Timing of Gestational Diabetes Diagnosis by Maternal Obesity Status: Impact on Gestational Weight Gain in a Diverse Population

Abstract

Background: We hypothesized that earlier gestational diabetes mellitus (GDM) diagnosis and treatment of high-risk women would reduce gestational weight gain (GWG) in the first trimester and overall. Materials and Methods: We evaluated timing of GDM diagnosis among 5,391 pregnant women who delivered singleton births 2010-2013 in a large diverse health maintenance organization (HMO). All GDM screening was by the same oral glucose tolerance testing protocol; GDM treatment protocols were also consistent irrespective of timing of diagnosis. Women without risk factors were universally screened at 24-28 weeks gestation (Usual). Early screening was recommended in obese and other high-risk women at the first prenatal visit; those who screened negative Early were rescreened at 24-28 weeks (Early+Usual). Results: Average GWG for all women was 12.8 kg; 10.7% of women were diagnosed with GDM. Average GWG for all women diagnosed with GDM was 10.7 kg, adjusted for gestational age. Women with EarlyGDM averaged 2.4 kg less GWG than women diagnosed with UsualGDM (p < 0.0001). Among obese women, only women diagnosed with EarlyGDM averaged overall GWG within Institute of Medicine (IOM) weight guidelines (mean 8.1 kg) and were weight neutral in the first trimester (-0.2 kg). Overall, 43% of all pregnant women exceeded IOM GWG guidelines (gained more total weight than recommended); 60% of obese women exceeded guidelines. Obese women diagnosed with GDM were less likely to exceed IOM guidelines if diagnosed earlier in pregnancy (35% EarlyGDM vs. 59% UsualGDM exceeded guidelines, p < 0.0001). Conclusion: Our results suggest that EarlyGDM diagnosis (and thus treatment) in high-risk women is beneficial for optimizing GWG.

Inadequate Weight Gain According to the Institute of Medicine 2009 Guidelines in Women with Gestational Diabetes: Frequency, Clinical Predictors, and the Association with Pregnancy Outcomes

“…The diet initially prescribed is normocaloric but it is modified afterwards (by healthcare providers and by pregnant women themselves) to achieve the metabolic goals [ 39 ]. This is in line with the observations of Berglund et al, where women with GDM had a lower total GWG versus women with normal glucose tolerance at the expense of a lower GWG after diagnosis [ 18 ], and with those of Hillier et al, who recently reported that obese women with GDM had less eGWG when diagnosed after early screening than at 24–28 weeks (35 vs. 59%) [ 40 ]. The current report establishes this fact in a much larger population.…”

Does weight management after gestational diabetes mellitus diagnosis improve pregnancy outcomes? A multi‐ethnic cohort study

“…Of those who gained below their personalised weight target more than half were diagnosed with gestational diabetes less than 24 weeks of gestation compared to those who achieved their personalised weight target (54.0% vs. 37%, p < 0.001). This finding is consistent with a recent study which found that women diagnosed earlier in pregnancy were more likely to gain an inadequate amount of weight 23 . Given recent guidelines advising that women with risk factors for hyperglycaemia in pregnancy be screened for gestational diabetes earlier, 24 many women will be diagnosed earlier than previously, and will consequently be advised to follow gestational diabetes medical nutrition therapy for a larger proportion of their pregnancy.…”

Association of Pregestational BMI and Gestational Weight Gain with Maternal and Neonatal Outcomes in Adolescents and Adults from Mexico City

“…These findings coincide with other research showing that insufficient GWG among women with prior diabetes and gestational diabetes is up to 50%, and excessive GWG is 20% in Hispanics [ 40 ] and Anglo-Saxon women [ 41 ]. An explanation for the insufficient GWG is that women diagnosed with gestational diabetes in weeks 24–28 are likely to change their habits, and less gestational weight gain is recommended after diagnosis [ 42 ]. In this sense, a healthy lifestyle is encouraged for pregnant women, and GWG is timely monitored, resulting in insufficient weight gain [ 43 ].…”