What is an appropriate gestational weight gain for women with gestational diabetes mellitus: based on the adverse pregnancy outcomes of over 12 thousand participants?
Open accessAbstract
Background: Evidence showed possible benefits of a less gestational weight gain (GWG) than the US Institute of Medicine (IOM) recommendation in gestational diabetes mellitus (GDM) pregnancy. Here, we aimed to explore an appropriate GWG range in GDM women according to adverse pregnancy outcomes. Methods: We enrolled all the singleton GDM pregnant women (n = 14,213) from January 2015 to December 2018 in Xi'an, Northwest China. According to the pre-pregnancy body mass index (BMI), they were classified into the Underweight (< 18.5 kg/m 2), Normal weight (18.5–24.9 kg/m 2), Overweight (25.0–29.9 kg/m 2) and Obesity (≥ 30.0 kg/m 2) group, respectively. Logistic regression analysis was used to calculate the odds ratio (OR) and 95% confidence intervals (95% CI). The appropriate ranges of GWG were determined based on a significant protective association (OR < 1). Results: Totally, 12,712 participants were finally recruited. There were 1180 (9.3%), 9134 (71.9%), 2097 (16.5%), and 301 (2.4%) patients in the Underweight, Normal weight, Overweight, and Obesity groups, respectively. Adverse outcomes increased with the elevation of pre-pregnancy BMI. Among them, the risk of cesarean section was the highest, followed by large for gestational age (LGA), small for gestational age (SGA), preeclampsia, and gestational hypertension. Through the analysis of the risk of adverse outcomes in continuous GWG categories in each group, an ideal GWG range obtained in this study was as follows: 10–15.9 kg, 8–11.9 kg, 6–7.9 kg, and -5–3.9 kg for the Underweight, Normal weight, Overweight and Obesity group, respectively. Furthermore, the ranges in this study were more protective for adverse outcomes than those from IOM. Conclusions: Based on the adverse pregnancy outcomes of over 12 thousand participants, our findings showed a more stringent GWG range for GDM women than the IOM criteria recommendation.
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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 [48]
The Discussion reports that the study’s lower recommended GWG ranges reduced cesarean-section and LGA risks, but explicitly says they significantly increased SGA risk. That directly contradicts the claim that lower GWG reduces adverse outcomes without increasing SGA risk. The paper measures LGA, not macrosomia as a separately defined outcome; no page number is available in our copy. (LLM, conf=0.90)
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- Authors
- Luo, X., Gao, J., He, Z., Ji, J., Zhang, W., Wu, P., Guo, X., Cao, D., Xu, Z., Li, C., & Mi, Y.
- Affiliations
- Xi'an Jiaotong University (CN)
- Northwest Women's and Children's Hospital (CN)
- Corresponding author
- Mi, Yang
- Venue
- Diabetology & Metabolic Syndrome
- Published
- 2022-11-11
- Volume
- 14
- Issue
- 1
- Pages
- 166-166
- ISSN
- 1758-5996 (ISSN-L)
- PMC
- PMC9652847
- OpenAlex
- W4308792148
- Cited by
- 12
- References
- 32
- Citations by year
- 2026: 2 · 2025: 3 · 2024: 4 · 2023: 3
- FWCI
- 2.51
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Locations
- Diabetology & Metabolic Syndrome (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Funders
- National Natural Science Foundation of China (81874263)
- Key Special Project of the Development Center for Medical Science & Technology of the National Health Commission of the People’s Republic of China (W2015CAE060)
- Topics
- Health Sciences › Medicine › Obstetrics and Gynecology › Gestational Diabetes Research and Management
- Health Sciences › Health Professions › General Health Professions › Maternal and Neonatal Healthcare
- Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Birth, Development, and Health
- Keywords
- gestational weight gain, gestational diabetes mellitus, adverse pregnancy outcomes, pre-pregnancy body mass index, cesarean section, large for gestational age, small for gestational age, preeclampsia, gestational hypertension, IOM weight gain guidelines, maternal obesity
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