266: Effect of gestational weight gain on perinatal outcomes in women with type 2 diabetes mellitus using the 2009 Institute of Medicine guidelines

The epidemics of obesity and type 2 diabetes mellitus (T2DM) globally are paralleling an increase in the number of women with T2DM becoming pregnant. Because T2DM is frequently undiagnosed before pregnancy, the risk of major malformations in the developing fetus is increased due to uncontrolled hyperglycemia. The lack of preconception care and the increase in complications of pregnancy due to the coexistence of obesity and T2DM are of concern from both an individual and a public health standpoint. Rapid achievement of normoglycemia with limited weight gain is critical to optimize maternal and fetal outcomes in all women with diabetes during pregnancy, regardless of the type of diabetes. This article will focus on T2DM preceding pregnancy due to its increasing prevalence and potentially dire fetal and maternal consequences. Euglycemia before, during, and after all pregnancies complicated by diabetes results in the best opportunity for optimal outcomes for mother and infant.

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Maternal and fetal genetic contribution to gestational weight gain

10.1101/116434 ◽

2017 ◽

Author(s):

Nicole M Warrington ◽

Rebecca Richmond ◽

Bjarke Fenstra ◽

Ronny Myhre ◽

Romy Gaillard ◽

...

Keyword(s):

Type 2 Diabetes ◽

Weight Gain ◽

Gestational Weight Gain ◽

Genetic Variants ◽

Genetic Contribution ◽

Gestational Weight ◽

Genome Wide ◽

Common Genetic Variants ◽

Maternal Bmi

AbstractBackgroundClinical recommendations to limit gestational weight gain (GWG) imply high GWG is causally related to adverse outcomes in mother or offspring, but GWG is the sum of several inter-related complex phenotypes (maternal fat deposition and vascular expansion, placenta, amniotic fluid and fetal growth). Understanding the genetic contribution to GWG could help clarify the potential effect of its different components on maternal and offspring health. Here we explore the genetic contribution to total, early and late GWG.Participants and MethodsA genome-wide association study was used to identify maternal and fetal variants contributing to GWG in up to 10,543 mothers and up to 16,317 offspring of European origin, with replication in 10,660 mothers and 7,561 offspring. Additional analyses determined the proportion of variability in GWG from maternal and fetal common genetic variants and the overlap of established genome-wide significant variants for phenotypes relevant to GWG (e.g. maternal BMI and glucose, birthweight).ResultsWe found that approximately 20% of the variability in GWG was tagged by common maternal genetic variants, and that the fetal genome made a surprisingly minor contribution to explaining variation in GWG. We were unable to identify any genetic variants that reached genome-wide levels of significance (P<5×10−8) and replicated. Some established maternal variants associated with increased BMI, fasting glucose and type 2 diabetes were associated with lower early, and higher later GWG. Maternal variants related to higher systolic blood pressure were related to lower late GWG. Established maternal and fetal birthweight variants were largely unrelated to GWG.ConclusionWe found a modest contribution of maternal common variants to GWG and some overlap of maternal BMI, glucose and type 2 diabetes variants with GWG. These findings suggest that associations between GWG and later offspring/maternal outcomes may be due to the relationship of maternal BMI and diabetes with GWG.

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Effect of motivational interviewing on gestational weight gain and fetal growth in pregnant women with type 2 diabetes

BMJ Open Diabetes Research & Care ◽

10.1136/bmjdrc-2019-000733 ◽

2019 ◽

Vol 7 (1) ◽

pp. e000733

Author(s):

Björg Ásbjörnsdóttir ◽

Marianne Vestgaard ◽

Lene Ringholm ◽

Lise Lotte Torvin Andersen ◽

Dorte Møller Jensen ◽

...

Keyword(s):

Type 2 Diabetes ◽

Weight Gain ◽

Motivational Interviewing ◽

Pregnant Women ◽

Gestational Weight Gain ◽

Healthy Eating ◽

Routine Care ◽

Gestational Weight ◽

Reference Cohort

ObjectiveTo study how lifestyle coaching with motivational interviewing to improve adherence to healthy eating affects gestational weight gain and fetal growth in pregnant women with type 2 diabetes in a real-world setting.Research design and methodsA cohort study including a prospective intervention cohort of consecutive, singleton pregnant, Danish-speaking women with type 2 diabetes included between August 2015 and February 2018 and a historical reference cohort included between February 2013 and August 2015. The intervention consisted of a motivational interviewing to improve adherence to healthy eating in addition to routine care. The reference cohort received routine care only. The main outcomes were gestational weight gain and large for gestational age (LGA) infants.ResultsNinety-seven women were included in the intervention cohort and 92 in the reference cohort. Pre-pregnancy body mass index (32.8±6.9 kg/m2vs 32.4±7.4 kg/m2, p=0.70), gestational weight gain (9.2±5.8 kg vs 10.2±5.8 kg, p=0.25), HbA1c in early pregnancy (6.7%±1.1% vs 6.5%±1.3% (50±12 mmol/mol vs 48±14 mmol/mol), p=0.32) and late pregnancy (5.9%±0.5% vs 6.0%±0.6% (41±6 mmol/mol vs 42±7 mmol/mol), p=0.34) were comparable in the two cohorts. LGA infants occurred in 20% vs 31%, p=0.07, respectively, and after adjustment for maternal characteristics 14% vs 27% delivered LGA infants (p=0.04). Birth weight z-score was 0.24±1.36 vs 0.61±1.38, p=0.06.ConclusionsMotivational interviewing to improve adherence to healthy eating in addition to routine care in pregnant women with type 2 diabetes tended to reduce fetal overgrowth without major effect on gestational weight gain. Further studies investigating the cost-benefit of enhancing motivation are needed.Trial registration numberNCT02883127.

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