Gestational Weight Gain and Adverse Maternal and Neonatal Outcomes for Pregnancies Complicated by Pregestational and Gestational Diabetes

Objective This study aimed to investigate the association between excess and less than recommended gestational weight gain (GWG) and adverse maternal and neonatal outcomes in women with pregestational and gestational diabetes. Study Design We conducted a secondary analysis of the National Institute of Child Health and Human Development (NICHD) Consortium on Safe Labor (CSL) study. We included deliveries >23 weeks of nonanomalous singletons with either pregestational or gestational diabetes. The exposure was GWG greater than or less than compared with the U.S. Institute of Medicine recommendations for total pregnancy weight gain per prepregnancy body mass index. Consistent with the 2020 Delphi outcome for diabetes in pregnancy, maternal outcomes included cesarean delivery and preeclampsia and neonatal outcomes included small for gestational age (SGA), large for gestational age (LGA), macrosomia >4,000 g, preterm birth <37 weeks, stillbirth, and neonatal death. We modeled both absolute GWG and GWG z-scores, standardized for gestational duration. Multivariable logistic regression with generalized estimating equations was used, adjusting for age, race/ethnicity, parity, prior cesarean delivery, chronic hypertension, tobacco use, U.S. region, and delivery year. Results Of 8,322 deliveries (n = 8,087 women) complicated by pregestational or gestational diabetes, 47% were in excess, 27% were within, and 26% were less than GWG recommendations. Deliveries with excess absolute GWG were at higher adjusted odds of cesarean delivery, preeclampsia, LGA, and macrosomia, compared with those within recommendations. Similar results were observed when using standardized GWG z-scores, in addition to higher likelihood of preterm birth and neonatal death. Less than recommended GWG was associated with a lower likelihood of these adverse outcomes but higher SGA. Additionally, less GWG by z-score was associated with a lower likelihood of stillbirth. Conclusion Excess GWG increases the risk of adverse maternal and neonatal outcomes for women with pregestational and gestational diabetes. Less GWG than recommended may decrease this risk. Key Points

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Using Non-inferiority Margins to Define Optimal Gestational Weight Gain Ranges Based on Reducing the Risk of Occurrence of Adverse Neonatal Outcomes

Current Developments in Nutrition ◽

10.1093/cdn/nzab046_025 ◽

2021 ◽

Vol 5 (Supplement_2) ◽

pp. 728-728

Author(s):

Thais Carrilho ◽

Jennifer Hutcheon ◽

Kathleen Rasmussen ◽

Dayana Farias ◽

Michael Reichenheim ◽

...

Keyword(s):

Weight Gain ◽

Preterm Birth ◽

Gestational Weight Gain ◽

Gestational Age ◽

National Research Council ◽

Neonatal Outcomes ◽

Composite Outcome ◽

Gestational Weight ◽

Adverse Neonatal Outcomes ◽

Z Scores

Abstract Objectives To identify optimal gestational weight gain (GWG) ranges to prevent adverse neonatal outcomes based on the new Brazilian GWG charts. Methods Data from 9,294 women from the Brazilian Maternal and Child Nutrition Consortium and Birth in Brazil study were used. Women aged ≥18 years, free of hypertensive disorders, diabetes in pregnancy, or diseases affecting GWG, were selected. Total GWG was calculated as last measured prenatal weight minus self-reported pre-pregnancy weight. Total GWG was standardized to gestational age-specific z scores according to the Brazilian GWG charts. A composite outcome was defined as the occurrence of any of small-for-gestational-age birth (SGA, birthweight < 10th percentile), large-for-gestational-age birth (LGA > 90th percentile) according to INTERGROWTH-21st charts, or preterm birth (birth < 37 weeks). We weighted each outcome in a composite index using previously-published weights to account for its relative seriousness. Logistic and Poisson regressions were performed with GWG z scores as exposure and independent outcomes and the composite outcome, respectively. Models were adjusted for maternal age, education, pre-pregnancy BMI, and smoking during pregnancy. GWG ranges associated with the lowest risk of the composite outcome were identified using the non-inferiority margins approach (20%). Results The median total GWG was 12.5 kg (IQR 9–16), and 6.2% of the neonates were SGA, 16.6% LGA, and 10.5% were preterm. Higher GWG z scores were associated with an increase in LGA probabilities and preterm birth compared with neonates born with appropriate weight and ≥37 weeks, respectively. Lower z scores were associated with an increase in SGA probability. The non-inferiority margins analysis showed that to prevent the occurrence of these adverse outcomes, women with underweight, normal-weight, overweight, or obesity should gain between 6.5–14.1 kg, 6.4–13.8 kg, 2.2–12.1 kg, and –2.2–8.9 kg, respectively. Conclusions Total GWG ranges associated with lower risk of adverse neonatal outcomes were identified using non-inferiority margins. The next step must incorporate maternal outcomes in this analysis. Funding Sources Brazilian National Research Council, Brazilian Ministry of Health, Bill and Melinda Gates Foundation.

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

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph19010280 ◽

2021 ◽

Vol 19 (1) ◽

pp. 280

Author(s):

Reyna Sámano ◽

Gabriela Chico-Barba ◽

María Eugenia Flores-Quijano ◽

Estela Godínez-Martínez ◽

Hugo Martínez-Rojano ◽

...

Keyword(s):

Weight Gain ◽

Birth Weight ◽

Low Birth Weight ◽

Gestational Diabetes ◽

Gestational Weight Gain ◽

Protective Factor ◽

Neonatal Outcomes ◽

Physical Growth ◽

Gestational Weight ◽

Maternal And Neonatal Outcomes

During pregnancy, adolescents experience physiological changes different from adults because they have not concluded their physical growth. Therefore, maternal and neonatal outcomes may not be the same. This paper aimed to analyze the association between pregestational BMI (pBMI) and gestational weight gain (GWG) with maternal and neonatal outcomes in adolescent and adult pregnant women. The authors performed an observational study that included 1112 women, where 52.6% (n = 585) were adolescents. Sociodemographic information, pBMI, GWG, neonatal anthropometric measures, and maternal and neonatal outcomes were obtained. Adolescent women had a mean lower (21.4 vs. 26.2, p ≤ 0.001) pBMI than adults and a higher gestational weight gain (12.3 vs. 10.7 kg, p ≤ 0.001). According to Poisson regression models, gestational diabetes is positively associated with insufficient GWG and with pregestational obesity. Furthermore, the probability of developing pregnancy-induced hypertension increased with pBMI of obesity compared to normal weight. Preeclampsia, anemia, and preterm birth were not associated with GWG. Insufficient GWG was a risk factor, and being overweight was a protective factor for low birth weight and small for gestational age. We conclude that pBMI, GWG, and age group were associated only with gestational diabetes and low birth weight.

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Maternal and neonatal outcomes according to gestational weight gain in twin pregnancies: Are the American IOM guidelines associated with better issues in Europe?

European Journal of Obstetrics & Gynecology and Reproductive Biology ◽

10.1016/j.ejogrb.2018.08.256 ◽

2019 ◽

Vol 234 ◽

pp. e46-e47

Author(s):

Océane Pécheux ◽

Charles Garabedian ◽

Elodie Drumez ◽

Sarah Mizrahi ◽

Sophie Cordiez ◽

...

Keyword(s):

Weight Gain ◽

Gestational Weight Gain ◽

Neonatal Outcomes ◽

Gestational Weight ◽

Maternal And Neonatal Outcomes ◽

Twin Pregnancies

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Characteristics of the Family Support Network of Pregnant Adolescents and Its Association with Gestational Weight Gain and Birth Weight of Newborns

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph16071222 ◽

2019 ◽

Vol 16 (7) ◽

pp. 1222

Author(s):

Reyna Sámano ◽

Hugo Martínez-Rojano ◽

Gabriela Chico-Barba ◽

Bernarda Sánchez-Jiménez ◽

Daniel Illescas-Zarate ◽

...

Keyword(s):

Weight Gain ◽

Family Support ◽

Gestational Weight Gain ◽

Neonatal Outcomes ◽

Support Network ◽

Pregnant Adolescents ◽

Gestational Weight ◽

The Family ◽

Maternal And Neonatal Outcomes ◽

Primary Support

It has been proposed that, in the Mexican culture, family support can be a factor that contributes to protect the maternal and child health of pregnant adolescents. There may be complex associations between family support and the circumstances of a pregnancy during adolescence. The aim of the study was to analyze the association between the family support network (FSN) characteristic and the maternal and neonatal outcomes in Mexican adolescents. A cross-sectional study was conducted, and 352 pregnant adolescents participated; their FSN during pregnancy was assessed. The gestational weight gain and birth weight/length of newborns were registered. The size of the FSN was described and divided into quartiles; the main members for each quartile were identified. Then, sociodemographic and clinical variables were compared by FSN quartiles. Logistic regression models were performed to assess the association of FSN size and pregnancy and neonatal outcomes. Our results indicate that the mean age was 15 ± 1 year old. The primary support member in the FSN was the mother of the adolescent in each quartile, except for quartile 3, where the primary support was the mother-in-law. In quartile 3 there was a significantly lower gestational weight gain compared to quartile 4 (11.8 ± 5 vs. 13 ± 5 kg, p = 0.054). According to the regression model, a higher risk of small for gestational age (OR 2.99, CI 95% 1.25–7.15) newborns was found in quartile 3. We conclude that the maternal and neonatal outcomes did not differ between quartiles of FSN size, except for quartile 3. Small for gestational age newborns were observed when a non-blood relative was present in the FSN. The quality rather than the network size might be more important for improving pregnancy outcomes.

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The Impact of Gestational Weight Gain on the Risks of Adverse Maternal and Infant Outcomes among Normal BMI Women with High Triglyceride Levels during Early Pregnancy

Nutrients ◽

10.3390/nu13103454 ◽

2021 ◽

Vol 13 (10) ◽

pp. 3454

Author(s):

Xia-Fei Jiang ◽

Hui Wang ◽

Dan-Dan Wu ◽

Jian-Lin Zhang ◽

Ling Gao ◽

...

Keyword(s):

Weight Gain ◽

Preterm Birth ◽

Gestational Diabetes ◽

Early Pregnancy ◽

Pregnancy Outcomes ◽

Gestational Hypertension ◽

Adverse Pregnancy Outcomes ◽

Gestational Weight ◽

Adverse Pregnancy ◽

The Impact

A high maternal triglyceride (mTG) level during early pregnancy is linked to adverse pregnancy outcomes, but the use of specific interventions has been met with limited success. A retrospective cohort study was designed to investigate the impact of gestational weight gain (GWG) on the relationship between high levels of mTG and adverse pregnancy outcomes in normal early pregnancy body mass index (BMI) women. The patients included 39,665 women with normal BMI who had a singleton pregnancy and underwent serum lipids screening during early pregnancy. The main outcomes were adverse pregnancy outcomes, including gestational hypertension, preeclampsia, gestational diabetes, cesarean delivery, preterm birth, and large or small size for gestational age (LGA or SGA) at birth. As a result, the high mTG (≥2.05mM) group had increased risks for gestational hypertension ((Adjusted odds ratio (AOR), 1.80; 95% CI, 1.46 to 2.24)), preeclampsia (1.70; 1.38 to 2.11), gestational diabetes (2.50; 2.26 to 2.76), cesarean delivery (1.22; 1.13 to 1.32), preterm birth (1.42, 1.21 to 1.66), and LGA (1.49, 1.33 to 1.68) compared to the low mTG group, after adjustment for potential confounding factors. Additionally, the risks of any adverse outcome were higher in each GWG subgroup among women with high mTG than those in the low mTG group. High mTG augmented risks of gestational hypertension, preeclampsia, preterm birth, and LGA among women with 50th or greater percentile of GWG. Interestingly, among women who gained less than the 50th percentile of GWG subgroups, there was no relationship between high mTG level and risks for those pregnancy outcomes when compared to low mTG women. Therefore, weight control and staying below 50th centile of the suggested GWG according to gestational age can diminish the increased risks of adverse pregnancy outcomes caused by high mTG during early pregnancy.

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