Excessive Weight Gain Before and During Gestational Diabetes Mellitus Management: What Is the Impact?

Abstract

Conventional gestational diabetes mellitus (GDM) management focuses on managing blood glucose in order to prevent adverse outcomes. We hypothesized that excessive weight gain at first presentation with GDM (excessive gestational weight gain [EGWG]) and continued EGWG (cEGWG) after commencing GDM management would increase the risk of adverse outcomes, despite treatment to optimize glycemia. RESEARCH DESIGN AND METHODSData collected prospectively from pregnant women with GDM at a single institution were analyzed. GDM was diagnosed on the basis of Australasian Diabetes in Pregnancy Society 1998 guidelines . EGWG means having exceeded the upper limit of the Institute of Medicine-recommended target ranges for the entire pregnancy, by GDM presentation. The relationship between EGWG and antenatal 75-g oral glucose tolerance test (oGTT) values and adverse outcomes was evaluated. Relationships were examined between cEGWG, insulin requirements, and large-for-gestational-age (LGA) infants. RESULTSOf 3,281 pregnant women, 776 (23.6%) had EGWG. Women with EGWG had higher mean fasting plasma glucose (FPG) on oGTT (5.2 mmol/L [95% CI 5.1-5.3] vs. 5.0 mmol/L [95% CI 4.9-5.0]; P < 0.01), after adjusting for confounders, and more often received insulin therapy (47.0% vs. 33.6%; P < 0.0001), with an adjusted odds ratio (aOR) of 1.4 (95% CI 1.1-1.7; P < 0.01). aORs for each 2-kg increment of cEGWG were a 1.3-fold higher use of insulin therapy (95% CI 1.1-1.5; P < 0.001), an 8-unit increase in final daily insulin dose (95% CI 5.4-11.0; P < 0.0001), and a 1.4-fold increase in the rate of delivery of LGA infants (95% CI 1.2-1.7; P < 0.0001). CONCLUSIONSThe absence of EGWG and restricting cEGWG in GDM have a mitigating effect on oGTT-based FPG, the risk of having an LGA infant, and insulin requirements.The traditional approach to gestational diabetes mellitus (GDM) management largely focuses on monitoring and treating maternal hyperglycemia. This practice is supported by evidence of fewer adverse maternal and neonatal outcomes with improved glycemic control during pregnancy (1,2). Medical nutrition therapy (MNT)

Contributing Factors to Perinatal Outcome in Pregnancies with Gestational Diabetes—What Matters Most? A Retrospective Analysis

“…However, adjusted analysis revealed, NICU admission to be solely influenced by the diagnosis of GDM, while the risk of LGA was also significantly increased by prepregnancy BMI (OR 1.06) and per kg weight gain (OR 1.07). Previous studies focusing on LGA confirm our findings concerning the impacts of BMI, GWG and GDM on LGA rates [ 19 , 22 , 23 , 24 , 25 , 41 ].…”

Circulating FABP4, nesfatin-1, and osteocalcin concentrations in women with gestational diabetes mellitus: a meta-analysis

“…The mechanism underlying the development of GDM remains to be illuminated [4]; however, GDM and type 2 diabetes mellitus (T2DM) are strongly linked, which confers a common pathogenesis of insulin resistance (IR) and/or a relative limitation in β-cell reserve [5]. Adipose tissue secretes a couple of specific factors (adipokines) that influence effects of insulin on various tissues, indicating that secretion of these adipokines might be related with GDM [6].…”

Factors Associated with Gestational Diabetes Mellitus: A Meta-Analysis

“…Another significant medical factor associated with a higher risk for developing GDM was history of GDM. Interestingly, a retrospective study [ 35 ] and two case-control studies [ 21 , 36 ] also had similar results showing that history of GDM was thought to be a common risk factor in repeated pregnancies [ 34 ].…”