Effect of Excess Gestational Weight Gain on Pregnancy Outcomes in Women With Type 1 Diabetes
To evaluate the prevalence and clinical effects of excess gestational weight gain on birth weight and other pregnancy outcomes in women with type 1 diabetes.
We performed a retrospective cohort study of women with type 1 diabetes delivered between 2009 and 2012. Patients with excess weight gain were identified using the 2009 Institute of Medicine weight gain recommendations adjusted for gestational age at delivery and prepregnancy body mass index (BMI) category. Demographic and outcome data were abstracted from the medical record, and pregnancy outcomes were compared between women with and without excess gestational weight gain.
Excess gestational weight gain occurred in 114 of 175 women (65.1%). Large-for-gestational-age (LGA) birth weight occurred in 48 of 114 (42.1%) of women with excess gestational weight gain and 5 of 61 (8.2%) of women with recommended weight gain (P<.001). The association between excess maternal weight gain and LGA birth weight remained significant after adjustment for prepregnancy BMI, gestational age at delivery, nulliparity, vascular complications, and hemoglobin A1c measurements (adjusted odds ratio 8.9, 95% confidence interval 3.1-26.2, P<.001). Stratified analyses demonstrated that excess maternal weight gain is associated with LGA neonates in both normal-weight and overweight or obese women.
Excess maternal weight gain is common and leads to higher rates of LGA neonates in both normal-weight and overweight or obese women with type 1 diabetes. Interventions designed to limit excess gestational weight gain may reduce the risk for fetal overgrowth in women with type 1 diabetes. LEVEL OF EVIDENCE:: II.
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ABSTRACT: Pregnancy in women with diabetes remains complicated despite improvements in glucose control. This seems mainly due to the fact that normoglycemia is still outside of reach. Congenital malformations are already significantly increased in the case of HbA1c values of 2–4SD above the mean, and fetal macrosomia is increasing in incidence. The latter may be due to an increase in maternal body mass index (BMI), absence of cardiovascular complications, better placentation, and increased weight gain during pregnancy. Severe maternal hypoglycemia is a frequent complication during the first trimester of pregnancy. The outcome is generally poorer in the case of type-2 diabetes as compared to type-1, which is likely to be due to a higher incidence of maternal metabolic syndrome. In this article, preconceptional and antenatal management and the mode and timing of delivery are discussed, both for women with preexisting diabetes and for those with gestational diabetes mellitus.
Bailliè re s Best Practice and Research in Clinical Obstetrics and Gynaecology 08/2014; 29(2). DOI:10.1016/j.bpobgyn.2014.08.005 · 1.92 Impact Factor
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ABSTRACT: Background: Increasing rates of overweight and obesity are also seen in patients with type-1 diabetes mellitus (DM 1). The combination of an excess of bodyweight and DM 1 are thought to have a negative effect on metabolic control in patients with DM 1 due to additional insulin resistance on top of absolute insulin deficiency. In overweight and obese women with DM 1, blood glucose management is a challenge before and during pregnancy in clinical practice. If additional overweight or obesity are associated with higher risk for fetal and maternal complications, is still unclear. In this study we aimed to evaluate the rate and impact of overweight and obesity in pregnant women with DM 1. Methods: We performed an analysis of 70 consecutive singleton pregnancies complicated by preexisting DM 1 who consulted the diabetes pregnancy clinic of an academic hospital between 2006 and 2014. We documented and analysed maternal as well as fetal characteristics and outcome data of these pregnancies based on BMI tertiles. Results: 54 % had a BMI ≥ 25 kg/m2 at pregnancy onset (mean age of 32 ± 6 years and average diabetes duration of 17 ± 9 years). A higher rate of preexisting long-term diabetes complications and arterial hypertension were observed in overweight and obese women, but diabetes duration and age were similar between the groups. Fetal and maternal complications did not differ between the BMI tertiles. Conclusion: Overweight and obesity are additional risk factors to consider in the management of pregnant women with DM 1 due to higher rates of preexisting diabetic complications and hypertension as well as its negative impact on metabolic control. Preventive measures in diabetes care and preconceptive counselling are required in order to cope with the growing obesity trend.
Journal fur Gynakologische Endokrinologie 01/2015; 25(3):6-9.
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ABSTRACT: The Institute of Medicine (IOM) does not provide recommendations for gestational weight gain (GWG) specific to women with pregestational diabetes. We aimed to assess the impact of GWG outside the IOM recommendations on perinatal outcomes.
We performed a retrospective cohort study of all singletons with pregestational diabetes from 2008-2013. Women were classified as GWG within, less than, or greater than IOM recommendations for body mass index per week of pregnancy. Maternal outcomes examined were cesarean delivery (CD), preeclampsia, and percentage of visits with glycemic control (>50% blood sugars at goal). Neonatal outcomes were birth weight, small for gestational age (SGA, <10(th) percentile), large for gestational age (LGA, >90(th) percentile), macrosomia (>4000 g), preterm delivery (PTD, <37 weeks), and birth injury (shoulder dystocia, fracture, brachial plexus injury, cephalohematoma). Groups were compared using analysis of variance and chi-squared test, as appropriate. Backwards stepwise logistic regression was used to adjust for confounding factors.
Of 340 subjects, 37 (10.9%) were within, 64 (18.8%) less than, and 239 (70.3%) greater than IOM recommendations. The incidence of CD, preeclampsia, glycemic control, PTD, and birth injury were not significantly different between GWG groups. The incidence of LGA and macrosomia increased as GWG category increased AOR 3.08, 95% CI 1.13-8.39 and AOR 4.02, 95% CI 1.16-13.9 respectively ) without decreasing the incidence of SGA (AOR 0.34, 0.10-1.19 CI 95%). Increases in the risk in LGA and macrosomia were not explained by differences in glycemic control by GWG groups.
Women with pregestational DM should be counseled to gain within the IOM recommendations to avoid LGA and macrosomic newborns.
Copyright © 2015 Elsevier Inc. All rights reserved.
American Journal of Obstetrics and Gynecology 01/2015; 212(1):S213-S214. DOI:10.1016/j.ajog.2014.10.454 · 4.70 Impact Factor
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