Association Between Gestational Weight Gain in Women With Gestational Diabetes Mellitus and Adverse Pregnancy Outcomes: a Retrospective Cohort Study
Abstract Purpose: To examine the association between gestational weight gain (GWG) in women with gestational diabetes mellitus (GDM) and adverse pregnancy outcomes (APOs).Methods: This retrospective cohort study enrolled women with GDM and singleton live birth pregnancies who delivered between January 2010 and December 2020. Univariable and multivariable logistic regression analyses were used to determine the association between GWG outside the Institute of Medicine (IOM) guidelines and APOs.Results: Overall, 1606 women with GDM fulfilled the inclusion criteria. After adjusting for confounders, total GWG above IOM guidelines in pregnancy was associated with an increased risk of caesarean delivery [adjusted odds ratio (aOR)=1.34, 95% confidence interval (CI): 1.04-1.72], hypertensive disorders of pregnancy (HDP) (aOR=2.00, 95% CI: 1.28-3.12), preeclampsia (aOR=2.06, 95% CI: 1.01-3.12), macrosomia (aOR=1.55, 95% CI: 1.13-2.13) and LGA (aOR=1.83, 95% CI: 1.43-2.10), and a decreased risk of premature rupture of membrane (PROM) (aOR=0.46, 95% CI: 0.36-0.60) and preterm birth (aOR=0.35, 95% CI: 0.26-0.44); total GWG below IOM guidelines in pregnancy was associated with an increased relative risk of preterm birth (aOR=1.96, 95% CI: 1.44-2.66) and SGA (aOR=1.32, 95% CI: 1.11-1.50) and a decreased relative risk of macrosomia (aOR=0.35, 95% CI: 0.23-0.53). Further, in both second and third trimesters of pregnancy, GWG above IOM guidelines was found to be associated with a high risk of HDP (aOR=2.55, 95% CI: 1.86-3.38; aOR=1.93, 95% CI: 1.08-2.98), preeclampsia (aOR=2.28, 95% CI: 1.21-3.81; aOR=2.17, 95% CI: 1.35-4.37), macrosomia (aOR=1.20, 95% CI: 1.02-1.82; aOR=2.02, 95% CI: 1.51-2.64) and LGA (aOR=1.65, 95% CI: 1.36-2.04; aOR=1.88, 95% CI: 1.62-2.18). GWG above IOM guidelines in the third trimester of pregnancy also increased the risk of caesarean delivery (aOR=1.48, 95% CI: 1.16-2.34). While GWG below IOM guidelines in both second and third trimesters of pregnancy was associated with a decreased relative risk of macrosomia (aOR=0.66, 95% CI: 0.52-0.78; aOR=0.52, 95% CI: 0.39-0.63). In addition, GWG below IOM guidelines in the third trimester of pregnancy was associated with an increased relative risk of preterm birth (aOR=1.52, 95% CI: 1.12-2.05) and SGA (aOR=1.21, 95% CI: 1.10-1.69).Conclusion: GWG, outside the IOM guidelines has increased risks of APOs among women with GDM, implying that careful surveillance for GWG during different stages of pregnancy is warranted.