Effect of second trimester and third trimester weight gain on immediate outcomes in neonates born to mothers with gestational diabetes: a retrospective observational study from India

Kashyap, Harish; Sharma, Deepak; Gala, Anisha; Oleti, Tejo Pratap; Murki, Srinivas

doi:10.1080/14767058.2018.1482270

Cited by 5 publications

(5 citation statements)

References 6 publications

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“…Drehmer et al also found that insufficient GWG in second trimester associated with SGA. In another retrospective observational study in India, Kashyap et al found that pregnant women who had poor rate of GWG in second trimester were at an increased risk of SGA [37]. However, in our study, there were no statistically significant differences in the odds ratios of SGA in the below or above IOM guidelines group.…”

Section: Discussioncontrasting

confidence: 83%

Association between gestational weight gain in women with gestational diabetes mellitus and adverse pregnancy outcomes: a retrospective cohort study

Shi

Liu

Yin

2021

BMC Pregnancy Childbirth

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Background To examine association between gestational weight gain (GWG) in women with gestational diabetes mellitus (GDM) and adverse pregnancy outcomes (APOs). Methods This retrospective cohort study enrolled women with GDM who delivered at 2010–2020 in Changzhou, Jiangsu. Total GWG, rates of GWG in second trimester and third trimesters were stratified into three categories according to IOM guidelines: within, below, and above IOM guidelines. Univariable and multivariable logistic regression analyses were used. Results Overall, 1606 women with GDM fulfilled inclusion criteria. Compared with within IOM guidelines and after adjusting for confounders, total GWG above IOM guidelines in pregnancy was associated with an increased odds of caesarean delivery [adjusted odds ratio (aOR) = 1.34, 95% confidence interval (CI): 1.04–1.72], hypertensive disorders of pregnancy (HDP) (aOR = 2.00, 1.28–3.12), preeclampsia (aOR = 2.06, 1.01–3.12), macrosomia (aOR = 1.55, 1.13–2.13) and large for gestational age (LGA) (aOR = 2.82, 1.94–3.23), and a decreased odds of premature rupture of membrane (PROM) (aOR = 0.46, 0.36–0.60) and preterm birth (aOR = 0.35, 0.26–0.44); total GWG below IOM guidelines in pregnancy was associated with an increased risk of preterm birth (aOR = 1.96, 1.44–2.66), small for gestational age (SGA) (aOR = 1.32, 1.11–1.50) and a decreased odds of macrosomia (aOR = 0.35, 0.23–0.53) and LGA (aOR = 0.54, 0.42–0.72). Further, in both second and third trimesters of pregnancy, rates of GWG above IOM guidelines was found to be associated with a high odds of HDP (aOR = 2.55, 1.86–3.38; aOR = 1.93, 1.08–2.98), preeclampsia (aOR = 2.28, 1.21–3.81; aOR = 2.17, 1.35–4.37), macrosomia (aOR = 1.20, 1.02–1.82; aOR = 2.02, 1.51–2.64) and LGA (aOR = 1.42, 1.24–1.97; aOR = 1.79, 1.51–2.54). Rates of GWG above IOM guidelines in third trimester of pregnancy also increased odds of caesarean delivery (aOR = 1.48, 1.16–2.34) when compared with within IOM guidelines. While rates of GWG below IOM guidelines in both second and third trimesters of pregnancy was associated with a decreased odds of macrosomia (aOR = 0.66, 95% CI: 0.52–0.78; aOR = 0.52, 0.39–0.63) and LGA(aOR = 0.71, 0.51–0.82; aOR = 0.67, 0.55–0.79). In addition, rate of GWG below IOM guidelines in third trimester of pregnancy was associated with an increased odds of preterm birth (aOR = 1.52, 1.12–2.05) and SGA (aOR = 1.21, 1.10–1.69). Conclusion GWG, outside IOM guidelines has increased risks of APOs among women with GDM, implying that careful surveillance for GWG during different stages of pregnancy is warranted.

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Section: Discussioncontrasting

confidence: 83%

Association between gestational weight gain in women with gestational diabetes mellitus and adverse pregnancy outcomes: a retrospective cohort study

Shi

Liu

Yin

2021

BMC Pregnancy Childbirth

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“…Neonatal death was defined as the death of an infant in the first 28 days after live birth [ 25 ]. Severe neonatal morbidity included birth asphyxia (5 min Apgar score < 7) [ 26 , 27 ], respiratory distress syndrome, neonatal sepsis, and seizures [ 7 , 28 ].…”

Section: Methodsmentioning

confidence: 99%

Institute of Medicine Recommendations on the Rate of Gestational Weight Gain and Perinatal Outcomes in Rural Bangladesh

Hasan

Khan

Ahmed

2021

IJERPH

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Although validated in other parts of the world, the suitability of the U.S. Institute of Medicine (IOM) 2009 recommendations on gestational weight gain (GWG) for Bangladeshi women remains to be examined. We evaluated the association between the weekly rate of weight gain during the second and third trimester of pregnancy, categorized according to IOM recommendations, and adverse perinatal outcomes among 1569 pregnant women with singleton live births in rural Matlab, Bangladesh. Gaining weight at rates below the IOM recommendations was associated with higher odds of preterm birth (adjusted odds ratio (AOR) = 2.0, 95% CI: 1.1–3.6), low birth weight (AOR = 1.4, 95% CI: 1.03–2.0), small-for-gestational-age newborns (AOR = 1.3, 95% CI: 1.04–1.7), and poor neonatal outcome (severe neonatal morbidity or death, AOR = 2.4, 95% CI: 1.03–5.6). A GWG rate above the recommendations was associated with higher odds of cesarean delivery (AOR = 1.7, 95% CI: 1.1–2.6), preterm birth (AOR = 2.2, 95% CI: 1.1–4.4), large-for-gestational-age newborns (AOR = 5.9, 95% CI: 1.5–23.1), and poor neonatal outcome (AOR = 2.7, 95% CI: 1.04–7.0). Our results suggest that the IOM 2009 recommendations on GWG rate during the second and third trimester may be suitable for guiding rural Bangladeshi women in the prenatal period, although the women should aim for rates near the lower bound of the range.

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“…In a study of 1606 women with GDM, Shi et al found that women with a WGR below the IOM standard had lower odds ratios for LGA and macrosomia than those women within the IOM standard [24]. In contrast, in a study of 593 Indian women with GDM, Kashyap et al found no statistical difference in the prevalence of LGA and SGA across groups below, within, and above the WGR targets [26], which is similar to the findings of Kurtzhals et al [25] and Harper et al [23] in white women. However, a certain limitation in these studies is that they failed to test the hypothesis across different BMI categories due to the limited sample size, even though BMI has been reported to be a key important confounder for gestational weight gain [36,37].…”

Section: Discussionmentioning

confidence: 99%

“…As such, monitoring the WGR in the late second and third trimesters, in contrast to GWG, would be more desirable for the management of weight for women with GDM. However, evidence on the applicability of the WGR targets for women with GDM was limited and conflicting [23][24][25][26]. Moreover, owing to the limited sample size, previous studies failed to assess the effect modification of pre-pregnancy BMI, although it is an important confounder for weight gain and adverse health outcomes [23][24][25][26].…”

Section: Introductionmentioning

confidence: 99%

Weight gain rate in the second and third trimesters and fetal growth in women with gestational diabetes mellitus: a retrospective cohort study

Miao

Liang

Zhang

et al. 2022

BMC Pregnancy Childbirth

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Background Controversial evidence regarding the applicability of the IOM’s gestational weight gain (GWG) targets for women with gestational diabetes mellitus (GDM) has been reported. However, little is known about the weight gain rate (WGR) during the second and third trimesters. Moreover, previous studies failed to assess the effect modification of pre-pregnancy BMI because of the limited sample size. Therefore, we aimed to assess the applicability of the IOM recommendation for the WGR in women with GDM in different pre-pregnancy BMI categories. Methods We conducted this retrospective cohort study of 5275 women with GDM who delivered at Guangzhou Women and Children’s Medical Center (GWCMC) between January 2017 and January 2021. Demographic and clinical information was collected from the electronic medical record system. The primary exposure was the WGR in the late second and third trimesters; they were classified as below, within, and above the IOM standard. The outcomes were fetal growth indicators, including large-for-gestational-age (LGA), macrosomia, small-for-gestational-age (SGA), and low birth weight (LBW). The associations between the WGR and such outcomes were assessed using multiple logistic regression. Results A WGR below the IOM standard was associated with the decreased odds of LGA (adjusted OR 0.74; 95% CI 0.49–1.13) and macrosomia (adjusted OR 0.54, 95% CI 0.32–0.92) for women with GDM in the normal weight BMI class. Such decreases were observed greater for women with GDM in the overweight/obese class, with adjusted ORs of 0.34 (95% CI 0.09–0.88) for LGA and 0.31 (95% CI 0.01–0.84) for macrosomia, respectively. No significant difference was observed in the odds ratios of SGA and LBW across the different WGR groups. Conclusion LGA and macrosomia are the main outcomes associated with the WGR in the late second and third trimesters, and a WGR below the IOM standard was associated with a decreased odds of such outcomes compared with a WGR within the IOM standard in women with GDM in the normal weight and overweight/obese classes. Our findings suggest that a stricter WGR target than that of the current IOM standard may be more beneficial for women with GDM.

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Effect of second trimester and third trimester weight gain on immediate outcomes in neonates born to mothers with gestational diabetes: a retrospective observational study from India

Cited by 5 publications

References 6 publications

Association between gestational weight gain in women with gestational diabetes mellitus and adverse pregnancy outcomes: a retrospective cohort study

Association between gestational weight gain in women with gestational diabetes mellitus and adverse pregnancy outcomes: a retrospective cohort study

Institute of Medicine Recommendations on the Rate of Gestational Weight Gain and Perinatal Outcomes in Rural Bangladesh

Weight gain rate in the second and third trimesters and fetal growth in women with gestational diabetes mellitus: a retrospective cohort study

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