1311Postpartum weight retention and pregnancy weight gain in women with Gestational Diabetes Mellitus (GDM)

Background Since GDM is important risk factor for type 2 diabetes and maternal obesity can potentiate this outcome, the study sought to describe gestational weight gain and one-year postpartum weight retention (PPWR) in women with GDM. Methods Multicentre cohort study of 598 women with GDM enrolled in prenatal clinics of the Brazilian National Health System and followed by telephone up to 1-year postpartum. Socioeconomic and nutritional data were evaluated in recruitment. Gestational weight gain (GWG) and pre-pregnancy BMI were classified according to Institute of Medicine, 2009. PPWR was the difference between weights 1-year postpartum and pre-pregnancy. Chi-square test compared proportions of PPWR, pre-gestational BMI and GWG. Results Women had mean age 31.2 ± 6.1 years. Mean pre-pregnancy BMI was 30.3 ± 6.5 kg/m², GWG was 9.6 ± 7.3 kg and PPWR was 0.8 ± 6.8. Pre-pregnancy BMI over 25 kg/m² was found in 78%, excessive GWG in 37.6% and PPWR 1-year in 47.7%. PPWR ≥ 5kg was found in 27.6% and was higher in excessive GWG (p < 0.001). Women with excessive GWG, 55.2% had PPWR ≥ 5kg. For all categories of pre-pregnancy BMI, there was higher proportion of PPWR ≥ 5kg in those who had excessive GWG. Conclusions Almost half of women who had GDM presented weight retention in 1-year postpartum. We found more PPWR in who had excessive pregnancy weight gain. Key messages PPWR is common in women with GDM and there is higher proportion of PPWR ≥ 5kg in women with excessive GWG in all pre-pregnancy BMI categories.

Maternal obesity, pregnancy weight gain, and birth weight and risk of colorectal cancer

ObjectiveColorectal cancer (CRC) is a leading cause of cancer-related death worldwide. Obesity is a well-established risk factor for CRC, and fetal or developmental origins of obesity may underlie its effect on cancer in adulthood. We examined associations of maternal obesity, pregnancy weight gain, and birth weight and CRC in adult offspring.DesignThe Child Health and Development Studies is a prospective cohort of women receiving prenatal care between 1959 and 1966 in Oakland, California (N=18 751 live births among 14 507 mothers). Clinical information was abstracted from mothers’ medical records 6 months prior to pregnancy through delivery. Diagnoses of CRC in adult (age ≥18 years) offspring were ascertained through 2019 by linkage with the California Cancer Registry. We used Cox proportional hazards models to estimate adjusted HR (aHR); we examined effect measure modification using single-referent models to estimate the relative excess risk due to interaction (RERI).Results68 offspring were diagnosed with CRC over 738 048 person-years of follow-up, and half (48.5%) were diagnosed younger than age 50 years. Maternal obesity (≥30 kg/m2) increased the risk of CRC in offspring (aHR 2.51, 95% CI 1.05 to 6.02). Total weight gain modified the association of rate of early weight gain (RERI −4.37, 95% CI −9.49 to 0.76), suggesting discordant growth from early to late pregnancy increases risk. There was an elevated association with birth weight (≥4000 g: aHR 1.95, 95% CI 0.8 to 4.38).ConclusionOur results suggest that in utero events are important risk factors for CRC and may contribute to increasing incidence rates in younger adults.

Diagnostic accuracy of modified Hadlock formula for fetal macrosomia in women with gestational diabetes and pregnancy weight gain above recommended

Objectives Women with gestational diabetes (GDM) and weight gain during pregnancy above recommended more often give birth to macrosomic children. The goal of this study was to evaluate the diagnostic accuracy of the modified formula for ultrasound assessment of fetal weight created in a pilot study using a similar specimen in comparison to the Hadlock-2 formula. Methods This is a prospective, cohort, applicative, observational, quantitative, and analytical study, which included 213 pregnant women with a singleton pregnancy, GDM, and pregnancy weight gain above recommended. Participants were consecutively followed in the time period between July 1st, 2016, and August 31st, 2020. Ultrasound estimations were made within three days before the delivery. Fetal weights estimated using both formulas were compared to the newborns’ weights. Results A total of 133 fetal weight estimations were made. In comparison to the newborns’ weight modified formula had significantly smaller deviation in weight estimation compared to the Hadlock-2 formula, higher frequency of deviation within 5% of newborns weights (78.2% [95% CI=0.74–0.83] vs. 60.2%), smaller frequency of deviations from 5 to 10% (19.5 vs. 33.8%) and above 10%, which was even more significant among macrosomic children. There were 36/50 (72%) correctly diagnosed cases of macrosomia by modified and 33/50 (66%) by Hadlock-2 formula. Area under the curve (AUC) for the modified formula was 0.854 (95% CI=0.776–0.932), and for the Hadlock-2 formula 0.824 (95% CI=0.740–0.908). The positive predictive value of the modified formula was 81.81%, the negative 97.91%. Conclusions In cases of greater fetal weights, the modified formula showed greater precision.

The Effects of Pre-Pregnancy Body Mass Index and Weight Gain During Pregnancy on Perinatal Outcomes: A Retrospective Cohort Study

OBJECTIVE: To investigate the effects of pre-pregnancy body mass index and weight gain during pregnancy on perinatal outcomes and delivery mode. STUDY DESIGN: In this retrospective cohort study, 722 pregnant women giving birth between 2018-2019 were screened from our hospital database. First, they were divided into four groups according to their pre-pregnancy body mass index (low-weight/normal-weight/overweight/obese), and then they were redivided into three groups according to pregnancy weight gain (≤7/8-15/≥16 kg). Prenatal body mass index and pregnancy weight gain were compared concerning maternal-neonatal results and mode of delivery. RESULTS: According to pre-pregnancy body mass index, among the obese pregnant group, gestational diabetes mellitus (p<0.001), preeclampsia (p=0.029), preterm delivery (p=0.011) and cesarean delivery (p=0.061) rates were more common. As the body mass index increases, neonatal intensive care requirement (p=0.0020) and low 1st minute APGAR scores (p=0.019) were detected more frequently. However, as pregnancy weight gain decreased, preterm delivery (p=0.041) increased. Also, birth weight increased (p<0.001) with the weight gain of the pregnant. Pregnant women gaining more than 16 kg were associated either with a lower <2500 g or a higher birth weight risk >4000 g. CONCLUSION: Pre-pregnancy high body mass index is associated with negative obstetric outcomes like gestational diabetes, preeclampsia, preterm delivery, and increased cesarean rates, and poor fetal incidences with a low APGAR score and high neonatal intensive care admission rates.