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

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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.


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).


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.


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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Adequate gestational weight gain


Body mass index


Excessive gestational weight gain


Fasting plasma glucose


Gestational diabetes mellitus


Gestational weight gain


International Association for Diabetes in Pregnancy Study Group


Institute of Medicine


International units


Insufficient gestational weight gain


Large for gestational age


Neonatal intensive care unit


Oral glucose tolerance test


Prepregnancy diabetes mellitus


Respiratory distress syndrome


Small for gestational age


Total daily dose


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Authors and Affiliations



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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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).

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