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OBJECTIVE -To investigate the effect of gestational weight gain in obese glucose-tolerant women.RESEARCH DESIGN AND METHODS -We performed a historical cohort study of 481 women with prepregnancy BMI Ն30 kg/m 2 and a normal 2-h 75-g oral glucose tolerance test (OGTT) during the third trimester (according to World Health Organization criteria). Data on OGTT results and clinical outcomes were collected from medical records. Four groups were defined according to weight gain: group 1, Ͻ5.0 kg (n ϭ 93); group 2, 5.0 -9.9 kg (n ϭ 134); group 3, 10.0 -14.9 kg (n ϭ 132); and group 4, Ն15.0 kg (n ϭ 122).RESULTS -Birth weight increased significantly with increasing weight gain (mean grams Ϯ SD): group 1, 3,456 Ϯ 620; group 2, 3,624 Ϯ 675; group 3, 3,757 Ϯ 582; and group 4, 3,784 Ϯ 597 (P Ͻ 0.001). The birth weight in group 1 was similar to that of the background population of primarily normal-weight women (3,478 g). In multivariate analyses, increasing weight gain was associated with significantly higher rates of hypertension (OR 4.8 [95% CI for group 4 vs. group 1: 1.7-13.1]), cesarean section (3.5 [1.6 -7.8]), induction of labor (3.7 [1.7-8.0]), and large-for-gestational-age infants (4.7 [2.0 -11.0]). There was no difference in rates of small-forgestational-age infants. Significant predictors for birth weight (determined by multiple linear regression) were gestational weight gain, 2-h OGTT result, pregestational BMI, maternal age, gestational age, and smoking.CONCLUSIONS -Increasing weight gain in obese women is associated with increasing pregnancy complications. Our data suggest that minimal gestational weight gain might normalize birth weight. Prospective studies should be performed to clarify the safety of recommending limited gestational weight gain. Diabetes Care 28:2118 -2122, 2005O verweight and obesity are related to a number of severe health problems, and their prevalence is increasing globally (1). Several studies have shown that maternal factors such as prepregnancy BMI, weight gain during pregnancy, and various degrees of glucose intolerance are associated with adverse pregnancy outcomes (2-12).Management of obesity during pregnancy includes recommendations of appropriate weight gain. In 1990, the American Institute of Medicine recommended weight gain of 6.8 -11.5 kg (15-25 lb) for women with high BMI (26.0 -29.0 kg/m 2 ) and a minimum weight gain of 6.8 kg (15 lb) in obese women (BMI Ն29 kg/m 2 ) (13). Subsequently, a maximum limit of 11.5 kg (25 lb) has been suggested for obese (BMI Ն29 kg/m 2 ) (3) and morbidly obese (BMI Ն35 kg/m 2 ) (6) women. Reduced gestational weight gain has been reported to increase the risk of infants that are small for gestational age (SGA) and preterm delivery (14,15), whereas excessive weight gain seems to increase the risk for other complications, predominantly macrosomia (3,6,12). The pattern of gestational weight gain depends on maternal pregestational BMI, and obese women tend to gain less weight than normal-and underweight women (3,9,16). Conclusions therefore might be rest...

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Pregnancies complicated by GDM are associated with a higher frequency of adverse maternal and fetal outcomes. The outcomes seem to be unaffected by treatment modality. However, because of the potential risk of hypoglycaemia in some neonates, tolbutamide treatment cannot be recommended in pregnancy.

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