Weight retention at six weeks postpartum and the risk of gestational diabetes mellitus in a second pregnancy

Abstract

Background Gestational diabetes mellitus (GDM) is a common cause of maternal morbidity, and can lead to the development of diabetes later in life. Pre-pregnancy body weight is associated with the change in body mass index (BMI) between a first and second pregnancy. Compared with long-term change in BMI between pregnancies, the most accessible follow-up point to investigate BMI change is 6 weeks after the initial pregnancy. The present study aimed to assess the association between weight retention at 6 weeks postpartum and the risk of GDM in a subsequent pregnancy. Methods We recruited 6429 singleton pregnancies into this retrospective cohort study. For each pregnancy, we calculated weight retention at 6 weeks postpartum after the first pregnancy, the interpregnancy BMI change between pregnancies, and the gestational weight gain in the second pregnancy. Risk was represented by the odds ratio (OR) and 95% confidence intervals (CIs). We then determined the relationship between postpartum weight retention at 6 weeks after the initial pregnancy, and the interpregnancy change in BMI between pregnancies. Analyses were stratified by BMI during the first pregnancy. Results Compared to women with a stable BMI (− 1 to 1), interpregnancy BMI gains were associated with an increased risk of GDM in the second pregnancy. Risk increased significantly for women with a BMI below and above 25 during the first pregnancy, although the increase was greater in the women with a BMI < 25. The risk of GDM in the second pregnancy was higher in women with inadequate weight gain during the second gestation. The weight retention at 6 weeks postpartum, where there was a gain of > 3 BMI units was significantly more related to weight gain more than when there was 1 BMI unit gain between pregnancies ( P < 0.05) and associated with an increased incidence of GDM in the second pregnancy (OR = 2.95, 95% CI: 1.95 ~ 4.45). Women who showed a change in BMI that was > 3 units at 6 weeks postpartum after the first pregnancy showed an increased risk for BMI subsequently (OR = 1.42, 95% CI: 1.08~1.87). Conclusions Women who gained more than 3 BMI units at 6 weeks postpartum were associated with an increased risk of BMI in a subsequent pregnancy. Six weeks postpartum provides a new early window of opportunity to identify risk factors for a subsequent pregnancy and allows us to implement primary prevention strategies.

Postpartum Metabolism: How Does It Change from Pregnancy and What are the Potential Implications?

“…Soria-Contreras et al found that postpartum weight retention and weight gain during the first year were positively correlated to HOMA-IR at six years postpartum. Another study found that women who gained excess weight from pregnancy to postpartum had a higher risk of gestational diabetes in subsequent pregnancies, 33 which suggests weight retained after pregnancy is intricately connected to insulin resistance during the months and even years after delivery. Taken together, the relationship noted in the present study may persist well beyond 6-months postpartum and potentially predispose mothers for gestational diabetes and type II diabetes development later in life.…”

Epicardial adipose tissue thickness as a potential predictor of gestational diabetes mellitus: a prospective cohort study

“…A range of anthropometric parameters were measured for each participant, including weight, height, heart rate, systolic blood pressure, and diastolic blood pressure; we also calculated the BMI [10]. At each visit, we also recorded the family history of diabetes as a parent or sibling may have been diagnosed as having diabetes in the interval since the previous visit [11].…”

Evaluation of weight retention four weeks after delivery as a risk factor for gestational diabetes mellitus in a subsequent pregnancy

“…However, it is meaningless to inform a woman with these factors that she has an increased risk of GDM when she has already become pregnant again; physicians need to identify women with a high risk of GDM and implement primary prevention strategies before that point. Recently, Liu et al reported that the findings of their retrospective cohort study suggest that excessive postpartum weight retention (PPWR) six weeks after the first pregnancy is a risk factor for GDM in the second pregnancy [8]. Their study is different than previous investigations in proposing that the postpartum checkup might provide the opportunity to identify factors that increase the risk of GDM in a subsequent pregnancy, allowing the implementation of primary prevention strategies.…”

“…Research estimates indicate that GDM affects approximately 7-10% of all pregnancies worldwide [3][4][5][6]. GDM presents significant risks to the fetus, including an increased risk of macrosomia, neonatal hypoglycemia, hyperbilirubinemia, shoulder dystocia, and birth trauma [7,8]. Further, previous studies demonstrated that women with GDM have an increased risk of hypertensive disorders of pregnancy [9,10] and metabolic syndrome, type 2 diabetes mellitus, and cardiovascular disease later in life [11,12].…”