Normal Gestational Weight Gain Protects From Large-for-Gestational-Age Birth Among Women With Obesity and Gestational Diabetes

Abstract

Background: Pre-pregnancy obesity, excess gestational weight gain (GWG), and gestational diabetes (GDM) increase fetal growth. Our aim was to assess whether normal GWG is associated with lower risk for a large-for-gestational-age (LGA; over the 90th percentile of birth weight for sex and gestational age) infant and lower birth weight standard deviation (SD) score in the presence of GDM and maternal obesity.Methods: This multicenter case-control study is part of the Finnish Gestational Diabetes (FinnGeDi) Study and includes singleton pregnancies of 1,055 women with GDM and 1,032 non-diabetic controls. Women were divided into 12 subgroups according to their GDM status, pre-pregnancy body mass index (BMI; kg/m2), and GWG. Non-diabetic women with normal BMI and normal GWG (according to Institute of Medicine recommendations) served as a reference group.Results: The prevalence of LGA birth was 12.2% among women with GDM and 6.2% among non-diabetic women (p < 0.001). Among all women, normal GWG was associated with lower odds of LGA [odds ratio (OR) 0.57, 95% CI: 0.41–0.78]. Among women with both obesity and GDM, the odds for giving birth to a LGA infant was 2.25-fold (95% CI: 1.04–4.85) among those with normal GWG and 7.63-fold (95% CI: 4.25–13.7) among those with excess GWG compared with the reference group. Compared with excess GWG, normal GWG was associated with 0.71 SD (95% CI: 0.47–0.97) lower birth weight SD score among women with GDM and obesity. Newborns of normal weight women with GDM and normal GWG had 0.28 SD (95% CI: 0.05–0.51) lower birth weight SD scores compared with their counterparts with excess GWG. In addition, in the group of normal weight non-diabetic women, normal GWG was associated with 0.46 SD (95% CI: 0.30–0.61) lower birth weight SD scores compared with excess GWG.Conclusion: GDM, obesity, and excess GWG are associated with higher risk for LGA infants. Interventions aiming at normal GWG have the potential to lower LGA rate and birth weight SD scores even when GDM and obesity are present.

Associations of Gestational Weight Gain at Different Trimesters with Adverse Pregnancy Outcomes. A Prospective Study of 1273 Subjects

“…Excessive GWG during periods 12-33 weeks and 12 weeks to delivery increased the risk of LGA and while insufficient GWG during periods 12-33 weeks, 12 weeks to delivery and 33 weeks to delivery week reduced the risk of LGA. These findings confirm previous studies which have indicated similar effects of excessive GWG on LGA [37][38][39][40][41]. Drehmer et al [42] reported that LGA was linked with excessive weight gain in the second trimester which is consistent with the results of our study [38].…”

Gestational weight gain and adverse maternal and perinatal outcomes among women with gestational diabetes mellitus according to International Association of Diabetes and Pregnancy Study Group (IADPSG) criteria: A cross sectional study

“…The results of this cross-sectional study show a high prevalence of inadequate GWG, as measured by IOM criteria, among adult Brazilian women diagnosed with GDM. Our findings point to a higher chance of newborn prematurity among women with insufficient GWG, and a higher chance of HDP and LGA infants among the women with excessive GWG, which is consistent with previous scientific evidence [11,18]. In a meta-analysis of studies of the North American and European population, any adverse outcome, including HDP, GDM, cesarean section, premature birth, SGA or LGA newborns, was observed in 37.2% of the 200,000 women included, ranging from 34.7% in the women who had pre- pregnancy underweight, to 61% in the women with grade 3 obesity before pregnancy [19].…”

“…According to a study conducted with 832 nulliparous women with GDM in China, similar results to the present study were found [21], as was observed in a multicenter caseecontrol study from Finland [18]. Excessive GWG was associated with pre-gestational obesity and also with an increased incidence of macrosomia and cesarean delivery [18,22,23]. It is fundamental to propose interventions aimed at achieving normal GWG that have the power to reduce the occurrence of LGA and birth weight SD scores, even in situations where GDM and obesity are present [18].…”

“…However, when evaluated the relationship between GWG patterns and birth weight in southern Brazil, they found similar rates of inadequate weight, with a slight predominance of excessive GWG in relation to insufficient GWG (38% and 36.5%, respectively). According to a study conducted with 832 nulliparous women with GDM in China, similar results to the present study were found [21], as was observed in a multicenter caseecontrol study from Finland [18]. Excessive GWG was associated with pre-gestational obesity and also with an increased incidence of macrosomia and cesarean delivery [18,22,23].…”

“…Excessive GWG was associated with pre-gestational obesity and also with an increased incidence of macrosomia and cesarean delivery [18,22,23]. It is fundamental to propose interventions aimed at achieving normal GWG that have the power to reduce the occurrence of LGA and birth weight SD scores, even in situations where GDM and obesity are present [18].…”