Dose-Response Relationship between Gestational Weight Gain and Neonatal Birthweight in Chinese Women with Excess Weight/Obesity and Gestational Diabetes Mellitus

Abstract

Total gestational weight gain (GWG) is identified as a strong and potentially controllable predictor of long-term health outcomes in women with gestational diabetes mellitus (GDM) and infants. When the total GWG of women with excess weight/obesity and GDM does not exceed the Institute of Medicine (IOM) suggested range, neonatal birthweight outcomes may be favorable, but the evidence is limited. Therefore, the objective of this study was to evaluate the dose-response relationship between increased total GWG and the risk of neonatal birthweight in Chinese women with excess weight/obesity and GDM. This study obtained electronic medical records (EMR) from the hospital information system (HIS) of the Chongqing Health Center for Women and Children between July 2017, and June 2020. A retrospective study analyzed the effect of the total GWG of women with excess weight/obesity and GDM on neonatal birthweight. The dose-response relationship between total GWG and neonatal birthweight was studied using a generalized linear model and embedded restricted cubic splines (RCS). The average age of all women with GDM was 31.99 ± 4.47 years, and 27.61% were advanced maternal age (≥35 years). The total GWG among women with excess weight and obesity and GDM greater than the IOM recommendations were found in 42.96% and 58.62% of cases, respectively. Total GWG in women with excess weight and excessing the IOM recommended range is a risk factor for large gestational age (LGA) [adjusted odds ratio (aOR) 0.1.47, 1.08–2.01] and macrosomia (aOR 1.55, 1.04–2.31). In the obesity above group, excessive weight gain increased the risk of LGA (aOR 2.92, 1.33–6.41) and macrosomia (aOR 2.83, 1.03–7.72). We used an RCS to examine pregnant women with excess weight and GDM and discovered a linear dose-response relationship between total GWG and LGA/macrosomia. In women with excess weight and obesity, increases in total GWG above the lowest end of the IOM recommendations range (7 kg and 5 kg) were associated with an increased risk of LGA and macrosomia. Therefore, research is urgently needed to support maternal and newborn health to provide recommendations for the ideal weight increase in women with excess weight/obesity and GDM.

Model of Factors Influencing Glycemic Control Behavior among Pregnant Women with Gestational Diabetes Mellitus A1

“…Additionally, recent evidence has underlined that GDM plays a significant role in increasing the risk of poor health outcomes in fetuses, with a five-fold higher risk of stillbirth and a two-fold higher risk of congenital disabilities compared to normal pregnancy. [10][11][12][13][14][15] Notably, babies born with maternal GDM potentially develop childhood obesity and adolescent type II diabetes mellitus in the future. 1,3,13 Unquestionably, pregnant women with GDM should be effectively managed to avoid adverse complications.…”

“…[12][13][14] Moreover, exercise or physical activity can induce insulin production and improve cellular glucose uptake, helping prevent excessive plasma glucose levels. [15][16][17][18][19] The World Health Organization 16 recommends 150 minutes of moderate-intensity physical activity throughout the week for pregnant women. 16 Most previous studies on modifying dietary and exercise behaviors have usually been based on the Theory of Planned Behavior (TPB), which states that various factors are associated with an individual's decision to perform health behavior.…”

Effects of women with gestational diabetes mellitus related weight gain on pregnancy outcomes and its experiences in weight management programs: a mixed-methods systematic review

“…There is a strong link between gestational weight gain in women with GDM and several clinically important outcomes, including higher insulin requirements, cesarean delivery rates, and significantly higher rates of large for gestational age (LGA) (8,9). According to a systematic review, 37% (95% CI 33-41%) of women with GDM gained excess weight (10).…”