Effect of Excess Gestational Weight Gain on Pregnancy Outcomes in Women With Type 1 Diabetes

Obstetrics and Gynecology (Impact Factor: 5.18). 05/2014; 123(6). DOI: 10.1097/AOG.0000000000000271
Source: PubMed


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.
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