Effect of pre-gestational weight and gestational weight gain in women with gestational diabetes controlled with medication on pregnancy outcomes – is recommended weight gain too liberal?

Abstract

This is a retrospective cohort study of women with GDM treated with glucose-lowering agents that were followed and gave birth between 2005 and 2015 in the Assaf Harofeh medical center, Israel. Classification and regression tree method identified four groups according to adverse outcomes, consisted of 74 women with pre-gestational BMI below 25, 98 women with BMI 25–31, 90 women 31–39 and 18 women above 39. Respectively, median GWG was 12 kg (8–16), 11 kg (8–15), 7.5 kg (3.75–11) and 5 kg (–1.5 to 11.5) (p < .001). The risk for composite adverse outcomes was higher in the groups of BMI 25–31 (73.5%) and 31–39 (83.3%) in comparison to BMI <25 (51.4%) and 39 < (55.6%), p < .001. In women with pre-gestational BMI of <25, GWG of more than the median resulted in odds ratio of 2.75 (1.07–7.08, p = .036) for adverse pregnancy outcomes compared with participants who gained less than the median. Maternal obesity is related to adverse pregnancy outcomes. Women with GDM with normal pre-gestational BMI who gained weight according to IOM recommendations still experienced adverse outcomes.

摘要

这是一项对2005年至2015年在以色列Assaf Harofeh医疗中心接受降糖药物治疗的妊娠期糖尿病妇女进行的回顾性队列研究。采用分类回归树法将不良结局分为4组, 其中孕前体重指数低于25的74例, 体重指数25-31的98例, 体重指数31-39的90例, 体重指数高于39的18例。平均妊娠期体重增加（GWG）分别为12公斤（8-16）、11公斤（8-15）、7.5公斤（3.75-11）和5公斤（-1.5至11.5）（p < .001）。与BMI <25（51.4%）和BMI < 39（55.6%）相比, BMI 25-31（73.5%）和31-39（83.3%）组发生综合不良反应的风险更高（p < .001）。在妊娠前体重指数小于25的孕妇中, 与体重增幅小于中位数的孕妇相比, GWG大于中位数者其不良妊娠结局的优势比为2.75 （1.07-7.08, p=.036）。孕妇肥胖与不良妊娠结局有关, 而且孕前BMI正常的GDM孕妇根据IOM的建议增加体重, 仍然会出现不良妊娠结局。

The Chinese abstracts are translated by Prof. Dr. Xiangyan Ruan and her team: Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing 100026, China.

Keywords:

• Gestational diabetes
• obesity
• pregnancy

Disclosure statement

No potential conflict of interest was reported by the authors.