Title : The heterogeneous associations between gestational weight gain and adverse pregnancy outcomes in gestational diabetes mellitus according to abnormal glucose metabolism
Abstract:
Objectives:
The gestational weight gain (GWG) and hyperglycemia are two key factors affecting adverse pregnancy outcomes among women with gestational diabetes mellitus (GDM). We aimed to investigate the combinatorial effect of abnormal glucose metabolism and GWG on adverse outcomes in GDM.
Methods:
This retrospective cohort study included 2611 pregnant women with GDM in Women’s Hospital School of Medicine Zhejiang University. Bases on the OGTT glucose levels, we categorized the GDM cohort into three subgroups: impaired fasting glucose (IFG) group, impaired glucose tolerance (IGT) group, and combined impaired glucose (IFG&IGT) group.
Results:
Among pregnant women with IGT, insufficient GWG (IGWG) was an independent protective factor for pregnancy-induced hypertension syndrome (PIH) (aOR 0.55, 95% CI 0.32-0.95), macrosomia (0.38, 0.19-0.74) and large for gestational age (0.45, 0.32-0.62), as well as an independent risk factor for low birth weight infants (2.29, 1.24-4.22) and small for gestational age (1.94, 1.17-3.19); and excessive GWG (EGWG) was related to increased risks of PIH (1.68, 1.12-2.52), preterm delivery (1.82, 1.28-2.58), postpartum hemorrhage (1.85, 1.05-3.28), cesarean delivery (1.84, 1.38-2.46) and low body weight infants (2.36, 1.33-4.20). Moreover, EGWG was positively associated with PIH (3.27, 1.09-9.80) in the IFG group. But there were no significant associations between either IGWG or EGWG and any pregnancy outcomes in women with combined IFG&IGT.
Conclusions:
The relationships between GWG and adverse outcomes were modified by abnormal glucose metabolism in women with GDM. Our results suggest that more specific GWG recommendations according to their metabolic state are needed for GDM.
Audience Takeaway:
- Our study observes significant heterogeneity in relationships between GWG and the adverse maternal and neonatal outcomes in GDM women with different abnormal glucose metabolism.
- For clinician, different recommendations for weight gain during pregnancy should be provided for GDM pregnant women. For pregnant women with IGT, proper weight gain during pregnancy is particularly important, while IFG and IFG&IGT women should not ignore other potential risk factors (including pre-pregnancy BMI, blood glucose values and so on) when paying attention to GWG.
- Our study emphasizes that stratified management and precision intervention for GDM will be a direction to improve the perinatal outcome of GDM and delaying the occurrence of long-term maternal and infant diseases.
