Does weight management after gestational diabetes mellitus diagnosis improve pregnancy outcomes? A multi‐ethnic cohort study

Abstract

Aims:To assess the impact of achieving an Institute of Medicine based personalised weight target in addition to conventional glycaemic management after gestational diabetes mellitus diagnosis on maternal and neonatal outcomes. Methods:A retrospective audit of clinical data (2016)(2017)(2018)(2019) for singleton gestational diabetes pregnancies was conducted in a multi-ethnic cohort. Logistic regression analyses assessed relationships between achieving, exceeding and gaining less than a personalised weight target provided after gestational diabetes diagnosis and rates of large for gestational age, small for gestational age infants, insulin therapy initiation and neonatal outcomes. Adjusted odds ratios (aOR) were adjusted for glucose 2-h post-glucose load value, family history of type 2 diabetes, previous gestational diabetes, macrosomia in a previous pregnancy, and East and South-East Asian ethnicity.Results: Of 1034 women, 44% (n = 449) achieved their personalised weight target. Women who exceeded their personalised weight target had significantly and higher mean insulin doses (28.8 ± 21.5 units vs. 22.7 ± 18.7, p = 0.006) and higher rates of large for gestational age infants (19% vs. 9.8%, p < 0.001), with aOR of 1.99 [95% CI 1.25-3.15] p = 0.004, but no difference in rates of small for gestational age infants (5.3% vs. 8.0%) (aOR 0.77 [0.41-1.44] p = 0.41). Lower rates of large for gestational age infants occurred in those who gained below their personalised weight target ] p = 0.034), but rates of small for gestational age infants concurrently increased (aOR 1.9 [1.19-3.12] p = 0.008).How to cite this article: Barnes RA, Flack JR, Wong T, et al. Does weight management after gestational diabetes mellitus diagnosis improve pregnancy outcomes? A multi-ethnic cohort study.

Modeling the Predictive Value of Evidence-Based Referral Criteria to Support Healthy Gestational Weight Gain among an Australian Pregnancy Cohort

“…Arguably, these numbers would require significant professional and organizational planning and prioritization of resources to meet referral demand. Importantly, with investment in APD services within maternity care using the +/−2 kg time point alone, it would provide the opportunity to not only optimize GWG but also improve glycemic profiles of women diagnosed with GDM [10].…”

“…Recent data from the Australian Institute of Health and Welfare (AIHW), Mothers and Babies 2021 report indicates that obtaining maternal weight to inform dietetic referral at two consecutive second trimester time points is feasible, with 76.6% of Australian women first accessing antenatal care before 14 weeks' gestation and over 90% of women first accessing antenatal care between 14-19 weeks' gestation [24]. Referral after 24 weeks' gestation rather than after 30 weeks' gestation also may afford more time for behavioral change to occur and may also assist with detection and/or management of women at concurrent risk of associated adverse pregnancy outcomes such as GDM [10].…”

“…A recent retrospective cohort study conducted by Barnes et al investigated patterns of GWG pre-and post-diagnosis of GDM and other outcome variables including interprofessional GDM management, insulin therapy, and large for gestational age infants (LGA), among a multiethnic cohort of Australian pregnant women (n = 1034) [10]. In this study, personalized weekly GWG targets were calculated for women according to the IOM guidelines using their self-reported pre-pregnancy BMI.…”

“…The findings indicated that patterns of early GWG, above a women's personalized GWG target prior to GDM diagnosis (mean gestation of diagnosis = 23 weeks), were more likely to occur among women with a mean pre-pregnancy BMI in the overweight category (mean BMI = 27.8 kg/m 2 ). Overweight women were also more likely to exhibit high total GWG (mean = 18.3 kg, last measured within 4 weeks from birth), compared to those that gained within or below their total personalized GWG targets [10]. Women who were observed to gain in excess of their weight gain targets (prior to giving birth) and who received interprofessional GDM management post-GDM diagnosis, were found to have a higher incidence of having a large for gestational age infant when compared to women who received interprofessional GDM management but gained below or within their personalized weight gain targets (adjusted odds ratio 1.99, 95% CI 1.25-3.15, p = 0.004) [10].…”

“…The results of one study among a cohort of Indigenous Australians by Schumacher et al found that 32% of pregnant women exhibited low GWG with 54% gaining weight above the IOM guidelines [9]. Of concern, a recent retrospective audit of a large (n = 1034) multiethnic Australian cohort of pregnant women with a diagnosis of gestational diabetes mellitus (GDM), conducted by Barnes et al, identified that 61% of the women in this cohort evidenced high rates of early EGWG (mean gestational age 23.0 weeks SD 5.5) with only 44% achieving their GWG targets within the IOM recommendations by the time they gave birth [10].…”