Ideal weight gain in pregnancy: should our targets be different for women with gestational diabetes?

The prevalence of obesity in pregnancy is rising exponentially; about 15–20% of pregnant women now enter pregnancy with a BMI which would define them as obese. This paper provides a review of the strong links between obesity and adverse pregnancy outcome which operate across a range of pregnancy complications. For example, obesity is associated with an increased risk of maternal mortality, gestational diabetes mellitus, thromboembolism, pre-eclampsia and postpartum haemorrhage. Obesity also complicates operative delivery; it makes operative delivery more difficult, increases complications and paradoxically increases the need for operative delivery. The risk of the majority of these complications is amplified by excess weight gain in pregnancy and increases in proportion to the degree of obesity, for example, women with extreme obesity have OR of 7·89 for gestational diabetes and 3·84 for postpartum haemorrhage compared to their lean counterparts. The consequences of maternal obesity do not stop once the baby is born. Maternal obesity programmes a variety of long-term adverse outcomes, including obesity in the offspring at adulthood. Such an effect is mediated at least in part via high birthweight; a recent study has suggested that the odds of adult obesity are two-fold greater in babies weighing more than 4 kg at birth. The mechanism by which obesity causes adverse pregnancy outcome is uncertain. This paper reviews the emerging evidence that hyperglycaemia and insulin resistance may both play a role: the links between hyperglycaemia in pregnancy and both increased birthweight and insulin resistance have been demonstrated in two large studies. Lastly, we discuss the nature and rationale for possible intervention strategies in obese pregnant women.

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Pregnant women’s knowledge of obesity and ideal weight gain in pregnancy, and health behaviours of pregnant women and their partners

Australian and New Zealand Journal of Obstetrics and Gynaecology ◽

10.1111/j.1479-828x.2011.01328.x ◽

2011 ◽

Vol 51 (5) ◽

pp. 460-463 ◽

Cited By ~ 8

Author(s):

Matthew W. THOMPSON ◽

Natasha NASSAR ◽

Meiri ROBERTSON ◽

Antonia W. SHAND

Keyword(s):

Weight Gain ◽

Pregnant Women ◽

Health Behaviours ◽

Ideal Weight ◽

Women's Knowledge ◽

Women’S Knowledge ◽

In Pregnancy

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Factors associated with fetal macrosomia

Revista de Saúde Pública ◽

10.11606/s1518-8787.2019053001269 ◽

2019 ◽

Vol 53 ◽

pp. 100

Author(s):

Vanessa Agudelo-Espitia ◽

Beatriz Elena Parra-Sosa ◽

Sandra L Restrepo-Mesa

Keyword(s):

Weight Gain ◽

Gestational Diabetes ◽

Pregnant Women ◽

Gestational Weight Gain ◽

Excess Weight ◽

Fetal Macrosomia ◽

Factors Associated ◽

Gestational Weight ◽

Newborn Weight ◽

In Pregnancy

OBJECTIVE: To evaluate the clinical factors, as well as weight gain, in a group of pregnant women, associating them with fetal macrosomia in a public institution in Antioquia, Colombia, from 2010-2017. METHODS: A case-control study, using secondary information registries. Cases were defined using newborn weight of ≥ 4000g, while controls were defined as newborn weight between 3000– 3999g. A proportion ratio (PR) was established to evaluate factors associated with macrosomia, and a generalized linear model (GLM) of Poisson regression with robust variance was used to evaluate the aspects that best explained macrosomia in the neonate. RESULTS: 122 pregnant women participated in the study, of which 611 were cases and 61 were controls. Of the participants, 44.3% had pre-pregnancy overweight and 48.4% had excess gestational weight gain. Statistically significant differences were found between the groups in the following variables: pre-pregnancy BMI (p = 0.004), gestational weight gain (p = 0.000), gestational diabetes (p = 0.000), and type of delivery (p = 0.004). According to the regression model, a macrosomic newborn is 3.5 times more likely in women with excessive gestational weight gain (95%CI 1.78-7.18) and twice more likely in women who have gestational diabetes (95%CI 1.51-2.76). Of women with pre-pregnancy excess weight, 63% had excess gestational weight gain. CONCLUSIONS: Within this cohort, pre-pregnancy BMI, excess weight gain in pregnancy, and the presence of gestational diabetes were associated with an increased risk of neonatal macrosomia. pre-pregnancy BMI and weight gain in pregnancy are modifiable risk factors that are responsive to nutrition interventions, which can minimize adverse perinatal outcomes.

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Longer duration of sitting down in pregnancy is associated with gestational diabetes, greater weight gain and depressive symptoms

Endocrine Abstracts ◽

10.1530/endoabs.38.p184 ◽

2015 ◽

Cited By ~ 2

Author(s):

Nithya Sukumar ◽

Jacqueline Farmer ◽

Hema Venkataraman ◽

Ponnusamy Saravanan

Keyword(s):

Depressive Symptoms ◽

Weight Gain ◽

Gestational Diabetes ◽

In Pregnancy

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Excessive Early Pregnancy Weight Gain and Risk of Gestational Diabetes Mellitus

Journal of SAFOG with DVD ◽

10.5005/jp-journals-10006-1415 ◽

2016 ◽

Vol 8 (3) ◽

pp. 189-192

Author(s):

K Vasantha ◽

Maya Menon

Keyword(s):

Diabetes Mellitus ◽

Weight Gain ◽

Gestational Diabetes ◽

Gestational Diabetes Mellitus ◽

Early Pregnancy ◽

Pregnancy Weight Gain ◽

Excessive Weight Gain ◽

Excessive Weight ◽

Pregnancy Weight ◽

In Pregnancy

ABSTRACT Objectives To study the association between excessive early pregnancy weight gain and risk of gestational diabetes mellitus (GDM). Materials and methods Study design-prospective observational study done at ESIC Medical College & PGIMSR, Chennai during the period November 2013 to May 2015. A total of 250 women who attended antenatal outpatient department at ESI Hospital Chennai were recruited for the study. Height and weight of the pregnant women was recorded during their first visit (up to 6 weeks) and at 14 weeks of gestation. Body mass index (BMI) was calculated according to Quetelet index. Waist hip ratio was measured at 6 weeks. The early gestation weight gain more than 2 kg was considered as excessive weight gain and was associated to the risk of developing GDM. Blood sugar was estimated using Diabetes in Pregnancy Study Group Index (DIPSI) standards. Results Of the 250 women studied, 104 women developed GDM. Excessive weight gain in the 1st trimester of pregnancy was significantly associated with the development of GDM with a p-value of 0.000. The other risk factors studied were BMI (p = 0.0064), waist/hip ratio (p = 0.0015), family history of diabetes mellitus (DM) (p = 0.00), which also had a significant association. Clinical significance This study shows that excessive weight gain in 1st trimester had an increased risk of GDM. The benefit of early identification of excess gestational weight gain would be the opportunity for intervention early in pregnancy to ideally decrease GDM. Conclusion Excessive early pregnancy weight gain, primarily in the 1st trimester may increase the risk of developing GDM. Thus, preventing excessive early pregnancy weight gain in the 1st trimester can be modified by lifestyle changes and simple exercise, which is a costless intervention, and can also decrease maternal and neonatal morbidity effectively. How to cite this article Menon M, Vasantha K. Excessive Early Pregnancy Weight Gain and Risk of Gestational Diabetes Mellitus. J South Asian Feder Obst Gynae 2016;8(3):189-192.

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The obese woman with gestational diabetes: effects of body mass index and weight gain in pregnancy on obstetric and glycaemic outcomes

Obstetric Medicine ◽

10.1258/om.2011.110009 ◽

2012 ◽

Vol 5 (2) ◽

pp. 65-70 ◽

Cited By ~ 1

Author(s):

Flora Ip ◽

Jennifer Bradford ◽

Tien-Ming Hng ◽

Susan Hendon ◽

Mark McLean

Keyword(s):

Body Mass Index ◽

Weight Gain ◽

Gestational Diabetes ◽

Body Mass ◽

Obese Woman ◽

Obstetric Outcomes ◽

Obese Women ◽

Group A ◽

Group B ◽

In Pregnancy

Background Obese women with gestational diabetes mellitus (GDM) represent a high-risk group in pregnancy, although the effects of increasing degrees of obesity and weight gain in pregnancy in this group is poorly defined. Methods We performed a retrospective analysis of 375 singleton pregnancies complicated by maternal obesity and GDM. Women with a body mass index (BMI) of 30–35 kg/m2 were compared with those with a BMI of ≥ 35 kg/m2. Additionally, women were categorized according to weight gain in pregnancy: Group A (<0.18 kg/week), Group B (0.18–0.27 kg/week), Group C (>0.27 kg/week). Results Obstetric outcomes did not differ between the groups; however, postpartum dysglycaemia was more likely in women with a BMI ≥ 35 kg/m2 (odds ratio [OR] 3.2, 95% confidence interval [CI]: 1.2–8.9). Group B and Group C had higher odds of LGA (OR 3.8, 95% CI: 1.3–11.3; OR 5.0, 95% CI: 2.0–12.1, respectively) compared with Group A. Group C also had a lower risk of SGA (OR 0.4, 95% CI: 0.2–1.0) and a higher risk of postpartum dysglycaemia (OR 6.8, 95% CI: 1.7–26.9) compared with Group A. Conclusion Greater degrees of obesity are associated with higher risk of abnormal metabolic outcomes after pregnancy. Excessive weight gain in pregnancy in obese women increases adverse obstetric and glycaemic outcomes. Our findings suggest that targets for weight gain in pregnancy for obese women should be reduced from current recommendations.

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