Tang Wong1,2,3, Robyn A Barnes4,5, Glynis P Ross4,6, Ngai W Cheung6,7, Jeff R Flack4,8,9. 1. Diabetes Centre, Bankstown-Lidcombe Hospital, 68 Eldridge Rd, Bankstown, NSW, 2200, Australia. drwongt@gmail.com. 2. Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia. drwongt@gmail.com. 3. Faculty of Medicine, University of Sydney, Sydney, NSW, Australia. drwongt@gmail.com. 4. Diabetes Centre, Bankstown-Lidcombe Hospital, 68 Eldridge Rd, Bankstown, NSW, 2200, Australia. 5. School of Health Sciences, Faculty of Health and Medicine, The University of Newcastle, Callaghan, NSW, Australia. 6. Faculty of Medicine, University of Sydney, Sydney, NSW, Australia. 7. Department of Diabetes and Endocrinology, Westmead Hospital, Westmead, NSW, Australia. 8. Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia. 9. School of Medicine, Western Sydney University, Sydney, NSW, Australia.
Abstract
AIMS/HYPOTHESIS: Our aim was to study the relationship between excessive gestational weight gain (GWG) according to Institute of Medicine (IOM) targets and perinatal outcomes, and examine whether modifying targets may improve outcomes in women with gestational diabetes mellitus (GDM). METHODS: This was a retrospective cohort study of all GDM pregnancies from 1992 to 2013. ORs were calculated for associations between excessive GWG (EGWG) using IOM targets and adverse pregnancy outcomes. ORs were then adjusted for maternal age, gestational age at diagnosis, prepregnancy BMI, gravidity, parity, ethnicity, antenatal fasting blood glucose level (BGL), 2 h BGL and HbA1c. BMI was categorised into underweight (<18.5 kg/m2), healthy weight (18.5-24.9 kg/m2), overweight (25-29.9 kg/m2) and obese (≥30 kg/m2). Large for gestational age (LGA) was defined as birthweight above the 90th percentile, small for gestational age (SGA) was birthweight below the 10th percentile, macrosomia was birthweight >4000 g, and preterm delivery was delivery prior to 37 weeks' gestation. Modified GWG targets were derived by: (1) subtracting 2 kg from the upper IOM target only; (2) subtracting 2 kg from both upper and lower targets; (3) using the interquartile range of maternal GWG of women with infants who were appropriate for gestational age per BMI category; and (4) restricting GWG to 0-4 kg in women with BMI ≥35 kg/m2. RESULTS: Among 3095 GDM pregnancies, only 31.7% had GWG within IOM guidelines. Adjusted ORs for women who exceeded GWG were Caesarean section (1.5; 95% CI 1.2, 1.9), LGA (1.8; 95% CI 1.4, 2.4) and macrosomia (2.3; 95% CI 1.6, 3.3); there was a lower risk of SGA (adjusted OR 0.5; 95% CI 0.3, 0.7). CONCLUSIONS/ INTERPRETATION: EGWG according to IOM targets was associated with Caesarean section, LGA and macrosomia. Modification of IOM criteria, including more restrictive targets, did not improve perinatal outcomes.
AIMS/HYPOTHESIS: Our aim was to study the relationship between excessive gestational weight gain (GWG) according to Institute of Medicine (IOM) targets and perinatal outcomes, and examine whether modifying targets may improve outcomes in women with gestational diabetes mellitus (GDM). METHODS: This was a retrospective cohort study of all GDM pregnancies from 1992 to 2013. ORs were calculated for associations between excessive GWG (EGWG) using IOM targets and adverse pregnancy outcomes. ORs were then adjusted for maternal age, gestational age at diagnosis, prepregnancy BMI, gravidity, parity, ethnicity, antenatal fasting blood glucose level (BGL), 2 h BGL and HbA1c. BMI was categorised into underweight (<18.5 kg/m2), healthy weight (18.5-24.9 kg/m2), overweight (25-29.9 kg/m2) and obese (≥30 kg/m2). Large for gestational age (LGA) was defined as birthweight above the 90th percentile, small for gestational age (SGA) was birthweight below the 10th percentile, macrosomia was birthweight >4000 g, and preterm delivery was delivery prior to 37 weeks' gestation. Modified GWG targets were derived by: (1) subtracting 2 kg from the upper IOM target only; (2) subtracting 2 kg from both upper and lower targets; (3) using the interquartile range of maternal GWG of women with infants who were appropriate for gestational age per BMI category; and (4) restricting GWG to 0-4 kg in women with BMI ≥35 kg/m2. RESULTS: Among 3095 GDM pregnancies, only 31.7% had GWG within IOM guidelines. Adjusted ORs for women who exceeded GWG were Caesarean section (1.5; 95% CI 1.2, 1.9), LGA (1.8; 95% CI 1.4, 2.4) and macrosomia (2.3; 95% CI 1.6, 3.3); there was a lower risk of SGA (adjusted OR 0.5; 95% CI 0.3, 0.7). CONCLUSIONS/ INTERPRETATION: EGWG according to IOM targets was associated with Caesarean section, LGA and macrosomia. Modification of IOM criteria, including more restrictive targets, did not improve perinatal outcomes.
Entities:
Keywords:
Gestational diabetes mellitus; Gestational weight gain; Institute of Medicine; Large for gestational age; Perinatal outcomes; Pregnancy
Authors: Sarah R Crozier; Hazel M Inskip; Keith M Godfrey; Cyrus Cooper; Nicolas C Harvey; Zoë A Cole; Siân M Robinson Journal: Am J Clin Nutr Date: 2010-04-07 Impact factor: 7.045
Authors: David Simmons; Judith G M Jelsma; Sander Galjaard; Roland Devlieger; Andre van Assche; Goele Jans; Rosa Corcoy; Juan M Adelantado; Fidelma Dunne; Gernot Desoye; Jürgen Harreiter; Alexandra Kautzky-Willer; Peter Damm; Elisabeth R Mathiesen; Dorte M Jensen; Lise Lotte Andersen; Annunziata Lapolla; Maria Dalfra; Alessandra Bertolotto; Ewa Wender-Ozegowska; Agnieszka Zawiejska; David Hill; Pablo Rebollo; Frank J Snoek; Mireille N M van Poppel Journal: Diabetes Care Date: 2015-06-25 Impact factor: 19.112
Authors: Saila B Koivusalo; Kristiina Rönö; Miira M Klemetti; Risto P Roine; Jaana Lindström; Maijaliisa Erkkola; Risto J Kaaja; Maritta Pöyhönen-Alho; Aila Tiitinen; Emilia Huvinen; Sture Andersson; Hannele Laivuori; Anita Valkama; Jelena Meinilä; Hannu Kautiainen; Johan G Eriksson; Beata Stach-Lempinen Journal: Diabetes Care Date: 2015-07-29 Impact factor: 19.112
Authors: Ute M Schaefer-Graf; Siri L Kjos; Omer Kilavuz; Andreas Plagemann; Martin Brauer; Joachim W Dudenhausen; Klaus Vetter Journal: Diabetes Care Date: 2003-01 Impact factor: 19.112
Authors: Carla Assaf-Balut; Nuria García de la Torre; Alejandra Duran; Manuel Fuentes; Elena Bordiú; Laura Del Valle; Cristina Familiar; Johanna Valerio; Inés Jiménez; Miguel A Herraiz; Nuria Izquierdo; María J Torrejon; Maria Ángeles Cuadrado; Isabel Ortega; Francisco J Illana; Isabelle Runkle; Paz de Miguel; Inmaculada Moraga; Carmen Montañez; Ana Barabash; Martín Cuesta; Miguel A Rubio; Alfonso L Calle-Pascual Journal: Ann Nutr Metab Date: 2018-12-14 Impact factor: 3.374
Authors: Xinglei Xie; Jiaming Liu; Isabel Pujol; Alicia López; María José Martínez; Apolonia García-Patterson; Juan M Adelantado; Gemma Ginovart; Rosa Corcoy Journal: J Clin Med Date: 2020-10-18 Impact factor: 4.964
Authors: Carla Assaf-Balut; Nuria Garcia de la Torre; Alejandra Durán; Manuel Fuentes; Elena Bordiú; Laura Del Valle; Johanna Valerio; Cristina Familiar; Inés Jiménez; Miguel Angel Herraiz; Nuria Izquierdo; Maria José Torrejón; Isabelle Runkle; Maria Paz de Miguel; Inmaculada Moraga; Maria Carmen Montañez; Ana Barabash; Martín Cuesta; Miguel A Rubio; Alfonso Luis Calle-Pascual Journal: BMJ Open Diabetes Res Care Date: 2018-10-11
Authors: Zhi Guo Chen; Ya Ting Xu; Lu Lu Ji; Xiao Li Zhang; Xiao Xing Chen; Rui Liu; Chao Wu; Yan Ling Wang; Han Yang Hu; Lin Wang Journal: BMC Pregnancy Childbirth Date: 2020-08-12 Impact factor: 3.007