Gestational Diabetes and Maternal Weight Management During and After Pregnancy

Abstract

Background: Women diagnosed with gestational diabetes mellitus (GDM) substantially modify their diets during pregnancy to control hyperglycemia. These changes could also affect maternal weight management. Materials and Methods: From July 2014 to December 2015 we enrolled women with and without GDM in a prospective cohort study to compare their mean rates of (1) weight gain before GDM screening, (2) weight gain after GDM screening, and (3) postpartum weight loss. All GDM-affected women were referred to Medical Nutrition Therapy and asked to self-monitor blood glucose until delivery. Rate comparisons were conducted separately for each interval using weighted t-tests and inverse probability of treatment weighting (IPTW) to account for age and prepregnancy body mass index (BMI). Linear regression models were developed to characterize the association of GDM status and rate of weight change. Results: The study included 40 women with GDM and 49 women without GDM. The IPTW analysis found that (1) women with and without GDM had similar mean rates of gestational weight gain before GDM screening (0.41-0.26 kg/week vs. 0.45-0.35 kg/week, respectively, p = 0.86), (2) women with GDM gained weight at a significantly lower mean rate than women without GDM following GDM screening (0.30-0.28 kg/week vs. 0.53-0.28 kg/week, respectively, p = 0.001), and (3) women with and without GDM had similar mean rates of postpartum weight loss (-1.37-0.58 kg/week vs.-1.28-0.46 kg/week, respectively, p = 0.73). The linear regression model (adjusted for age and prepregnancy BMI) demonstrated that women with GDM gained 0.19 kg/ week less than women without GDM (p = 0.004) during pregnancy after GDM screening. Conclusions: In the postpartum period, women with GDM lose weight at similar rates to women without GDM despite gaining weight at significantly lower rates following GDM screening. Diagnosis and treatment of GDM may improve maternal weight management, but this benefit is limited to late pregnancy.

Influence of GDM Diagnosis and Treatment on Weight Gain, Dietary Intake and Physical Activity in Pregnant Women with Obesity: Secondary Analysis of the UPBEAT Study

“…Consistent with our findings, previous studies in women with heterogeneous BMIs assessing weight gain in the interval after GDM screening have found that women without GDM gain more weight than women with GDM [12,14]. In a small US study of 89 women, Chakkalakal et al reported that women with GDM gained weight at a lower rate than women without GDM (0.30 ± 0.28 kg/week vs. 0.53 ± 0.28 kg/week, p = 0.001) [12].…”

“…Consistent with our findings, previous studies in women with heterogeneous BMIs assessing weight gain in the interval after GDM screening have found that women without GDM gain more weight than women with GDM [12,14]. In a small US study of 89 women, Chakkalakal et al reported that women with GDM gained weight at a lower rate than women without GDM (0.30 ± 0.28 kg/week vs. 0.53 ± 0.28 kg/week, p = 0.001) [12]. Similarly, women with GDM gained less total weight than women without GDM in a study of 212 Australian women, when weight was assessed in the second and third trimester (GDM: 1.18 kg (1.6%) vs. non-GDM: 4.0 kg (4.8%), p < 0.001) [14].…”

“…Consistent with our findings, previous studies in women with heterogeneous BMIs assessing weight gain in the interval after GDM screening have found that women without GDM gain more weight than women with GDM [12,14]. In a small US study of 89 women, Chakkalakal et al reported There were no differences in change in total fat intake, saturated fat intake or glycaemic index between the GDM and non-GDM women ( Table 2).…”

“…Whilst differences in diet and weight gain between women with and without a diagnosis of GDM have been reported [8][9][10][11][12][13][14], there is a paucity of longitudinal data that explores behaviour change and gestational weight gain following a negative or positive oral glucose tolerance test (OGTT) for the diagnosis and associated treatment of GDM. In a recent longitudinal study of 702 women living in Norway, minimal differences in dietary intake between those with and without GDM were observed, and the women with GDM gained more weight compared to those without GDM [15].…”

Effect of maternal weight gain according to the Institute of Medicine recommendations on pregnancy outcomes in a Chinese population

“…Previous studies on the role of GWG in GDM are contradictory. 33,34 These contradictory results may be attributed to dietary regulation and exercise of pregnant women after being diagnosed with GDM. [35][36][37] In this study, many pregnant women gained more weight than that recommended by the IOM guidelines, especially for women who were overweight and obese.…”