Interpregnancy Weight Change and Gestational Diabetes Mellitus: A Systematic Review and Meta‐Analysis

Abstract

This study aimed to synthesize evidence regarding the association between interpregnancy weight change (IPWC) and gestational diabetes mellitus (GDM) in the subsequent pregnancy. Methods: MEDLINE, EMBASE, Cochrane Library, and Web of Science were searched from inception to May 10, 2020. This review included studies that reported the association between IPWC and GDM in the subsequent pregnancy without restriction on study design, IPWC classification, or parity. The "no weight change" interpregnancy category was defined by each study, and data were synthesized to analyze the risk of GDM according to weight change. Results: Thirteen observational studies were included. A higher risk of GDM in the subsequent pregnancy when there was interpregnancy weight gain (odds ratio [OR] = 1.56; 95% CI: 1.30-1.83; I 2 = 82.30%) was found. However, interpregnancy weight loss was associated with lower risk of GDM in the subsequent pregnancy (OR = 0.83; 95% CI: 0.68-0.98; I 2 = 58.10%), but the decrease in the risk of GDM in the subsequent pregnancy was greater among women with pregestational BMI higher than 25 kg/m 2 (OR = 0.58; 95% CI: 0.39-0.77; I 2 = 0.00%). Conclusions: The risk of GDM in the subsequent pregnancy increases with interpregnancy weight gain, whereas it decreases with interpregnancy weight loss.

Distribution and association of interpregnancy weight change with subsequent pregnancy outcomes: a cohort study using electronic medical records

“…This may be attributed to the greater weight loss among women who were overweight or obese within the interpregnancy interval of 1-2 years, compared with women who were lean (BMI loss 1.9 vs 1.5 kg/m 2 , p<0.001). In addition, unlike other studies which showed a reduction in the risk of adverse pregnancy outcomes among overweight and obese women who lost weight, 10,[19][20][21] our study did not find any significant risk reduction among women with BMI [? ]23 kg/m 2 who lost weight.…”

“…The results on interpregnancy BMI gain and the increased risks of subsequent LGA, GDM and emergency caesarean delivery are consistent with previous studies. 9,10,20 These adverse complications could be due to reduced insulin sensitivity due to interpregnancy weight gain accompanied by body fat rather than muscle gain, which is common among Asians. 19,[21][22][23][24] The heightened risk of emergency caesarean delivery in women with an initial BMI <23 kg/m 2 is consistent with a systematic review and meta-analysis by Oteng-Ntim et al 21 , suggesting that lean women could be more susceptible to subsequent delivery complications in response to weight gain between pregnancies.…”

Recurrence of Gestational Diabetes Mellitus: To Assess Glucose Metabolism and Clinical Risk Factors at the Beginning of a Subsequent Pregnancy

“…However, a retrospective Korean study found that patients with recurrent GDM had increased fasting glucose concentrations and impaired insulin action (assessed by the Homeostasis Model Assessment of Insulin Resistance, HOMA-IR) two months after index pregnancy, which is in line with our results in early gestation of women with subsequent pregnancy [ 24 ]. In this context, a recent meta-analysis indicated that interpregnancy weight loss can reduce the prevalence of GDM recurrence in overweight or obese mothers with a history of GDM [ 25 ]. Weight loss in the interconception period may improve insulin sensitivity and support an adequate adaptation to physiological demands in a subsequent pregnancy, resulting in lower glucose levels and lower risk for GDM and associated complications [ 26 ].…”

Translation and psychometric validation of the Arabic version of Summary of the Diabetes Self-Care Activities (SDSCA) among pregnant women with gestational diabetes

“…For instance, excessive weight gain during pregnancy in mothers with GDM was significantly linked to cesarean deliveries, gestational hypertension, hypoglycemic agents use after delivery, and increased infant birth weight [9,29,40,43]. Further, excessive weight gain between pregnancies was connected with a higher risk of GDM in the subsequent pregnancy [28,40]. A systematic review and a meta-analysis of 13 studies have reported that inter-pregnancy weight loss decreases the risk of developing GDM in subsequent pregnancies [28].…”

“…Further, excessive weight gain between pregnancies was connected with a higher risk of GDM in the subsequent pregnancy [28,40]. A systematic review and a meta-analysis of 13 studies have reported that inter-pregnancy weight loss decreases the risk of developing GDM in subsequent pregnancies [28]. Furthermore, adherence to lifestyle modifications and self-care management (e.g., weight, diet, and exercise) showed their effectiveness in achieving glycemic control and reducing complications in GDM [8].…”