Objective To compare perinatal outcomes among women diagnosed with gestational diabetes by National Diabetes Data Group (NDDG) with women only meeting Carpenter-Coustan criteria. Study design Fourteen-year retrospective cohort; women screened positive with 1-hour glucose load ≥140 mg/dL underwent a diagnostic 3-hour oral glucose tolerance test. We report adjusted prevalence ratios (aPR) of multivariate analyses. Results Of the 4659 screen-positive women with diagnostic testing, 1082 (3.3%, 1082/33,179) met NDDG criteria; 1542 (4.6%, 1542/33,179), or 460 more, met Carpenter-Coustan. These untreated 460 women had greater risk of pre-eclampsia than women diagnosed by NDDG criteria (aPR 1.70, 95% CI 1.23-2.35). They had greater risk of cesarean delivery (aPR 1.16, 95% CI 1.04-1.30) and infants >4000g (aPR 1.25, 95% CI 1.01-1.56) than women not meeting either diagnostic criteria. Conclusion The 42.5% additional women diagnosed only by Carpenter-Coustan criteria are at greater risk for some adverse outcomes. Cost-effectiveness of a change remains to be determined.

Background Weight gain in pregnancy is an essential physiological adaptation, supporting growth and development of a fetus, and is distributed among lean mass including total body water, and fat mass gains. Although gestational weight gain provides a source of energy for the mother and fetus, excess gestational weight gain may underlie reported associations between parity and future metabolic disorders, and is linked to postpartum weight retention and insulin resistance. Although weight gain is often proposed as a modifiable variable to mitigate adverse maternal and offspring health outcomes, our knowledge of specific maternal body composition changes with weight gain, and the potential metabolic consequences, is limited. Furthermore, although gestational weight gain alters maternal body composition, the impact of excess weight gain on fat and lean mass is not well studied. Understanding the accrual of fat and lean body mass may improve our understanding of the role of excessive gestational weight gain and metabolic dysfunction. Objective To quantify the relationship between gestational weight gain and maternal fat and lean body mass accrual, and to compare fat and lean body mass accrual according to 2009 Institute of Medicine Guidelines for Gestational Weight Gain in Pregnancy adherence. We hypothesized that exceeding current weight gain guidelines would be associated with greater fat, compared with lean body, mass accrual. Study Design This is a secondary analysis of a randomized controlled trial of 49 overweight/obese women; all 49 are included in this secondary analysis. Maternal weight and body composition using air densitometry (BOD POD) were collected in early (13 0/6-16 6/7 weeks) and late (34 0/7-36 6/7 weeks) pregnancy. Correlations were made between gestational weight gain and change in fat and lean body mass. We compared change in fat and lean body mass by adherence to 2009 Institute of Medicine Guidelines for Gestational Weight Gain in Pregnancy. Nonparametric tests and Chi-Square analyses were performed, reporting median [interquartile range, IQR] and n (%), respectively, with p<0.05 significant. Results Early pregnancy body mass index was 30.3 [28.5-35.2] kg/m2; women gained 9.0 [5.3-13.2] kg. Overweight and obese women were equally likely to gain excess weight (48% vs. 35%, p=0.6). Weight gain correlated strongly with fat mass change (r=0.87, p<0.001); women with excess vs. adequate vs. inadequate weight gain had greater fat mass change, overall (5.2 [4.2-8.1] vs. 0.2 [−0.4-2.2] vs. −2.7 [−5.2-−0.7] kg, p<0.001) and in all pairwise comparisons. Weight gain also correlated with lean body mass change (r=0.52, p=0.001), but women with excess vs. adequate weight gain had similar lean body mass change (8.4 [7.2-10.1] vs. 7.8 [6.0-8.7] kg, p=0.1). Conclusion Excess gestational weight gain is associated primarily with maternal fat, but not lean body mass accrual. Our results may help explain why excess gestational weight gain, or fat mass accrual, is associated with long-term obesity, metabolic...

Background There are significant variations in gestational weight gain with many women gaining in excess of Institute of Medicine guidelines. Unfortunately, efforts to improve appropriate gestational weight gain have had only limited success. To date, interventions have focused primarily on decreasing energy intake and/or increasing physical activity. Maternal resting energy expenditure, which comprises ~60% of total energy expenditure compared with the ~20% that comes from physical activity, may be an important consideration in understanding variations in gestational weight gain. Objective Our objective was to quantify the changes in resting energy expenditure during pregnancy and their relationship to gestational weight gain and body composition changes among healthy women. We hypothesized that greater gestational weight gain, and fat mass accrual in particular, are inversely related to variations in resting energy expenditure. Study design We conducted a secondary analysis of a prospective cohort studied preconception and late (34–36 weeks) pregnancy. Body composition (estimated using air densitometry, BodPod) and resting energy expenditure (estimated using indirect calorimetry) were measured. The relationship between changes in resting energy expenditure and gestational weight gain, and change in fat mass and fat free mass were quantified. Resting energy expenditure was expressed as kilocalories per kilogram of fat free mass per day (kcal.kg FFM−.day−1) and kilocalories per day (kcal/day). Correlations are reported as r. Results Among 51 women, preconception body mass index was 23.0 (4.7) kg/m2; gestational weight gain was 12.8 (4.7) kg. Preconception and late pregnancy resting energy expenditure (kcal/day) correlated positively with the change in fat free mass (r=0.37, p=0.008; r=0.51, p=0.001). Late pregnancy resting energy expenditure (kcal.kg FFM−.day−1) was inversely associated with the change in fat mass (r=−0.34, p=0.02) and gestational weight gain (r=−0.29, p=0.04). From pre-pregnancy through late gestation, the increase in resting energy expenditure (kcal/day) correlated positively with the change in fat free mass (r=0.44, p=0.002), and negatively with the change in fat mass (r=−0.27, p=0.06). Conclusions The change in resting energy expenditure from preconception through late gestation correlated positively with changes in fat free mass but negatively with fat mass accrual. Women with smaller increases in resting energy expenditure across pregnancy had greater gestational weight gain, specifically more adipose tissue. These data suggest that resting energy expenditure is an important factor in gestational weight gain, particularly excess fat mass accrual. Future lifestyle intervention studies need to consider clinically feasible means of estimating resting energy expenditure and, in response, tailor nutrient intake and composition recommendations. Implementing and testing such interventions would be a novel approach to improve compliance with gestational weight gain guidelines.