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Cited by 80Gestational Diabetes Research and ManagementDiabetes, Cardiovascular Risks, and LipoproteinsBirth, Development, and Health

Excessive Weight Gain Before and During Gestational Diabetes Mellitus Management: What Is the Impact?

Barnes, Robyn A., Wong, Tang, Ross, Glynis P., Griffiths, Michelle M., Smart, Carmel E., Collins, Clare E., MacDonald-Wicks, Lesley, Flack, Jeff R.·2020·Diabetes Care
DOI 10.2337/dc19-0800
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Abstract

OBJECTIVE: Conventional gestational diabetes mellitus (GDM) management focuses on managing blood glucose in order to prevent adverse outcomes. We hypothesized that excessive weight gain at first presentation with GDM (excessive gestational weight gain [EGWG]) and continued EGWG (cEGWG) after commencing GDM management would increase the risk of adverse outcomes, despite treatment to optimize glycemia. RESEARCH DESIGN AND METHODS: Data collected prospectively from pregnant women with GDM at a single institution were analyzed. GDM was diagnosed on the basis of Australasian Diabetes in Pregnancy Society 1998 guidelines (1992–2015). EGWG means having exceeded the upper limit of the Institute of Medicine–recommended target ranges for the entire pregnancy, by GDM presentation. The relationship between EGWG and antenatal 75-g oral glucose tolerance test (oGTT) values and adverse outcomes was evaluated. Relationships were examined between cEGWG, insulin requirements, and large-for-gestational-age (LGA) infants. RESULTS: Of 3,281 pregnant women, 776 (23.6%) had EGWG. Women with EGWG had higher mean fasting plasma glucose (FPG) on oGTT (5.2 mmol/L [95% CI 5.1–5.3] vs. 5.0 mmol/L [95% CI 4.9–5.0]; P < 0.01), after adjusting for confounders, and more often received insulin therapy (47.0% vs. 33.6%; P < 0.0001), with an adjusted odds ratio (aOR) of 1.4 (95% CI 1.1–1.7; P < 0.01). aORs for each 2-kg increment of cEGWG were a 1.3-fold higher use of insulin therapy (95% CI 1.1–1.5; P < 0.001), an 8-unit increase in final daily insulin dose (95% CI 5.4–11.0; P < 0.0001), and a 1.4-fold increase in the rate of delivery of LGA infants (95% CI 1.2–1.7; P < 0.0001). CONCLUSIONS: The absence of EGWG and restricting cEGWG in GDM have a mitigating effect on oGTT-based FPG, the risk of having an LGA infant, and insulin requirements.

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Authors
Barnes, R. A., Wong, T., Ross, G. P., Griffiths, M. M., Smart, C. E., Collins, C. E., MacDonald-Wicks, L., & Flack, J. R.
Affiliations
  • Bankstown Lidcombe Hospital (AU)
  • The University of Sydney (AU)
  • John Hunter Hospital (AU)
  • University of Newcastle Australia (AU)
  • School of Health Sciences, Faculty of Health and Medicine, University of Newcastle, Callaghan, New South Wales, Australia
Corresponding author
Barnes, Robyn A.
ORCID
Venue
Diabetes Care
Publisher
American Diabetes Association
Published
2019-11-05
Volume
43
Issue
1
Pages
74-81
ISSN
  • 0149-5992 (ISSN-L)
  • 1935-5548
DOI
10.2337/dc19-0800
OpenAlex
W2983124858
Cited by
80
References
41
Citations by year
2026: 4 · 2025: 9 · 2024: 20 · 2023: 13 · 2022: 16 · 2021: 11 · 2020: 7
FWCI
9.25
Type
journal article
Language
en
Open access
closed
Licence
www.diabetesjournals.org/content/license (vor, 45 d)
Locations
  • Diabetes Care (publishedVersion)
  • PubMed (publishedVersion)
  • NOVA (University of Newcastle Australia) (submittedVersion)
Topics
  • Health Sciences › Medicine › Obstetrics and Gynecology › Gestational Diabetes Research and Management
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes, Cardiovascular Risks, and Lipoproteins
  • Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Birth, Development, and Health
Keywords
gestational diabetes mellitus, excessive gestational weight gain, insulin therapy, insulin dose, large for gestational age, fasting blood glucose, oral glucose tolerance test, glycemic control, adverse pregnancy outcomes, pregnancy weight gain guidelines, insulin resistance in pregnancy, gestational hypertension, gestational diabetes management
MeSH terms
Gestational Weight Gain, Adult, Blood Glucose, Female, Fetal Macrosomia, Glucose Tolerance Test, Humans, Infant, Newborn, Insulin, Pregnancy, Pregnancy Complications, Pregnancy Outcome, Prognosis, Prospective Studies, Weight Gain, Diabetes, Gestational, Overweight

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