Weight gain adequacy and pregnancy outcomes in gestational diabetes: a meta‐analysis

Abstract

The Institute of Medicine updated guidelines for gestational weight gain in 2009, with no special recommendations for gestational diabetes. Our objectives were to describe the prevalence of weight gain adequacy and their association with adverse pregnancy outcomes in gestational diabetes. We searched MEDLINE, EMBASE, COCHRANE and SCOPUS. We calculated the pooled prevalence of gain adequacy and relative risks for pregnancy outcomes within Institute of Medicine categories. Thirty-three studies/abstracts (88,599 women) were included. Thirty-one studies provided data on the prevalence of weight gain adequacy; it was adequate in 34% (95% CI: 29-39%) of women, insufficient in 30% (95% CI: 27-34%) and excessive in 37% (95% CI: 33-41%). Excessive gain was associated with increased risks of pharmacological treatment, hypertensive disorders of pregnancy, caesarean section, large for gestational age and macrosomic babies, compared to adequate or non-excessive gain. Weight gain below the guidance had a protective effect on large babies (RR: 0.71; 95% CI: 0.56-0.90) and macrosomia (RR 0.57; 95% CI 0.40-0.83), and did not increase the risk of small babies (RR 1.40; 95% CI 0.86-2.27). Less than recommended weight gain would be beneficial, while effective prevention of excessive gain is of utmost importance, in gestational diabetes pregnancies. Nevertheless, no ideal range for weight gain could be established.

Weight control before and during pregnancy for patients with gestational diabetes mellitus

“…A meta‐analysis including 33 clinical studies on the effects of gestational weight gain on infant birthweight for gestational age in patients with GDM, only three of which were carried out among Asian, non‐Japanese patients with GDM, showed that excessive gestational weight gain is a risk factor for delivering LGA infants; the present data are compatible with this finding. However, the adequate range of gestational weight gain remains to be determined, and the data of Asian patients available to date are limited.…”

“…The Hyperglycemia and Adverse Pregnancy Outcome Study showed that obesity is a strong risk factor associated with the delivery of LGA infants and infants with neonatal obesity, and that this association is independent from maternal blood glucose concentrations. Furthermore, excessive gestational weight gain in mothers with GDM can lead to maternal complications (e.g., hypertensive disorders of pregnancy and cesarean section) and is a risk factor for the delivery of LGA infants.…”

Relationship between Maternal Central Obesity and the Risk of Gestational Diabetes Mellitus: A Systematic Review and Meta-Analysis of Cohort Studies

“…This meta-analysis of 11 articles is the first study to offer convincing evidence of the relationship between increased maternal central obesity and the risk of GDM. Some metaanalyses have shown that the risk of GDM is directly related to prepregnancy BMI and pregnancy weight gain [27][28][29][30]. One study reported both the crude and adjusted ORs and RRs [30], and three other studies reported the crude and adjusted ORs or RRs of the effect of prepregnancy BMI (as a categorical variable) on the risk of GDM [36][37][38], which were adjusted for potential confounders, such as maternal age, ethnicity, family history of diabetes, education level, parity, and smoking status.…”

“…Although some studies and meta-analyses have noted a relationship between BMI and GDM [27][28][29][30], there are no general studies and agreements about central obesity. An Australian longitudinal cohort study found that SFT was an important factor in determining obesity-related risk in pregnancy [31].…”

Autophagy and its link to type II diabetes mellitus

“…Insulin resistance can be enhanced by weight reduction and exercise [117]. (3) Gestational diabetes: pregnant women without a previous history of diabetes develop high blood sugar levels [118, 119]. …”