Women with gestational diabetes (GDM) and excessive weight gain are more likely to undergo instrumental delivery and have large-for-gestational age infants, according to a recent study published in the Journal of Clinical Endocrinology & Metabolism.¹ Their newborns also had higher rates of hypoglycemia. On the other hand, women with GDM and low gestational weight gain were less likely to be overweight or obese in the postpartum period.

In this prospective study, Belgian researchers recruited 1843 women from 7 hospitals in Belgium. These women had been screened for GDM with a 75-g oral glucose tolerance test (OGTT). Their aim was to compare the impact of gestational weight gain on outcomes of pregnancy including in the postpartum period, between women with normal glucose tolerance (NGT) and those with gestational diabetes (GDM). Weight gain during pregnancy was categorised as low, within range or excessive as per the guidelines of the Institute of Medicine (IOM) guidelines. Ninety-seven women (52.4%) with gestational diabetes had low gestational weight gain, weight gain was within the normal range in 58 women (31.3%), 30 (16.2%) had excessive weight gain, while 383 women (28.3%) with normal glucose tolerance had excessive gestational weight gain.

Compared to women with gestational diabetes and weight gain within range, those with low gestational weight gain were less likely to be overweight or obese in the postpartum period (56.5% vs 35.7%); they also had postpartum weight retention less often (87.9% vs 48.8%). Women with excessive weight gain were 7 times more likely to have neonatal hypoglycemia than those whose weight gain was within normal limits (30.8% vs 5.9%) with an adjusted odds ratio of 7.15.

Normoglycemic women with excessive weight gain had higher probability of instrumental delivery compared to women who had gestational weight gain within range; 15.9% vs 11.9%, respectively with an aOR of 1.67. Also, Infants born to women with normal glucose tolerance but excessive gestational weight gain were more likely to be large-for-gestational age (19.3%) compared to women with weight gain within range (10.4%).

This study reaffirms the association of excessive weight gain with adverse pregnancy and neonatal outcomes in women with gestational diabetes. In addition, it demonstrates association of excessive weight gain in women with normal glucose tolerance with adverse maternal and fetal outcomes including greater odds of instrumental delivery, hypoglycemia in newborns and large-for gestational age infants.

Reference

1. Minschart C, et al. Low gestational weight gain in women with gestational diabetes is safe with better metabolic profile postpartum. J Clin Endocrinol Metab. 2023 Feb 15;108(3):665-679. doi: 10.1210/clinem/dgac599.