The heterogeneous associations between gestational weight gain and adverse pregnancy outcomes in gestational diabetes mellitus according to abnormal glucose metabolism
Open accessAbstract
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.
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Lower GWG in women with GDM is associated with reduced risks of pregnancy-induced hypertension, pre-eclampsia, caesarean section, and macrosomia without increasing small-for-gestational-age risks.
“Lower GWG in women with GDM [44,45,46,47,48,49] is associated with reduced risks of pregnancy-induced hypertension, pre-eclampsia [49,50,51], caesarean section [47], and macrosomia [43,49] without increasing small-for-gestational-age (SGA) risks [43,49].”
From Medical Nutrition Therapy for Women with Gestational Diabetes: Current Practice and Future Perspectives (2025) · cites this paper as [45]
The Results (page unavailable) associate insufficient gestational weight gain with lower risks of pregnancy-induced hypertension and macrosomia in women with impaired glucose tolerance, a subgroup of women with GDM. But they report an increased risk of small-for-gestational-age birth (adjusted OR 1.94), contrary to the claim; pre-eclampsia was included in the hypertension outcome but not reported separately. The caesarean-section clause cites a different source. (LLM, conf=0.91)
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Cites
Hyperglycemia and adverse pregnancy outcomes
(2008) · New England Journal of Medicine · doi:10.1056/nejmoa0707943 · Cited by 5,563 · see citing works
International Association of Diabetes and Pregnancy Study Groups Consensus Panel (2010) · Diabetes Care · doi:10.2337/dc09-1848 · Cited by 5,390 · see citing works
Effect of Treatment of Gestational Diabetes Mellitus on Pregnancy Outcomes
Crowther, C. A., Hiller, J. E., Moss, J. R., McPhee, A. J., Jeffries, W. S., & Robinson, J. S. (2005) · New England Journal of Medicine · doi:10.1056/nejmoa042973 · Cited by 3,159 · see citing works
Elective induction versus spontaneous labor after sonographic diagnosis of fetal macrosomia.
Combs, C. A., Singh, N. B., & Khoury, J. C. (1993) · PubMed · Cited by 2,462 · see citing works
A Multicenter, Randomized Trial of Treatment for Mild Gestational Diabetes
Landon, M. B., Spong, C. Y., Thom, E., Carpenter, M. W., Ramin, S. M., Casey, B., Wapner, R. J., Varner, M. W., Rouse, D. J., Thorp, J. M., et al. (2009) · New England Journal of Medicine · doi:10.1056/nejmoa0902430 · Cited by 2,122 · cited 1× · see citing works
“However, other studies also showed that the incidence of LGA was comparable to that of SGA in intervened GDM group [32, 33].”
ResultBrown, M. A., Lindheimer, M. D., de Swiet, M., Assche, A. V., & Moutquin, J. (2001) · Hypertension in Pregnancy · doi:10.1081/prg-100104165 · Cited by 1,894 · see citing works
Association of Gestational Weight Gain With Maternal and Infant Outcomes
Goldstein, R. F., Abell, S. K., Ranasinha, S., Misso, M. L., Boyle, J. A., Black, M. H., Li, N., Hu, G., Corrado, F., Rode, L., et al. (2017) · JAMA · doi:10.1001/jama.2017.3635 · Cited by 1,646 · see citing works
Impaired Fasting Glucose and Impaired Glucose Tolerance
Nathan, D. M., Davidson, M. B., DeFronzo, R. A., Heine, R. J., Henry, R. R., Pratley, R., & Zinman, B. (2007) · Diabetes Care · doi:10.2337/dc07-9920 · Cited by 1,396 · see citing works
Increasing Prevalence of Gestational Diabetes Mellitus
Ferrara, A. (2007) · Diabetes Care · doi:10.2337/dc07-s206 · Cited by 1,171 · see citing works
The Hyperglycemia and Adverse Pregnancy Outcome Study
Catalano, P. M., McIntyre, H. D., Cruickshank, J. K., McCance, D. R., Dyer, A. R., Metzger, B. E., Lowe, L. P., Trimble, E. R., Coustan, D. R., Hadden, D. R., et al. (2012) · Diabetes Care · doi:10.2337/dc11-1790 · Cited by 954 · see citing works
Gestational Diabetes Mellitus and Macrosomia: A Literature Review
Kc, K., Shakya, S., & Zhang, H. (2015) · Annals of Nutrition and Metabolism · doi:10.1159/000371628 · Cited by 924 · see citing works
Abdul-Ghani, M. A., Tripathy, D., & DeFronzo, R. A. (2006) · Diabetes Care · doi:10.2337/dc05-2179 · Cited by 744 · see citing works
Prevalence of gestational diabetes mellitus in mainland China: A systematic review and meta‐analysis
Gao, C., Sun, X., Lu, L., Liu, F., & Yuan, J. (2018) · Journal of Diabetes Investigation · doi:10.1111/jdi.12854 · Cited by 690 · see citing works
Sacks, D. A., Hadden, D. R., Maresh, M., Deerochanawong, C., Dyer, A. R., Metzger, B. E., Lowe, L. P., Coustan, D. R., Hod, M., Oats, J. J. N., et al. (2012) · Diabetes Care · doi:10.2337/dc11-1641 · Cited by 687 · see citing works
König, I. R., Fuchs, O., Hansen, G., von Mutius, E., & Kopp, M. (2017) · European Respiratory Journal · doi:10.1183/13993003.00391-2017 · Cited by 579 · see citing works
Hyperglycaemia and risk of adverse perinatal outcomes: systematic review and meta-analysis
Farrar, D., Simmonds, M. C., Bryant, M., Sheldon, T., Tuffnell, D. J., Golder, S., Dunne, F., & Lawlor, D. A. (2016) · BMJ · doi:10.1136/bmj.i4694 · Cited by 413 · see citing works
Williams, B., MacDonald, T. M., Morant, S. V., Webb, D. J., Sever, P., McInnes, G. T., Ford, I., Cruickshank, J. K., Caulfield, M. J., Padmanabhan, S., et al. (2018) · Research Portal (King's College London) · doi:10.1016/s2213-8587 · Cited by 409 · see citing works
Maternal obesity during pregnancy and cardiovascular development and disease in the offspring
Gaillard, R. (2015) · European Journal of Epidemiology · doi:10.1007/s10654-015-0085-7 · Cited by 322 · see citing works
Scholtens, D. M., Kuang, A., Lowe, L. P., Hamilton, J., Lawrence, J. M., Lebenthal, Y., Brickman, W. J., Clayton, P., Ma, R. C., McCance, D., et al. (2019) · Diabetes Care · doi:10.2337/dc18-2021 · Cited by 310 · see citing works
Haugen, M. A., Brantsæter, A. L., Winkvist, A., Lissner, L., Alexander, J., Oftedal, B., Magnus, P. M., & Meltzer, H. M. (2014) · BMC Pregnancy and Childbirth · doi:10.1186/1471-2393-14-201 · Cited by 289 · see citing works
Pregnancy Outcomes With Weight Gain Above or Below the 2009 Institute of Medicine Guidelines
Johnson, J. M., Clifton, R. G., Roberts, J. M., Myatt, L., Hauth, J. C., Spong, C. Y., Varner, M. W., Wapner, R. J., Thorp, J. M., Mercer, B. M., et al. (2013) · Obstetrics and Gynecology · doi:10.1097/aog.0b013e31828aea03 · Cited by 254 · see citing works
Markolf Hanefeld, E., Koehler, C., Fuecker, K., Henkel, E., Schäper, F., & Temelkova-Kurktschiev, T. S. (2003) · Diabetes Care · doi:10.2337/diacare.26.3.868 · Cited by 238 · see citing works
Mack, L. R., & Tomich, P. G. (2017) · Obstetrics and Gynecology Clinics of North America · doi:10.1016/j.ogc.2017.02.002 · Cited by 237 · see citing works
The accuracy of self‐reported pregnancy‐related weight: a systematic review
Headen, I. E., Cohen, A. K., Mujahid, M. S., & Abrams, B. F. (2017) · Obesity Reviews · doi:10.1111/obr.12486 · Cited by 223 · see citing works
How Early Should Obesity Prevention Start?
Gillman, M. W., & Ludwig, D. S. (2013) · New England Journal of Medicine · doi:10.1056/nejmp1310577 · Cited by 211 · see citing works
Black, M. H., Sacks, D. A., Xiang, A. H., & Lawrence, J. M. (2010) · Diabetes Care · doi:10.2337/dc10-1445 · Cited by 157 · see citing works
A prospective study of prepregnancy dietary fat intake and risk of gestational diabetes
Bowers, K., Tobias, D. K., Yeung, E., Hu, F. B., & Zhang, C. (2012) · The American Journal of Clinical Nutrition · doi:10.3945/ajcn.111.026294 · Cited by 156 · see citing works
Association Between Gestational Weight Gain and Perinatal Outcomes
Kominiarek, M. A., Saade, G., Mele, L., Bailit, J., Reddy, U. M., Wapner, R. J., Varner, M. W., Thorp, J. M., Caritis, S. N., Prasad, M., et al. (2018) · Obstetrics & Gynecology · doi:10.1097/aog.0000000000002854 · Cited by 148 · see citing works
Weight Gain Recommendations in Pregnancy and the Obesity Epidemic
Artal, R., Lockwood, C. J., & Brown, H. L. (2010) · Obstetrics & Gynecology · doi:10.1097/aog.0b013e3181c51908 · Cited by 125 · see citing works
Li, C., Liu, Y., & Zhang, W. (2015) · PLOS ONE · doi:10.1371/journal.pone.0136850 · Cited by 125 · see citing works
Weight gain in pregnancy: does the Institute of Medicine have it right?
Truong, Y., Yee, L., Caughey, A., & Cheng, Y. W. (2015) · American Journal of Obstetrics and Gynecology · doi:10.1016/j.ajog.2015.01.027 · Cited by 120 · see citing works
Gestational diabetes: weight gain during pregnancy and its relationship to pregnancy outcomes
Gou, B.-H., Guan, H.-M., Bi, Y.-X., & Ding, B.-J. (2019) · Chinese Medical Journal · doi:10.1097/cm9.0000000000000036 · Cited by 91 · see citing works
Weight gain adequacy and pregnancy outcomes in gestational diabetes: a meta‐analysis
Viecceli, C., Remonti, L. R., Hirakata, V. N., Mastella, L. S., Gnielka, V., Oppermann, M. L. R., Silveiro, S. P., & Reichelt, A. J. (2017) · Obesity Reviews · doi:10.1111/obr.12521 · Cited by 90 · see citing works
Barnes, R. A., Wong, T., Ross, G. P., Griffiths, M. M., Smart, C. E., Collins, C. E., MacDonald-Wicks, L., & Flack, J. R. (2020) · Diabetes Care · doi:10.2337/dc19-0800 · Cited by 80 · see citing works
Gestational weight gain and preterm birth in obese women: a systematic review and meta‐analysis
Faucher, M., Hastings‐Tolsma, M., Song, J., Willoughby, D., & Bader, S. G. (2015) · BJOG An International Journal of Obstetrics & Gynaecology · doi:10.1111/1471-0528.13797 · Cited by 76 · see citing works
Role of Body Mass Index and gestational weight gain on preterm birth and adverse perinatal outcomes
Silva, F. P., Souza, R. T., Cecatti, J. G., Passini, R., Tedesco, R. P., Lajos, G. J., Nomura, M. L., Rehder, P. M., Dias, T. Z., Oliveira, P. F., et al. (2019) · Scientific Reports · doi:10.1038/s41598-019-49704-x · Cited by 73 · see citing works
Wong, T., Barnes, R. A., Ross, G. P., Cheung, N. W., & Flack, J. R. (2017) · Diabetologia · doi:10.1007/s00125-016-4173-3 · Cited by 54 · see citing works
Adverse Outcomes and Potential Targets for Intervention in Gestational Diabetes and Obesity
Scifres, C., Feghali, M., Althouse, A. D., Caritis, S., & Catov, J. (2015) · Obstetrics & Gynecology · doi:10.1097/aog.0000000000000928 · Cited by 49 · see citing works
Glucose Intolerance in Pregnancy and Offspring Obesity in Late Adolescence
Bendor, C. D., Bardugo, A., Rotem, R. S., Derazne, E., Gerstein, H. C., Tzur, D., Pinhas‐Hamiel, O., Tsur, A. M., Cukierman‐Yaffe, T., Lebenthal, Y., et al. (2022) · Diabetes Care · doi:10.2337/dc21-2634 · Cited by 48 · see citing works
Xu, Q., Ge, Z., Bi, Y., Hu, J., Shen, S., & Zhu, D. (2019) · Endocrine Practice · doi:10.4158/ep-2019-0011 · Cited by 32 · see citing works
Disse, E., Graeppi-Dulac, J., Joncour-Mills, G., Dupuis, O., & Thivolet, C. H. (2012) · Diabetes & Metabolism · doi:10.1016/j.diabet.2012.09.006 · Cited by 30 · see citing works
Barquiel, B., Herranz, L., Grande, C., Castro-Dufourny, I., Llaro, M., Ramírez, P. A. P., Burgos, M. A., & Pallardo, L. F. (2014) · Diabetes & Metabolism · doi:10.1016/j.diabet.2013.12.011 · Cited by 27 · see citing works
Chow, E., & Chan, J. C. N. (2019) · The Lancet Diabetes & Endocrinology · doi:10.1016/s2213-8587(19)30421-8 · Cited by 20 · see citing works
da Silveira, L. R. P., Schmidt, M. I., Reichelt, A. J., & Drehmer, M. (2020) · Jornal de Pediatria · doi:10.1016/j.jped.2020.02.004 · Cited by 19 · see citing works
Chiou, Y., Hung, C., & Liao, H. (2018) · Worldviews on Evidence-Based Nursing · doi:10.1111/wvn.12305 · Cited by 17 · see citing works
Zhang, Q., Lee, C. S., Zhang, L., Wu, Q., Chen, Y., Chen, D., Qi, L., & Liang, Z. (2022) · Frontiers in Medicine · doi:10.3389/fmed.2022.842428 · Cited by 11 · see citing works
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2 of the 48 references couldn’t be matched to a known paper.
Research works printed but not linked: 1
- [8]Institute of M, National Research Council Committee to Reexamine IOMPWG. The National Academies Collection: Reports funded by National Institutes of Health. In Weight gain During Pregnancy: Reexamining the Guidelines (Eds Rasmussen KM, Yaktine AL) Washington (DC): National Academies Press (US); 2009. 20669500
Cited by
Sorted by citations
Zhang, Z., Zhou, Z., & Li, H. (2023) · Journal of Diabetes Investigation · doi:10.1111/jdi.14119 · Cited by 47 · see citing works
Wu, Y., Liu, Y., Yang, X., Tong, M., Jiang, X., & Gu, X. (2024) · ACS Sensors · doi:10.1021/acssensors.4c00426 · Cited by 19 · see citing works
Cheong, L., Law, L. S.-C., Tan, L. Y. L., Amal, A. A.-A., Khoo, C. M., & Eng, P. C. (2025) · Nutrients · doi:10.3390/nu17071210 · Cited by 14 · see citing works
Almulla, A. A., Ahmed, L. A., Hesselink, A., Augustin, H., & Bärebring, L. (2024) · Nutrition and Health · doi:10.1177/02601060231224010 · Cited by 12 · see citing works
Xiao, Y., Shi, Y., Ni, Y., Ni, M., Yang, Y., & Zhang, X. (2024) · Frontiers in Cellular and Infection Microbiology · doi:10.3389/fcimb.2024.1496447 · Cited by 8 · see citing works
Wu, Q., Wu, Y., Zhu, S., Tang, Y., Zhang, L., Tang, J., Chen, Q., Hu, L., Zhu, P., Fu, X., et al. (2025) · Nature Communications · doi:10.1038/s41467-025-65992-6 · Cited by 8 · see citing works
Self-citationSun, Y., Shen, C., Li, J., Kang, W., Li, X., & Fan, W. (2025) · American Journal of Reproductive Immunology · doi:10.1111/aji.70070 · Cited by 7 · see citing works
Mu, Y., Huang, J., Yang, J., Zuo, H., Monami, M., Moreira, N. C. D. V., & Hussain, A. (2024) · Diabetes Research and Clinical Practice · doi:10.1016/j.diabres.2024.111875 · Cited by 6 · see citing works
Huang, Y., Ainiwan, D., Qiu, Y., Zhang, L., Alifu, X., Cheng, H., Zhou, H., Xu, N., Wang, B., Wang, S., et al. (2025) · Nutrition and Diabetes · doi:10.1038/s41387-025-00365-y · Cited by 4 · see citing works
Self-citationYuan, P., Huang, J., Wan, J., Yu, L., Li, J. J., Huang, B., Li, N., Wei, H., Kong, L., & Qin, J. (2026) · Frontiers in Endocrinology · doi:10.3389/fendo.2026.1861824 · Cited by 2 · see citing works
Fan, X. (2024) · American Journal of Translational Research · doi:10.62347/nigm4906 · Cited by 1 · see citing works
Tang, W., Huang, K.-J., Li, X., Chen, Y., Wang, L., Wang, Y.-X., Tang, Y. Y., Deng, B., Liu, T., & Lan, X. (2025) · Journal of Endocrinological Investigation · doi:10.1007/s40618-025-02585-6
Self-citationJin, W. Y., Huang, Y., Qiu, Y., Alifu, X., Cheng, H., Xu, N., Wang, B., Wang, S., Liu, H., Chen, D., et al. (2025) · Journal of Translational Medicine · doi:10.1186/s12967-025-07474-3
Self-citationGuan, M., Yu, H., Feng, J., Zhu, M., Wang, Y. X., Ge, H., Shi, B., Lu, F., Yu, J., Gao, Z., et al. (2026) · Reproductive Biology and Endocrinology · doi:10.1186/s12958-026-01531-2
Correlation analysis of serum PAPP-A2, PIGF with the prognosis of gestational diabetes mellitus
Gao, M., Sheng, X., Wang, M., Gu, X., Yu, H., Huang, T., Zhang, L., Li, W., & Gui, Y. (2026) · Journal of Medical Biochemistry · doi:10.5937/jomb0-62756
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- Authors
- Wu, Q., Chen, Y., Ma, H., Zhou, T., Hu, Y., Liang, Z., & Chen, D.
- Affiliations
- Women's Hospital, School of Medicine, Zhejiang University (CN)
- Tulane University (US)
- Corresponding author
- Liang, Zhaoxia
- Venue
- Nutrition & Diabetes
- Published
- 2023-07-04
- Volume
- 13
- Issue
- 1
- Pages
- 10-10
- ISSN
- 2044-4052 (ISSN-L)
- PMC
- PMC10319727
- OpenAlex
- W4383070133
- Cited by
- 16
- References
- 48
- Citations by year
- 2026: 4 · 2025: 6 · 2024: 5 · 2023: 1
- FWCI
- 5.00
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Locations
- Nutrition and Diabetes (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Funders
- Tulane University
- National Natural Science Foundation of China (81974234)
- National Key Research and Development Program of China (2021YFC2700700, 2018YFC1004603)
- Topics
- Health Sciences › Medicine › Obstetrics and Gynecology › Gestational Diabetes Research and Management
- Health Sciences › Medicine › Obstetrics and Gynecology › Pregnancy and preeclampsia studies
- Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Birth, Development, and Health
- Keywords
- gestational weight gain, gestational diabetes mellitus, abnormal glucose metabolism, impaired fasting glucose, impaired glucose tolerance, gestational hypertension, macrosomia, large for gestational age, low birth weight, preterm birth, postpartum hemorrhage, cesarean section, excessive weight gain, insufficient weight gain, glucose tolerance test
- MeSH terms
- Gestational Weight Gain, Female, Glucose, Humans, Infant, Newborn, Prediabetic State, Pregnancy, Pregnancy Outcome, Retrospective Studies, Body Mass Index, Diabetes, Gestational, Glucose Intolerance
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