The Institute of Medicine Guidelines for Gestational Weight Gain after a Diagnosis of Gestational Diabetes and Pregnancy Outcomes
Open accessAbstract
OBJECTIVE: The objective of this study was to assess the impact of gestational weight gain outside the Institute of Medicine (IOM) recommendations after the diagnosis of gestational diabetes (GDM) on perinatal outcomes. MATERIALS AND METHODS: This was a retrospective cohort study. Women were classified as gestational weight gain (GWG) within, less than, or greater than IOM recommendations for body mass index as calculated by gestational weight gain per week after a diagnosis of GDM. Outcomes assessed were preeclampsia, cesarean delivery, A2 GDM, birth weight, small for gestational age (SGA), large for gestational age (LGA), macrosomia, and preterm delivery. Groups were compared using analysis of variance and chi-square test for trend, as appropriate. Backward stepwise logistic regression was used to adjust for significant confounding factors. RESULTS: Of 635 subjects, 92 gained within, 175 gained less than, and 368 gained more than IOM recommendations. The risk of cesarean delivery and A2 GDM was increased in those gaining above the IOM recommendations compared with within. For every 1-lb/week increase in weight gain after diagnosis of GDM, there was a 36 to 83% increase in the risk of preeclampsia, cesarean delivery, A2 GDM, macrosomia, and LGA, without decreases in SGA or preterm delivery. CONCLUSION: Weight gain more than the IOM recommendations per week of gestation after a diagnosis of GDM is associated with adverse pregnancy outcomes.
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Excessive GWG in women with GDM increases risks of pre-eclampsia, caesarean section, macrosomia, and LGA (36%-83% higher risk per 0.5 kg per week increase in weight gain after diagnosis of GDM).
“Excessive GWG in women with GDM increases risks of pre-eclampsia, caesarean section, macrosomia, and LGA (36%–83% higher risk per 0.5 kg per week increase in weight gain after diagnosis of GDM) [37].”
From Medical Nutrition Therapy for Women with Gestational Diabetes: Current Practice and Future Perspectives (2025) · cites this paper as [37]
The Results report 36–83% higher adjusted odds of preeclampsia, primary cesarean delivery, macrosomia, and LGA for each 1 lb/week (about 0.45 kg/week) increase in weight gain after GDM diagnosis. The claim closely matches the outcomes and magnitude, but presents an observational association as an increase in risk caused by excessive gain; the Discussion explicitly limits the findings to associations rather than causation. (LLM, conf=0.86)
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Cites
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Feig, D. S., Berger, H., Donovan, L., Godbout, A., Kader, T., Keely, E., & Sanghera, R. (2018) · Canadian Journal of Diabetes · doi:10.1016/j.jcjd.2017.10.038 · Cited by 344 · see citing works
Gestational Diabetes Mellitus and Preeclampsia: Correlation and Influencing Factors
Yang, Y., & Wu, N. (2022) · Frontiers in Cardiovascular Medicine · doi:10.3389/fcvm.2022.831297 · Cited by 155 · see citing works
Weight gain adequacy and pregnancy outcomes in gestational diabetes: a meta‐analysis
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Gestational weight gain and weight loss among women with gestational diabetes mellitus
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Fougner, S. L., Vanky, E., Løvvik, T. S., & Carlsen, S. M. (2021) · PLOS ONE · doi:10.1371/journal.pone.0254895 · Cited by 23 · see citing works
“Our finding that gestational weight gain correlated independently to offspring birth weight is in accordance with previous studies on pregnant women with GDM [33,34].”
ResultCheong, 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
- Authors
- Tita, A., Biggio, J., & Harper, L.
- Affiliations
- University of Alabama at Birmingham (US)
- Corresponding author
- Harper, Lorie
- Venue
- American Journal of Perinatology
- Publisher
- Georg Thieme Verlag KG
- Published
- 2014-06-27
- Volume
- 32
- Issue
- 03
- Pages
- 239-246
- ISSN
- 0735-1631 (ISSN-L)
- 1098-8785
- PMC
- PMC4277741
- OpenAlex
- W2033991684
- Cited by
- 58
- References
- 2
- Citations by year
- 2025: 1 · 2024: 4 · 2023: 7 · 2022: 9 · 2021: 6 · 2020: 3 · 2019: 4 · 2018: 7 · 2017: 5 · 2016: 6 · 2015: 6
- FWCI
- 6.03
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- American Journal of Perinatology (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institute of Diabetes and Digestive and Kidney Diseases (P30DK079626)
- Eunice Kennedy Shriver National Institute of Child Health and Human Development (K12HD001258)
- Topics
- Health Sciences › Medicine › Obstetrics and Gynecology › Gestational Diabetes Research and Management
- Health Sciences › Medicine › Obstetrics and Gynecology › Pregnancy and preeclampsia studies
- Health Sciences › Health Professions › General Health Professions › Maternal and Neonatal Healthcare
- Keywords
- gestational weight gain, gestational diabetes mellitus, IOM guidelines, perinatal outcomes, preeclampsia, cesarean section, macrosomia, large for gestational age, small for gestational age, preterm birth, birth weight
- MeSH terms
- Adult, Birth Weight, Cesarean Section, Female, Fetal Macrosomia, Humans, Pre-Eclampsia, Pregnancy, Pregnancy Complications, Pregnancy Outcome, Retrospective Studies, United States, Weight Gain, National Academies of Science, Engineering, and Medicine, U.S., Health and Medicine Division, Body Mass Index, Diabetes, Gestational, Practice Guidelines as Topic, Premature Birth, Young Adult
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