes mellitus (GDM) have overall lower gestational weight gain (GWG) compared to those with later-onset GDM, albeit with usually worse maternofetal outcomes. We intent to investigate the association between inadequate GWG and maternofetal outcomes in pregnant women with early-onset GDM.

Methods

We performed a retrospective study of women with early-onset GDM based on the National Registry of GDM. Three study groups were defined according to the recommendations of the Institute of Medicine for GWG: excessive GWG (eGWG), adequate (aGWG) or insufficient (iGWG).

Results

A total of 8040 pregnant women were included: 27% (n = 2170) eGWG, 31% (n = 2492) aGWG and 42% (n = 3378) iGWG. Preeclampsia (4.3 vs 3 vs 1.6%, p < 0.001), polyhydramnios (3.1 vs 2.3 vs 1.8%, p = 0.008) and cesarean section (37.4 vs 34.1 vs 29.5%, p < 0.001) were significantly more frequent among women with eGWG. Additionally, there was a higher frequency of macrosomia (8.1 vs 3.6 vs 2.4%, p < 0.001), large-for-gestational-age (8.2 vs 3.7 vs 2.6%, p < 0.001) and birth trauma (2.6 vs 1.5 vs 1.1%, p < 0.001) in this group. On the other hand, fetal death (0.2 vs 0.2 vs 0.5%, p = 0.04), small-for-gestational-age (9 vs 10.3 vs 14.9, p < 0.001) and preterm delivery (5.6 vs 7.1 vs 7.5%, p = 0.03) were more frequent in iGWG group.

Conclusions

Over two-thirds of pregnant women with early-onset GDM had inappropriate GWG, which was significantly associated with adverse maternofetal outcomes. Weight management must be a focus of special attention in women with early-onset GDM, beyond glycemic control, to achieve healthy pregnancy outcomes.

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Abbreviations

aGWG:

Adequate gestational weight gain

BMI:

Body mass index

eGWG:

Excessive gestational weight gain

FPG:

Fasting plasma glucose

GDM:

Gestational diabetes mellitus

GWG:

Gestational weight gain

IADPSG:

International Association for Diabetes in Pregnancy Study Group

IOM:

Institute of Medicine

IU:

International units

iGWG:

Insufficient gestational weight gain

LGA:

Large for gestational age

NICU:

Neonatal intensive care unit

OGTT:

Oral glucose tolerance test

PPDM:

Prepregnancy diabetes mellitus

RDS:

Respiratory distress syndrome

SGA:

Small for gestational age

TDD:

Total daily dose

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Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

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Authors

Contributions

SSM, TSS and JD designed the study. SSM, TSS, LF and MS acquired the data. SSM, TSS and JD interpreted the data. SSM and TSS drafted the work and all authors revised it critically for important intellectual content. All authors approved the final version submitted and are accountable for all aspects of the work. All authors read and approved the final manuscript.

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Correspondence to S. S. Monteiro.

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The authors declare that they have no conflict of interest.

Ethical approval

Even though we do not have a formal approval from a Bioethics Committee, this work refers to a retrospective observational study using data from an anonymized and well-established national gestational diabetes mellitus database. All data were anonymously collected and analyzed.

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Monteiro, S.S., Santos, T.S., Fonseca, L. et al. Maternofetal outcomes in early-onset gestational diabetes: does weight gain matter?. J Endocrinol Invest 45, 2257–2264 (2022). https://doi.org/10.1007/s40618-022-01855-x

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