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Lin D, Fan D, Li P, Chen G, Zhou Z, Rao J, Ye S, Wang L, Feng J, Lu D, Luo C, Liu Z. Optimal gestational weight gain in women with twin pregnancies and gestational diabetes mellitus: a population-based study in the United States. Am J Obstet Gynecol MFM 2023; 5:100766. [PMID: 36216311 DOI: 10.1016/j.ajogmf.2022.100766] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Revised: 09/30/2022] [Accepted: 10/03/2022] [Indexed: 11/05/2022]
Abstract
BACKGROUND There is limited evidence regarding optimal gestational weight gain in women with twin pregnancies and gestational diabetes mellitus. OBJECTIVE This study aimed to examine the association between gestational weight gain and perinatal outcomes among women with gestational diabetes mellitus and twin pregnancies and to explore the gestational weight gain targets by prepregnancy body mass index category. STUDY DESIGN A national population-based cohort study of twin pregnancies with gestational diabetes mellitus was conducted between 2014 and 2020. Women with gestational diabetes mellitus aged between 18 and 45 years with live-born twins without congenital malformations between 24 and 42 weeks of gestation were included in the analysis. Two approaches were used to determine the optimal gestational weight gain targets by body mass index category: an interquartile range method to calculate targets in low-risk gestational diabetes mellitus pregnancies and a logistic model method to identify the odds ratio targets at which a composite adverse outcome decreased. RESULTS Of 29,308 women with gestational diabetes mellitus and twin pregnancies, 8239 (28.1%) were normal-weight, 7626 (26.0%) were overweight, and 13,443 (45.9%) were obese. The continuous standardized gestational weight gain by 36 weeks was associated with preterm birth <36 weeks, large-for-gestational-age infants, small-for-gestational-age infants, and gestational hypertensive disorders. The interquartile range targets were 13.6 to 20.9 kg, 10.9 to 20.4 kg, and 7.7 to 17.7 kg for normal-weight, overweight, and obese women, respectively. The odds ratio targets were 14.1 to 20.0 kg, 12.1 to 16.0 kg, and 6.1 to 12.0 kg for normal-weight, overweight, and obese women, respectively. Gestational weight gain outside these targets was associated with preterm birth <36 weeks, large-for-gestational-age and small-for-gestational-age infants, and gestational hypertensive disorders, and exhibited significant population attributable fractions for preterm birth <36 weeks, large-for-gestational-age infants, and gestational hypertensive disorders across body mass index categories. CONCLUSION Compared with the Institute of Medicine guidelines, more stringent gestational weight gain targets would be beneficial for improved perinatal outcomes in women with gestational diabetes mellitus and twin pregnancies.
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Affiliation(s)
- Dongxin Lin
- Foshan Institute of Fetal Medicine, Southern Medical University Affiliated Maternal and Child Health Hospital of Foshan, Foshan, China (Drs Lin, Fan, Li, Chen, Zhou, and Rao, Ms Ye, and Dr Liu); Department of Obstetrics, Southern Medical University Affiliated Maternal & Child Health Hospital of Foshan, Foshan, Guangdong, China (Drs Lin, Fan, Li, Chen, Zhou, and Rao, Ms Ye, Ms Wang, Ms Feng, Ms Lu, Ms Luo, and Dr Liu).
| | - Dazhi Fan
- Foshan Institute of Fetal Medicine, Southern Medical University Affiliated Maternal and Child Health Hospital of Foshan, Foshan, China (Drs Lin, Fan, Li, Chen, Zhou, and Rao, Ms Ye, and Dr Liu); Department of Obstetrics, Southern Medical University Affiliated Maternal & Child Health Hospital of Foshan, Foshan, Guangdong, China (Drs Lin, Fan, Li, Chen, Zhou, and Rao, Ms Ye, Ms Wang, Ms Feng, Ms Lu, Ms Luo, and Dr Liu)
| | - Pengsheng Li
- Foshan Institute of Fetal Medicine, Southern Medical University Affiliated Maternal and Child Health Hospital of Foshan, Foshan, China (Drs Lin, Fan, Li, Chen, Zhou, and Rao, Ms Ye, and Dr Liu); Department of Obstetrics, Southern Medical University Affiliated Maternal & Child Health Hospital of Foshan, Foshan, Guangdong, China (Drs Lin, Fan, Li, Chen, Zhou, and Rao, Ms Ye, Ms Wang, Ms Feng, Ms Lu, Ms Luo, and Dr Liu)
| | - Gengdong Chen
- Foshan Institute of Fetal Medicine, Southern Medical University Affiliated Maternal and Child Health Hospital of Foshan, Foshan, China (Drs Lin, Fan, Li, Chen, Zhou, and Rao, Ms Ye, and Dr Liu); Department of Obstetrics, Southern Medical University Affiliated Maternal & Child Health Hospital of Foshan, Foshan, Guangdong, China (Drs Lin, Fan, Li, Chen, Zhou, and Rao, Ms Ye, Ms Wang, Ms Feng, Ms Lu, Ms Luo, and Dr Liu)
| | - Zixing Zhou
- Foshan Institute of Fetal Medicine, Southern Medical University Affiliated Maternal and Child Health Hospital of Foshan, Foshan, China (Drs Lin, Fan, Li, Chen, Zhou, and Rao, Ms Ye, and Dr Liu); Department of Obstetrics, Southern Medical University Affiliated Maternal & Child Health Hospital of Foshan, Foshan, Guangdong, China (Drs Lin, Fan, Li, Chen, Zhou, and Rao, Ms Ye, Ms Wang, Ms Feng, Ms Lu, Ms Luo, and Dr Liu)
| | - Jiaming Rao
- Foshan Institute of Fetal Medicine, Southern Medical University Affiliated Maternal and Child Health Hospital of Foshan, Foshan, China (Drs Lin, Fan, Li, Chen, Zhou, and Rao, Ms Ye, and Dr Liu); Department of Obstetrics, Southern Medical University Affiliated Maternal & Child Health Hospital of Foshan, Foshan, Guangdong, China (Drs Lin, Fan, Li, Chen, Zhou, and Rao, Ms Ye, Ms Wang, Ms Feng, Ms Lu, Ms Luo, and Dr Liu)
| | - Shaoxin Ye
- Foshan Institute of Fetal Medicine, Southern Medical University Affiliated Maternal and Child Health Hospital of Foshan, Foshan, China (Drs Lin, Fan, Li, Chen, Zhou, and Rao, Ms Ye, and Dr Liu); Department of Obstetrics, Southern Medical University Affiliated Maternal & Child Health Hospital of Foshan, Foshan, Guangdong, China (Drs Lin, Fan, Li, Chen, Zhou, and Rao, Ms Ye, Ms Wang, Ms Feng, Ms Lu, Ms Luo, and Dr Liu)
| | - Lijuan Wang
- Department of Obstetrics, Southern Medical University Affiliated Maternal & Child Health Hospital of Foshan, Foshan, Guangdong, China (Drs Lin, Fan, Li, Chen, Zhou, and Rao, Ms Ye, Ms Wang, Ms Feng, Ms Lu, Ms Luo, and Dr Liu)
| | - Jinping Feng
- Foshan Institute of Fetal Medicine, Southern Medical University Affiliated Maternal and Child Health Hospital of Foshan, Foshan, China (Drs Lin, Fan, Li, Chen, Zhou, and Rao, Ms Ye, and Dr Liu); Department of Obstetrics, Southern Medical University Affiliated Maternal & Child Health Hospital of Foshan, Foshan, Guangdong, China (Drs Lin, Fan, Li, Chen, Zhou, and Rao, Ms Ye, Ms Wang, Ms Feng, Ms Lu, Ms Luo, and Dr Liu)
| | - Demei Lu
- Department of Obstetrics, Southern Medical University Affiliated Maternal & Child Health Hospital of Foshan, Foshan, Guangdong, China (Drs Lin, Fan, Li, Chen, Zhou, and Rao, Ms Ye, Ms Wang, Ms Feng, Ms Lu, Ms Luo, and Dr Liu)
| | - Caihong Luo
- Department of Obstetrics, Southern Medical University Affiliated Maternal & Child Health Hospital of Foshan, Foshan, Guangdong, China (Drs Lin, Fan, Li, Chen, Zhou, and Rao, Ms Ye, Ms Wang, Ms Feng, Ms Lu, Ms Luo, and Dr Liu)
| | - Zhengping Liu
- Foshan Institute of Fetal Medicine, Southern Medical University Affiliated Maternal and Child Health Hospital of Foshan, Foshan, China (Drs Lin, Fan, Li, Chen, Zhou, and Rao, Ms Ye, and Dr Liu); Department of Obstetrics, Southern Medical University Affiliated Maternal & Child Health Hospital of Foshan, Foshan, Guangdong, China (Drs Lin, Fan, Li, Chen, Zhou, and Rao, Ms Ye, Ms Wang, Ms Feng, Ms Lu, Ms Luo, and Dr Liu)
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Exercise-Diet Therapy Combined with Insulin Aspart Injection for the Treatment of Gestational Diabetes Mellitus: A Study on Clinical Effect and Its Impact. COMPUTATIONAL AND MATHEMATICAL METHODS IN MEDICINE 2022; 2022:4882061. [PMID: 35936373 PMCID: PMC9352494 DOI: 10.1155/2022/4882061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Revised: 07/11/2022] [Accepted: 07/15/2022] [Indexed: 11/17/2022]
Abstract
Objective To explore the clinical effect and impact of exercise-diet therapy combined with Insulin Aspart Injection on gestational diabetes mellitus (GDM). Methods The objects of study were patients with pregestational diabetes mellitus (PGDM) and 62 patients with GDM who were diagnosed by oral glucose tolerance test (OGTT) and insulin release test from February 2017 to February 2019. According to the severity of the disease, enrolled patients were informed to have appropriate exercise and diet control or Insulin Aspart Injection on this basis until the completion of delivery. By using 50 pregnant women with normal glucose as the control, the fasting plasma glucose (FPG), 1-hour postprandial glucose (1hPG), 2-hour postprandial glucose (2hPG), nocturnal glucose, and glycosylated hemoglobin (HbA1c) levels were compared between the PGDM group and the GDM group before and after treatment; besides, further comparison was made in terms of glucose compliance rate, islet B-cell secretory function, and insulin resistance after treatment. The pregnant women were examined by B-ultrasound at 24 and 26 weeks of gestation to check if the fetus had abnormalities in the central nervous system and the heart. Further B-ultrasound examination was performed at 32 and 37 weeks of gestation to check the problems such as polyhydramnios and stillbirth. In addition, a comparative analysis was carried out in terms of the adverse pregnancy outcomes and complications, associated with the comparison of the results after treatment with control group. Results After treatment, the levels of FPG, 1hPG, 2hPG, nocturnal glucose, and HbA1c were decreased in the PGDM group and GDM group than those before treatment, especially in the GDM group, with significant difference still when compared with the control group (P < 0.05). Statistical analysis revealed that the blood glucose compliance rate in the GDM group was higher than that in the PGDM group, showing a better therapeutic effect. Fasting insulin (FINS) and homeostasis model assessment index for insulin resistance (HOMA-IR) in the GDM group were significantly higher than those in control group, but lower than those in the PGDM group (P < 0.01), while the level of HOMA-β was lower in the GDM group than that in the control group and higher than that in PGDM (P < 0.01). Further ultrasound examination revealed the presence of fetal cardiac abnormality, polyhydramnios, stillbirth, and problems, showing a higher incidence in the PGDM group but almost nonexistence in the control group. In addition, the incidence of hypertension, macrosomia, premature rupture of membranes, postpartum hemorrhage, and infection were obviously higher in the PGDM group than those in the GDM group and control group (P < 0.05). Conclusion Exercise-diet therapy combined with Insulin Aspart Injection can effectively control the blood glucose level of pregnant patients with GDM, improve the pregnancy outcome to a certain extent, and ensure the health of pregnant women and fetus, which is worthy of clinical application.
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Cheng ZH, Wei YM, Li HT, Yu HZ, Liu JM, Zhou YB. Gestational Diabetes Mellitus as an Effect Modifier of the Association of Gestational Weight Gain with Perinatal Outcomes: A Prospective Cohort Study in China. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19095615. [PMID: 35565005 PMCID: PMC9101455 DOI: 10.3390/ijerph19095615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Revised: 04/26/2022] [Accepted: 04/29/2022] [Indexed: 11/23/2022]
Abstract
The association of gestational weight gain (GWG) with perinatal outcomes seems to differ between women with and without gestational diabetes mellitus (GDM). Whether GDM is an effect-modifier of the association has not been verified. This study aimed to assess the modifying effect of GDM on the association of GWG with perinatal outcomes. Data on 12,128 pregnant women (3013 with GDM and 9115 without GDM) were extracted from a prospective, multicenter, cohort study in China. The associations of total and trimester-specific GWG rates (GWGR) with perinatal outcomes, including small size for gestational age, large size for gestational age (LGA), preterm birth, cesarean delivery, and gestational hypertension disorders, were assessed. The modifying effect of GDM on the association was assessed on both multiplicative and additive scales, as estimated by mixed-effects logistic regression. As a result, total GWGR was associated with all of the perinatal outcomes. GDM modified the association of total GWGR with LGA and cesarean delivery on both scales (all p < 0.05) but did not modify the association with other outcomes. The modifying effect was observed in the third trimester but not in the first or the second trimester. Therefore, maternal GWG is associated with perinatal outcomes, and GDM modifies the association with LGA and cesarean delivery in the third trimester.
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Affiliation(s)
- Zhi-Hao Cheng
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing 100191, China; (Z.-H.C.); (H.-Z.Y.)
| | - Yu-Mei Wei
- Department of Obstetrics and Gynecology, Peking University First Hospital, Beijing 100034, China;
| | - Hong-Tian Li
- National Health Commission Key Laboratory of Reproductive Health, Institute of Reproductive and Child Health, Peking University, Beijing 100191, China;
| | - Hong-Zhao Yu
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing 100191, China; (Z.-H.C.); (H.-Z.Y.)
| | - Jian-Meng Liu
- National Health Commission Key Laboratory of Reproductive Health, Institute of Reproductive and Child Health, Peking University, Beijing 100191, China;
- Correspondence: (J.-M.L.); (Y.-B.Z.); Tel.: +86-10-82801136 (J.-M.L.); +86-10-82801759-114 (Y.-B.Z.)
| | - Yu-Bo Zhou
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing 100191, China; (Z.-H.C.); (H.-Z.Y.)
- Correspondence: (J.-M.L.); (Y.-B.Z.); Tel.: +86-10-82801136 (J.-M.L.); +86-10-82801759-114 (Y.-B.Z.)
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Saha S, Saha S. Changes in anthropometric and blood 25-hydroxyvitamin D measurements in antenatal vitamin supplemented gestational diabetes mellitus patients: a systematic review and meta-analysis of randomized controlled trials. J Turk Ger Gynecol Assoc 2021; 22:217-234. [PMID: 33663196 PMCID: PMC8420744 DOI: 10.4274/jtgga.galenos.2021.2020.0197] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Objective: Gestation weight (GW), body mass index (BMI), and blood 25-hydroxyvitamin D [25(OH)D] level during pregnancy are important determinants of the gestational outcomes. This study aimed to study how these parameters vary between antenatal vitamin D recipients and non-recipients in gestational diabetes mellitus (GDM) patients. Material and Methods: The randomized controlled trials comparing these outcomes between vitamin D recipient and non-recipient GDM patients were searched in electronic databases (PubMed, Embase, and Scopus). The reviewed studies’ data were abstracted and critically appraised using the Cochrane tool. The estimation of the weighted mean difference for GW and BMI and standardized mean difference (SMD) for 25(OH)D levels occurred by juxtaposing the interventions meta-analytically (random-effect model). The statistical inconsistency was determined by Chi2 and I2 method. The statistical significance was estimated at p<0.05 and 95% confidence interval (CI). Results: Eleven eligible trials (all Iran-based, except one), sourcing data from about 875 GDM patients, were reviewed. Overall, the risk of bias was low, except for selection and performance bias. On random-effect model meta-analysis, the 25(OH)D levels of the GDM patients favored the vitamin D recipients when compared to non-vitamin D (SMD 1.97, 95% CI: 1.06-2.88, p<0.001; I2 96.2%, p of Chi2 <0.001) and placebo (SMD 1.86, 95% CI: 0.95-2.77, p<0.001; I2 95.3%, p of Chi2 <0.001) recipients, respectively. On meta-regression, sample size was a predictor of the observed heterogeneity. For GW and BMI the interventions did not differ statistically significantly. Conclusion: In GDM patients, antenatal use of vitamin D aids in the rise of blood 25(OH)D levels. However, vitamin D supplementation did not affect change in GW or BMI.
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Shi P, Liu A, Yin X. Association between gestational weight gain in women with gestational diabetes mellitus and adverse pregnancy outcomes: a retrospective cohort study. BMC Pregnancy Childbirth 2021; 21:508. [PMID: 34261430 PMCID: PMC8281617 DOI: 10.1186/s12884-021-03982-4] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2021] [Accepted: 06/21/2021] [Indexed: 03/14/2023] Open
Abstract
Background To examine association between gestational weight gain (GWG) in women with gestational diabetes mellitus (GDM) and adverse pregnancy outcomes (APOs). Methods This retrospective cohort study enrolled women with GDM who delivered at 2010–2020 in Changzhou, Jiangsu. Total GWG, rates of GWG in second trimester and third trimesters were stratified into three categories according to IOM guidelines: within, below, and above IOM guidelines. Univariable and multivariable logistic regression analyses were used. Results Overall, 1606 women with GDM fulfilled inclusion criteria. Compared with within IOM guidelines and after adjusting for confounders, total GWG above IOM guidelines in pregnancy was associated with an increased odds of caesarean delivery [adjusted odds ratio (aOR) = 1.34, 95% confidence interval (CI): 1.04–1.72], hypertensive disorders of pregnancy (HDP) (aOR = 2.00, 1.28–3.12), preeclampsia (aOR = 2.06, 1.01–3.12), macrosomia (aOR = 1.55, 1.13–2.13) and large for gestational age (LGA) (aOR = 2.82, 1.94–3.23), and a decreased odds of premature rupture of membrane (PROM) (aOR = 0.46, 0.36–0.60) and preterm birth (aOR = 0.35, 0.26–0.44); total GWG below IOM guidelines in pregnancy was associated with an increased risk of preterm birth (aOR = 1.96, 1.44–2.66), small for gestational age (SGA) (aOR = 1.32, 1.11–1.50) and a decreased odds of macrosomia (aOR = 0.35, 0.23–0.53) and LGA (aOR = 0.54, 0.42–0.72). Further, in both second and third trimesters of pregnancy, rates of GWG above IOM guidelines was found to be associated with a high odds of HDP (aOR = 2.55, 1.86–3.38; aOR = 1.93, 1.08–2.98), preeclampsia (aOR = 2.28, 1.21–3.81; aOR = 2.17, 1.35–4.37), macrosomia (aOR = 1.20, 1.02–1.82; aOR = 2.02, 1.51–2.64) and LGA (aOR = 1.42, 1.24–1.97; aOR = 1.79, 1.51–2.54). Rates of GWG above IOM guidelines in third trimester of pregnancy also increased odds of caesarean delivery (aOR = 1.48, 1.16–2.34) when compared with within IOM guidelines. While rates of GWG below IOM guidelines in both second and third trimesters of pregnancy was associated with a decreased odds of macrosomia (aOR = 0.66, 95% CI: 0.52–0.78; aOR = 0.52, 0.39–0.63) and LGA(aOR = 0.71, 0.51–0.82; aOR = 0.67, 0.55–0.79). In addition, rate of GWG below IOM guidelines in third trimester of pregnancy was associated with an increased odds of preterm birth (aOR = 1.52, 1.12–2.05) and SGA (aOR = 1.21, 1.10–1.69). Conclusion GWG, outside IOM guidelines has increased risks of APOs among women with GDM, implying that careful surveillance for GWG during different stages of pregnancy is warranted.
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Affiliation(s)
- Ping Shi
- Wujin Hospital Affiliated With Jiangsu University, Tianning District, No 2 Yongning North Road, Changzhou, Jiangsu, China.,The Wujin Clinical College of Xuzhou Medical University, Tianning District, No 2 Yongning North Road, Changzhou, Jiangsu, China
| | - Aimin Liu
- Wujin Hospital Affiliated With Jiangsu University, Tianning District, No 2 Yongning North Road, Changzhou, Jiangsu, China.,The Wujin Clinical College of Xuzhou Medical University, Tianning District, No 2 Yongning North Road, Changzhou, Jiangsu, China
| | - Xiaoyan Yin
- Wujin Hospital Affiliated With Jiangsu University, Tianning District, No 2 Yongning North Road, Changzhou, Jiangsu, China. .,The Wujin Clinical College of Xuzhou Medical University, Tianning District, No 2 Yongning North Road, Changzhou, Jiangsu, China.
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Rugină C, Mărginean CO, Meliţ LE, Giga DV, Modi V, Mărginean C. Relationships between excessive gestational weight gain and energy and macronutrient intake in pregnant women. J Int Med Res 2021; 48:300060520933808. [PMID: 32776838 PMCID: PMC7418251 DOI: 10.1177/0300060520933808] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
OBJECTIVE This study aimed to compare energy and macronutrient intake, birth weight, and anthropometric parameters (mid-upper arm circumference or tricipital skin-fold thickness) between women who had adequate and excessive gestational weight gain (GWG) during pregnancy. METHODS We studied 115 pregnant women and divided them according to GWG into two groups: adequate GWG (n = 49) and excessive GWG (n = 66). We assessed the medical history, clinical examinations, and dietary habits through a detailed 7-day dietary recall using myfitnesspal software. RESULTS Weight, body mass index, mid-upper arm circumference, and tricipital skin-fold thickness were significantly higher at the time of delivery in women with excessive GWG compared with those with adequate GWG. A lipid-based diet was a risk factor for excessive GWG (relative risk: 1.488, 95% confidence interval: 1.112-1.991), whereas a protein-based diet was a protective factor (relative risk: 0.6723, 95% confidence interval: 0.4431-1.020). We found no significant relationship between a carbohydrate-based diet and GWG. The total energy intake was significantly higher in the excessive GWG group than in the adequate GWG group. CONCLUSIONS Mainly a lipid-based diet in pregnant women might represent a risk factor for excessive GWG. However, a protein-based diet is a protective factor for excessive GWG.
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Affiliation(s)
- Cosmin Rugină
- Department of Obstetrics and Gynecology, "George Emil Palade" University of Medicine, Pharmacy, Sciences and Technology, Târgu Mureș, Romania
| | - Cristina Oana Mărginean
- Department of Pediatrics, "George Emil Palade" University of Medicine, Pharmacy, Sciences and Technology, Târgu Mureș, Romania
| | - Lorena Elena Meliţ
- Department of Pediatrics, "George Emil Palade" University of Medicine, Pharmacy, Sciences and Technology, Târgu Mureș, Romania
| | - Dana Valentina Giga
- Department of Medical Informatics and Biostatistics, "George Emil Palade" University of Medicine, Pharmacy, Sciences and Technology, Târgu Mureș, Romania
| | - Viviana Modi
- Department of Obstetrics and Gynecology, "George Emil Palade" University of Medicine, Pharmacy, Sciences and Technology, Târgu Mureș, Romania
| | - Claudiu Mărginean
- Department of Obstetrics and Gynecology, "George Emil Palade" University of Medicine, Pharmacy, Sciences and Technology, Târgu Mureș, Romania
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Bogdanet D, Mustafa M, Khattak A, Shea PMO, Dunne FP. Atlantic DIP: is weight gain less than that recommended by IOM safe in obese women with gestational diabetes mellitus? Int J Obes (Lond) 2021; 45:1044-1051. [PMID: 33627772 DOI: 10.1038/s41366-021-00769-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2020] [Revised: 12/10/2020] [Accepted: 01/20/2021] [Indexed: 11/09/2022]
Abstract
BACKGROUND/OBJECTIVES The Institute of Medicine (IOM) recommends gestational weight gain (GWG) of 5-9 kg in women with a body mass index (BMI) ≥ 30 kg/m2. Debate continues as to whether GWG less than that recommended is safe in women with gestational diabetes mellitus (GDM). The study objective was to examine maternal and infant outcomes for obese women with GDM who lost weight or gained 0-5 kg during pregnancy. SUBJECTS/METHODS A 7-year retrospective cohort study of pregnancy outcomes for obese women with GDM recorded in the Atlantic Diabetes in Pregnancy database was conducted. We examined pregnancy outcomes for mothers with GDM and a BMI ≥ 30 who either lost weight or gained 0-5 kg (Group 1, n = 237) and women who gained 5-9 kg (Group 2, n = 77). We further divided groups 1 and 2 into women treated by diet only (GDM-D) (n = 120) and those requiring additional treatment with insulin (GDM-I) (n = 194). RESULTS GDM-D women in Group 1 were more likely to deliver earlier (38.9 vs 39.8 weeks, p < 0.01), to develop pregnancy induced hypertension (PIH) (15.4% v 0%; p = 0.02) or have a post-partum haemorrhage (PPH) (13.2% vs 0, p = 0.03) compared to women in Group 2. Rates of prematurity were higher in group 1 vs 2 (14.3% vs 0%, p = 0.03). However, further logistic regression analysis adjusted for smoking status, family history of diabetes, ethnicity and age determined no significant difference in maternal or infant outcomes for women in Group 1 compared to those in Group 2. CONCLUSION In our population, weight gain less than IOM guideline appears safe and is not associated with any further increase in adverse outcomes. However, validation through a prospective study with a larger obese GDM cohort is required before the findings presented here could be recommended for routine clinical use.
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Affiliation(s)
- Delia Bogdanet
- College of Medicine, Nursing and Health Sciences National University Ireland, Galway, Ireland. .,Galway University Hospital, Galway, Ireland.
| | | | | | - Paula M O' Shea
- College of Medicine, Nursing and Health Sciences National University Ireland, Galway, Ireland.,Galway University Hospital, Galway, Ireland
| | - Fidelma P Dunne
- College of Medicine, Nursing and Health Sciences National University Ireland, Galway, Ireland.,Galway University Hospital, Galway, Ireland
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Lima Ferreira J, Voss G, Dória M, Sá Couto A, Príncipe RM. Benefit of insufficient gestational weight gain in obese women with gestational diabetes mellitus: A multicenter study in Portugal. Diabetes Metab Syndr 2021; 15:419-424. [PMID: 33582580 DOI: 10.1016/j.dsx.2021.01.020] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Revised: 01/24/2021] [Accepted: 01/26/2021] [Indexed: 12/22/2022]
Abstract
BACKGROUND Both obesity and gestational diabetes mellitus (GDM) are independent risk factors for adverse maternal and fetal outcomes. The Institute of Medicine (IOM) recommends different targets for an adequate gestational weight gain (GWG), depending on the prepregnancy body mass index, but they have been questioned. We aim to compare obese pregnant women with GDM according to GWG stratification (insufficient, adequate and excessive) with regard to maternal and neonatal outcomes and to clarify whether insufficient GWG can be associated with better outcomes. METHODS A multicenter observational study with prospectively collected data of obese singleton pregnant women with GDM was conducted. GWG was expressed according to the 2009 IOM's recommendations. RESULTS Of 4563 obese women with GDM, 34.5%, 30.4% and 35.2% registered insufficient, adequate and excessive GWG, respectively. Multiple logistic regression analysis revealed that women with insufficient GWG had lower odds of gestational hypertension, preeclampsia, caesarean section, large for gestational age (LGA) neonates and prediabetes in postpartum. Despite the higher incidence of small for gestational age (SGA) neonates, they were not associated with adverse outcomes. Women with excessive GWG had higher odds of caesarean section, macrosomic and LGA neonates. CONCLUSIONS Insufficient GWG in obese women with GDM was beneficial due to better maternal and neonatal outcomes. In clinical practice, we should be strict with regard to weight gain in obese pregnant women with GDM and encourage a reduced GWG, provided an adequate fetal growth is guaranteed.
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Affiliation(s)
- Joana Lima Ferreira
- Department of Endocrinology, Hospital Pedro Hispano, Matosinhos Local Health Unit, Rua Dr. Eduardo Torres, 4464-513, Senhora da Hora, Matosinhos, Portugal.
| | - Gina Voss
- Centro de Estudos de Comunicação e Sociedade, Instituto de Ciências Sociais, Universidade do Minho, Campus de Gualtar, 4710-057, Braga, Braga, Portugal
| | - Mariana Dória
- Department of Gynecology and Obstetrics, Hospital Pedro Hispano, Matosinhos Local Health Unit, Rua Dr. Eduardo Torres, 4464-513, Senhora da Hora, Matosinhos, Portugal
| | - Adelina Sá Couto
- Department of Gynecology and Obstetrics, Hospital Pedro Hispano, Matosinhos Local Health Unit, Rua Dr. Eduardo Torres, 4464-513, Senhora da Hora, Matosinhos, Portugal
| | - Rosa Maria Príncipe
- Department of Endocrinology, Hospital Pedro Hispano, Matosinhos Local Health Unit, Rua Dr. Eduardo Torres, 4464-513, Senhora da Hora, Matosinhos, Portugal
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Tebbani F, Oulamara H, Agli A. Facteurs associés au gain pondéral insuffisant au cours de la grossesse. Rev Epidemiol Sante Publique 2019; 67:253-260. [DOI: 10.1016/j.respe.2019.03.121] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2018] [Revised: 03/13/2019] [Accepted: 03/13/2019] [Indexed: 01/27/2023] Open
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Wang N, Ding Y, Wu J. Effects of pre-pregnancy body mass index and gestational weight gain on neonatal birth weight in women with gestational diabetes mellitus. Early Hum Dev 2018; 124:17-21. [PMID: 30081354 DOI: 10.1016/j.earlhumdev.2018.07.008] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2017] [Revised: 05/17/2018] [Accepted: 07/23/2018] [Indexed: 01/09/2023]
Abstract
AIM To study the impact of pre-pregnancy body mass index (BMI) and gestational weight gain (GWG) on neonatal birth weight in women with gestational diabetes mellitus (GDM). METHODS This was a prospective cohort study of 622 singleton pregnant women diagnosed with GDM recruited from 1 April 2014 and 30 December 2014 in a university teaching hospital in China. Binary logistic regression was used to analyze the factors influencing macrosomia. RESULTS Pre-pregnancy BMI categories were: underweight (10.6%), normal (65.6%), overweight (18.0%) and obese (5.8%). Mean GWG was 14.4 ± 4.8 kg and birth weight 3353.1 ± 467.3 g. The incidence of macrosomia was 7.8% and low birth weight 2.3%. Logistic regression analysis showed that pre-pregnancy BMI was not associated with macrosomia. However, excessive GWG was a risk factor for macrosomia (odds ratio (OR) 2.884, 95% confidence interval (CI) 1.385-6.004, p < 0.01). In addition, high maternal fasting plasma glucose (FPG) (OR 1.933, 95% CI 1.126-3.316) and serum triglyceride (TG) (OR 1.235, 95% CI 1.053-1.449) in the third trimester of pregnancy were risk factors for macrosomia. CONCLUSIONS Patients with GDM can be advised that excessive GWG and uncontrolled hyperglycaemia influence their chances for macrosomia.
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Affiliation(s)
- Na Wang
- Nursing Department, Obstetrics and Gynaecology Hospital of Fudan University, Shanghai, China
| | - Yan Ding
- Nursing Department, Obstetrics and Gynaecology Hospital of Fudan University, Shanghai, China.
| | - Jiangnan Wu
- Department of Clinical Epidemiology, Obstetrics and Gynaecology Hospital of Fudan University, Shanghai, China
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Komem D, Salman L, Krispin E, Arbib N, Bardin R, Wiznitzer A, Hadar E. Gestational weight gain and weight loss among women with gestational diabetes mellitus. Diabetes Res Clin Pract 2018; 141:88-97. [PMID: 29689321 DOI: 10.1016/j.diabres.2018.04.034] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2018] [Revised: 04/04/2018] [Accepted: 04/17/2018] [Indexed: 10/17/2022]
Abstract
AIMS To assess the association of gestational weight gain or loss with adverse pregnancy outcome among women with gestational diabetes mellitus (GDM). METHODS Retrospective study of all women diagnosed with GDM, from July 2012 to December 2016, stratified by gestational weight change according to the institute of medicine recommendations. Primary maternal outcome was glycemic control and primary neonatal outcome was large or small for gestational age (LGA or SGA). RESULTS 451 women were enrolled. Total weight change was associated with poor glycemic control, cesarean delivery, polyhydramnios, higher birthweight (when above recommendations), oligohydramnios and SGA (when below recommendations). GDM-related weight change was associated with polyhydramnios, cesarean delivery, higher birthweight (when above recommendations) and lower incidence of hypertensive disorders (when below recommendations). Adjusted odds ratio for poor glucose control among those with total weight gain above recommendations was 2.194 (95% CI 1.214-3.961) vs. those within-; and 1.048 (95% CI 0.611-1.799) vs. those who gained below- recommendations. The rate of SGA or LGA was not different for those gaining below or above vs. within recommendations. CONCLUSION Gestational weight gain is an important predictor of glycemic control and adverse pregnancy outcome among women with GDM - both overall and GDM-related.
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Affiliation(s)
- Daphna Komem
- Helen Schneider's Hospital for Women, Rabin Medical Center, Petach-Tikva, Israel
| | - Lina Salman
- Helen Schneider's Hospital for Women, Rabin Medical Center, Petach-Tikva, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Eyal Krispin
- Helen Schneider's Hospital for Women, Rabin Medical Center, Petach-Tikva, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Nissim Arbib
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; Department of Obstetrics & Gynecology, Meir Medical Center, Kfar Saba, Israel
| | - Ron Bardin
- Helen Schneider's Hospital for Women, Rabin Medical Center, Petach-Tikva, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Arnon Wiznitzer
- Helen Schneider's Hospital for Women, Rabin Medical Center, Petach-Tikva, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Eran Hadar
- Helen Schneider's Hospital for Women, Rabin Medical Center, Petach-Tikva, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
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12
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Mastella LS, Weinert LS, Gnielka V, Hirakata VN, Oppermann MLR, Silveiro SP, Reichelt AJ. Influence of maternal weight gain on birth weight: a gestational diabetes cohort. ARCHIVES OF ENDOCRINOLOGY AND METABOLISM 2018; 62:55-63. [PMID: 29694632 PMCID: PMC10118693 DOI: 10.20945/2359-3997000000009] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/11/2016] [Accepted: 06/12/2017] [Indexed: 11/23/2022]
Abstract
Objective Our objective was to evaluate gestational weight gain (GWG) patterns and their relation to birth weight. Subjects and methods We prospectively enrolled 474 women with gestational diabetes mellitus (GDM) at a university hospital (Porto Alegre, Brazil, November 2009-May 2015). GWG was categorized according to the 2009 Institute of Medicine guidelines; birth weight was classified as large (LGA) or small (SGA) for gestational age. Adjusted relative risks (aRRs) and 95% confidence intervals (95% CIs) were determined. Results Adequate GWG occurred in 121 women [25.5%, 95% CI: 22, 30%]; excessive, in 180 [38.0%, 95% CI: 34, 43%]; and insufficient, in 173 [36.5%, 95% CI: 32, 41%]. In women with normal body mass index (BMI), the prevalence of SGA was higher in those with insufficient compared to adequate GWG (30% vs. 0%, p < 0.001). In women with BMI ≥ 25 kg/m2, excessive GWG increased the prevalence of LGA [aRR 2.58, 95% CI: 1.06, 6.29] and protected from SGA [aRR 0.25, 95% CI: 0.10, 0.64]. Insufficient vs. adequate GWG did not influence the prevalence of SGA [aRR 0.61, 95% CI: 0.31, 1.22]; insufficient vs. excessive GWG protected from LGA [aRR 0.46, 95% CI: 0.23, 0.91]. Conclusions One quarter of this cohort achieved adequate GWG, indicating that specific ranges have to be tailored for GDM. To prevent inadequate birth weight, excessive GWG in women with higher BMI and less than recommended GWG in normal BMI women should be avoided; less than recommended GWG may be suitable for overweight and obese women.
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Affiliation(s)
- Livia S Mastella
- Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brasil
| | | | - Vanessa Gnielka
- Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brasil
| | - Vânia N Hirakata
- Unidade de Bioestatística, Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brasil
| | - Maria Lúcia R Oppermann
- Serviço de Obstetrícia e Ginecologia, Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brasil
| | | | - Angela J Reichelt
- Serviço de Endocrinologia, Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brasil
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13
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Rodrigo N, Glastras SJ. The Emerging Role of Biomarkers in the Diagnosis of Gestational Diabetes Mellitus. J Clin Med 2018; 7:E120. [PMID: 29882903 PMCID: PMC6024961 DOI: 10.3390/jcm7060120] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2018] [Revised: 05/10/2018] [Accepted: 05/14/2018] [Indexed: 02/06/2023] Open
Abstract
Gestational diabetes mellitus (GDM) is a common complication of pregnancy; its rising incidence is a result of increased maternal obesity and older maternal age together with altered diagnostic criteria identifying a greater proportion of pregnant women with GDM. Its consequences are far-reaching, associated with poorer maternal and neonatal outcomes compared to non-GDM pregnancies, and GDM has implications for metabolic health in both mother and offspring. Objective markers to identify women at high risk for the development of GDM are useful to target therapy and potentially prevent its development. Established clinical risk factors for GDM include overweight/obesity, age, ethnicity, and family history of diabetes, though they lack specificity for its development. The addition of biomarkers to predictive models of GDM may improve the ability to identify women at risk of GDM prior to its development. These biomarkers reflect the pathophysiologic mechanisms of GDM involving insulin resistance, chronic inflammation, and altered placental function. In addition, the role of epigenetic changes in GDM pathogenesis highlights the complex interplay between genetic and environmental factors, potentially offering further refinement of the prediction of GDM risk. In this review, we will discuss the clinical challenges associated with the diagnosis of GDM and its current pathophysiologic basis, giving rise to potential biomarkers that may aid in its identification. While not yet validated for clinical use, we explore the possible clinical role of biomarkers in the future. We also explore novel diagnostic tools, including high throughput methodologies, that may have potential future application in the identification of women with GDM.
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Affiliation(s)
- Natassia Rodrigo
- Department of Diabetes, Endocrinology & Metabolism, Royal North Shore Hospital, St Leonards, Sydney 2065, Australia.
- The Kolling Institute of Medical Research, St Leonards, Sydney 2065, Australia.
- Faculty of Medicine, The University of Sydney, Sydney 2006, Australia.
| | - Sarah J Glastras
- Department of Diabetes, Endocrinology & Metabolism, Royal North Shore Hospital, St Leonards, Sydney 2065, Australia.
- The Kolling Institute of Medical Research, St Leonards, Sydney 2065, Australia.
- Faculty of Medicine, The University of Sydney, Sydney 2006, Australia.
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14
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Yang Y, Wei Q, Yu H, Wang P, Xia W, Huang R, Cai R, Sun H, Wang S. Higher pre-pregnancy body mass index is associated with excessive gestational weight gain in normal weight Chinese mothers with gestational diabetes. J Obstet Gynaecol Res 2016; 42:511-8. [PMID: 26786662 DOI: 10.1111/jog.12934] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2015] [Revised: 09/07/2015] [Accepted: 11/27/2015] [Indexed: 12/16/2022]
Affiliation(s)
- Yue Yang
- Departments of Endocrinology; Affiliated ZhongDa Hospital of Southeast University; Nanjing China
| | - Qiong Wei
- Departments of Endocrinology; Affiliated ZhongDa Hospital of Southeast University; Nanjing China
| | - Hong Yu
- Department of Obstetrics and Gynecology; Affiliated ZhongDa Hospital of Southeast University; Nanjing China
| | - Pin Wang
- Departments of Endocrinology; Affiliated ZhongDa Hospital of Southeast University; Nanjing China
| | - Wenqing Xia
- Departments of Endocrinology; Affiliated ZhongDa Hospital of Southeast University; Nanjing China
| | - Rong Huang
- Departments of Endocrinology; Affiliated ZhongDa Hospital of Southeast University; Nanjing China
| | - Rongrong Cai
- Departments of Endocrinology; Affiliated ZhongDa Hospital of Southeast University; Nanjing China
| | - Haixia Sun
- Departments of Endocrinology; Affiliated ZhongDa Hospital of Southeast University; Nanjing China
| | - Shaohua Wang
- Departments of Endocrinology; Affiliated ZhongDa Hospital of Southeast University; Nanjing China
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15
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Gante I, Amaral N, Dores J, Almeida MC. Impact of gestational weight gain on obstetric and neonatal outcomes in obese diabetic women. BMC Pregnancy Childbirth 2015; 15:249. [PMID: 26449278 PMCID: PMC4599662 DOI: 10.1186/s12884-015-0692-z] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2015] [Accepted: 10/05/2015] [Indexed: 11/10/2022] Open
Abstract
Background Both obesity and gestational diabetes mellitus are increasing in prevalence, being a major health problem in pregnancy with independent and additive impact on obstetrics outcomes. It is recognized that inadequate gestational weight gain is an independent risk factor for pregnancy-related morbidity. The aim of this study was to evaluate the effect of gestational weight gain on obstetric and neonatal outcomes in obese women with gestational diabetes. Methods Retrospective multicenter study of obese women with gestational diabetes. The assessed group was divided into three categories: women who gained below (<5 kg), within (5–9 kg) and above (>9 kg) the 2009 Institute of Medicine recommendations. Maternal and neonatal outcomes were compared and adjusted odds ratios calculated controlling for confounders. Results Only 35,1 % of obese women with gestational diabetes (n = 634) achieved the recommended gestational weight gain; 27,8 % (n = 502) gained below and 37,1 % (n = 670) above the recommendations. There was a positive correlation between gestational weight gain and neonatal birthweight (r = 0,225; p < 0,001). Gestational weight gain below recommendations was associated with lower odds for cesarean section, even adjusting for birthweight [aOR = 0,67 (0,54–0,85); p < 0,001]; lower odds for large for gestational age neonates [aOR = 0,39 (0,28–0,57); p < 0,001] and macrosomia [aOR = 0,34 (0,21–0,55); p < 0,001]. Excessive weight gain, even adjusting for birthweight, was associated with higher odds for cesarean section [aOR = 1,31 (1,07–1,61); p = 0,009], low Apgar score [aOR = 4,79 (1,19–19,21); p = 0,027], large for gestational age neonates [aOR = 2,32 (1,76–3,04); p < 0,001] and macrosomia [aOR = 2,39 (1,68–3,38); p < 0,001]. Conclusions In obese women with gestational diabetes, a reduced gestational weight gain (<5 kg) is associated with better obstetric and neonatal outcomes than an excessive or even an adequate weight gain. Therefore, specific recommendations should be created since gestational weight gain could be a modifiable risk factor for adverse obstetric outcomes.
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Affiliation(s)
- Inês Gante
- Department of Obstetrics, Maternidade Bissaya Barreto - Centro Hospitalar e Universitário de Coimbra, Rua Augusta, 3000-061, Coimbra, Portugal.
| | - Njila Amaral
- Department of Obstetrics, Hospital Beatriz Ângelo, Loures, Portugal.
| | - Jorge Dores
- Department of Obstetrics, Centro Hospitalar do Porto, Porto, Portugal.
| | - Maria C Almeida
- Department of Obstetrics, Maternidade Bissaya Barreto - Centro Hospitalar e Universitário de Coimbra, Rua Augusta, 3000-061, Coimbra, Portugal.
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Park S, Yoon HK, Ryu HM, Han YJ, Lee SW, Park BK, Park SY, Yim CH, Kim SH. Maternal vitamin D deficiency in early pregnancy is not associated with gestational diabetes mellitus development or pregnancy outcomes in Korean pregnant women in a prospective study. J Nutr Sci Vitaminol (Tokyo) 2015; 60:269-75. [PMID: 25297616 DOI: 10.3177/jnsv.60.269] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
The association between vitamin D deficiency in the first trimester and GDM development remains controversial in various ethnicities. We prospectively assessed whether pregnant women with vitamin D deficiency during early pregnancy had an increased likelihood of GDM development or poor fetal growth or pregnancy outcomes compared to those with sufficient vitamin D levels. Serum 25-OH-D measurements and fetal ultrasonograms were carried out at 12-14, 20-22, and 32-34 wk in 523 pregnant women. Each woman was screened for GDM at 24-28 wk. There were no differences in serum 25-OH-D levels at 12-14 wk or 22-24 wk of pregnancy between GDM and non-GDM women after adjusting for maternal age, BMI at prepregnancy, BMI at first visit, BMI at GDM screening, gestational age at sampling, previous history of GDM, vitamin D intake, and seasonal variation in sampling. The risk of GDM, insulin resistance, and impaired β-cell function had no association with serum 25-OH-D levels in crude or adjusted logistic regression analysis. GDM was not associated with maternal serum 25-OH-D deficiency during the first trimester or fetal growth during the first and second trimesters. Pregnancy outcomes such as miscarriage, Apgar 1, Apgar 5 and birth weight were independent of maternal serum 25-OH-D levels during the first, second and third trimester of pregnancy. In conclusion, neither GDM prevalence nor fetal growth during pregnancy is associated with vitamin D deficiency at the first trimester in Korean women. Pregnancy outcomes are also independent of maternal vitamin D status.
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Affiliation(s)
- Sunmin Park
- Department of Food & Nutrition, Hoseo University
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17
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Effects of pre-pregnancy weight on incidence of large for gestational age newborn in pregnant women with gestational diabetes mellitus. Int J Diabetes Dev Ctries 2015. [DOI: 10.1007/s13410-015-0381-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Abstract
Obesity in pregnancy is the leading cause of maternal and fetal morbidity, and gestational weight gain (GWG) is one modifiable risk factor that improves pregnancy outcomes. Most pregnant women gain more than the 2009 Institute of Medicine recommendations, particularly overweight and obese women. GWG even less than the 2009 IOM guidelines in obese women may improve pregnancy outcomes and reduce large-for-gestational-age (LGA) infants, an independent risk factor for childhood obesity, without increasing small-for-gestational-age (SGA) infants. Unfortunately, despite the fact that over 50 interventional trials designed to decrease excess GWG have been conducted, these interventions have been only modestly effective, and interventions designed to facilitate weight postpartum weight loss have also been disappointing. Successful interventions are of paramount importance not only to improve pregnancy outcomes but also for the future metabolic health of the mother and her infant, and may be key in attenuating the trans-generational risk on childhood obesity.
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Affiliation(s)
- Jacinda M. Nicklas
- Division of General Internal Medicine, University of Colorado School of Medicine, 12348 E. Montview Blvd, C263, Aurora, CO 80045, 303-724-9028 (work phone), 617-510-7273 (cell phone), 303-724-9976 (fax)
| | - Linda A. Barbour
- Professor of Medicine and Obstetrics and Gynecology, Divisions of Endocrinology, Metabolism, and Diabetes and Maternal-Fetal Medicine, University of Colorado School of Medicine, Mail Stop 8106, 12801 E. 17 Avenue, Aurora, CO 80045, 303-724-3921 (work phone), 303-594-0474 (cell phone), 303-724-3920 (fax)
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Park S, Park JY, Lee JH, Kim SH. Plasma levels of lysine, tyrosine, and valine during pregnancy are independent risk factors of insulin resistance and gestational diabetes. Metab Syndr Relat Disord 2014; 13:64-70. [PMID: 25419905 DOI: 10.1089/met.2014.0113] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND This study compared plasma concentrations of amino acids in pregnant women with and without gestational diabetes mellitus (GDM) and identified the association between plasma amino acid levels and GDM, insulin resistance, and insulin secretion at 24-28 weeks of pregnancy. METHODS Circulating amino acid levels were evaluated using high-performance liquid chromatography at 24-28 weeks of pregnancy in 25 non-GDM and 64 GDM women after adjusting for covariates such as maternal age, body mass index (BMI) before pregnancy, BMI and gestational age at screening GDM, and daily caloric intake. Backward stepwise logistic regression analysis was used to identify the predictors of developing GDM, and homeostatic model assessments for insulin resistance (HOMA-IR) and β-cell function (HOMA-B). RESULTS Circulating levels of amino acids except threonine and tyrosine were significantly higher in GDM women than non-GDM women. Along with the intakes of energy, protein, and fat from animal sources, the intakes of each amino acid were significantly higher in the GDM group without a direct correlation to plasma amino acid levels. The variation in GDM development was explained by maternal age, diastolic blood pressure, and plasma lysine levels (R(2)=0.691). Height, BMI before pregnancy, systolic blood pressure, and plasma tyrosine and valine levels accounted for the variation in HOMA-IR (R(2)=0.589). The 53.3% variation of HOMA-B was explained by maternal age, BMI at GDM screening, plasma insulin level at 1 h during the oral glucose tolerance test (OGTT), and plasma valine level. CONCLUSIONS Circulating concentrations of lysine, tyrosine, and valine were independently and positively associated with GDM through modifying insulin resistance and secretion.
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Affiliation(s)
- Sunmin Park
- 1 Department of Food & Nutrition, Obesity/Diabetes Center, Hoseo University , Asan, Korea
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20
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Gestational weight gain is an important risk factor for excessive fetal growth. Obstet Gynecol Sci 2014; 57:442-7. [PMID: 25469331 PMCID: PMC4245336 DOI: 10.5468/ogs.2014.57.6.442] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2014] [Revised: 07/18/2014] [Accepted: 08/11/2014] [Indexed: 12/16/2022] Open
Abstract
Objective To estimate the odds ratio of prepregnant body mass index (BMI), gestational weight gain (GWG), and gestational diabetes mellitus (GDM) for excessive fetal growth, which we define as large for gestational age (LGA). Methods We included 16,297 women who delivered a live-born singleton baby at term. We fit logistic regressions to estimate the odds ratios of variables, including maternal age, parity, prepregnant BMI ≥23, GWG ≥15 kg, and GDM, for LGA. We classified GWG into four categories (<10, 10-14.9, 15-19.9, and ≥20 kg) and BMI into four categories (underweight, normal, overweight, and obese). After adjusting for age and parity, we analyzed the odds ratios of prepregnant BMI according to GWG between non-GDM and GDM women for LGA. Results The odds ratios of GWG ≥15 kg and prepregnancy BMI ≥23 for LGA were 2.40 (95% confidence interval [CI], 2.16-2.67) and 2.24 (95% CI, 1.99-2.51), respectively. The odd ratio of GDM was 1.37 (95% CI, 1.09-1.71). The risk of GDM women with normal/-overweight BMI and GWG <15 kg for LGA was not significantly greater than those of the reference group. The odd ratios of GDM women with overweight/obese BMI and GWG 15 to 19.9 kg were 3.95 (95% CI, 1.26-12.38) and 9.70 (95% CI, 3.79-24.87), respectively. Conclusion GWG ≥15 kg might be a more important risk factor for LGA than either prepregnancy BMI ≥23 or GDM. Risk for LGA was highest in obese GDM women with GWG ≥15 kg.
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Park S, Kim MH, Kim SH. Early gestational weight gains within current recommendations result in increased risk of gestational diabetes mellitus among Korean women. Diabetes Metab Res Rev 2014; 30:716-25. [PMID: 24639422 DOI: 10.1002/dmrr.2540] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2013] [Revised: 02/13/2014] [Accepted: 03/03/2014] [Indexed: 11/11/2022]
Abstract
BACKGROUND We prospectively assessed whether maternal weight gain at 24-28 weeks of gestation (MWG24) influences the risk of developing gestational complications, such as gestational diabetes mellitus (GDM) and other adverse pregnancy outcomes, in pregnant Korean women. METHODS Maternal weight gain from self-reported pre-pregnancy weight until 24-28 weeks of gestation was measured in 731 pregnant women, and an expected MWG24 was determined using the Institute of Medicine 2009 guidelines. Glucose tolerance, insulin resistance, insulin secretory capacity, anthropometric measurements, lipid profiles, nutrient intakes and pregnancy outcomes were evaluated at 24-28 weeks of gestation. The adjusted odds ratios (ORs) for GDM, large-for-gestational-age infants, small-for-gestational-age infants and preterm delivery were determined according to maternal weight gain by logistic regression analysis after adjusting for covariates. RESULTS Compared with a normal MWG24, an inadequate MWG24 reduced the OR (0.565) for GDM, but an excessive MWG24 did not affect the OR (0.854). However, ORs for preterm delivery were significantly higher in both inadequate and excessive MWG24 groups in comparison with the normal MWG24. There were no other adverse pregnancy outcomes due to the inadequate MWG24. MWG24 was not associated with a significant increase in ORs for delivering large-for-gestational-age or small-for-gestational-age infants or delivery by caesarean section. Although energy intake was less than the estimated energy requirement in all groups, MWG24 was linearly associated with energy intake such that energy balance was positive in the excessive MWG24 group. CONCLUSIONS This study suggests that both target weight gain and energy intake recommendations for early pregnancy may not be optimal for Korean women and that race-specific recommendations are needed to decrease the risk of GDM without increasing adverse pregnancy outcomes.
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MESH Headings
- Adult
- Cohort Studies
- Diabetes, Gestational/epidemiology
- Diabetes, Gestational/ethnology
- Diabetes, Gestational/etiology
- Diabetes, Gestational/metabolism
- Diet/adverse effects
- Diet/ethnology
- Energy Intake/ethnology
- Female
- Humans
- Insulin Resistance/ethnology
- Maternal Nutritional Physiological Phenomena/ethnology
- National Academies of Science, Engineering, and Medicine, U.S., Health and Medicine Division
- Nutrition Policy
- Obstetric Labor, Premature/epidemiology
- Obstetric Labor, Premature/ethnology
- Obstetric Labor, Premature/etiology
- Obstetric Labor, Premature/metabolism
- Patient Compliance/ethnology
- Pregnancy
- Pregnancy Trimester, Second
- Prospective Studies
- Republic of Korea/epidemiology
- Risk Factors
- United States
- Weight Gain/ethnology
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Affiliation(s)
- Sunmin Park
- Department of Food & Nutrition, Hoseo University, Asan, Korea
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22
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Barbour LA. Changing perspectives in pre-existing diabetes and obesity in pregnancy: maternal and infant short- and long-term outcomes. Curr Opin Endocrinol Diabetes Obes 2014; 21:257-63. [PMID: 24937039 DOI: 10.1097/med.0000000000000079] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
PURPOSE OF REVIEW Climbing obesity rates in women have propelled the increasing prevalence of type 2 diabetes mellitus (T2DM) in pregnancy, and an increasing number of women with type 1 diabetes mellitus (T1DM) are also affected by obesity. Increasing recognition that an intrauterine environment characterized by obesity, insulin resistance, nutrient excess, and diabetes may be fueling the obesity epidemic in children has created enormous pressure to re-examine the conventional wisdom of our current approaches. RECENT FINDINGS Compelling data in pregnancies complicated by diabetes, in particular those accompanied by insulin resistance and obesity, support a fetal programming effect resulting in increased susceptibility to metabolic disease for the offspring later in life. Recent data also underscore the contribution of obesity, lipids, and lesser degrees of hyperglycemia on fetal fat accretion, challenging the wisdom of current gestational weight gain recommendations with and without diabetes. The risks of adverse pregnancy outcomes in T2DM are at least as high as in T1DM and there remains controversy about the ideal glucose treatment targets, the benefit of different insulin analogues, and the role of continuous glucose monitoring in T1DM and T2DM. SUMMARY It has become unmistakably evident that achieving optimal outcomes in mothers with diabetes is clearly impacted by ideal glycemic control but goes far beyond it. The intrauterine metabolic environment seems to have long-term implications on the future health of the offspring so that the effectiveness of our current approaches can no longer be simply measured by whether or not maternal glucose values are at goal.
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Affiliation(s)
- Linda A Barbour
- Divisions of Endocrinology, Metabolism and Diabetes and Maternal-Fetal Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA
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Kim C. Gestational diabetes mellitus in korean women: similarities and differences from other racial/ethnic groups. Diabetes Metab J 2014; 38:1-12. [PMID: 24627822 PMCID: PMC3950189 DOI: 10.4093/dmj.2014.38.1.1] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Gestational diabetes mellitus (GDM) reflects defects in insulin secretion in response to the metabolic demands of pregnancy. While GDM is increasingly common worldwide due in large part to the obesity epidemic, its frequency is relatively low in Korean women. In this report, the prevalence and risk factors for GDM, perinatal outcomes, and postpartum course are compared in non-Korean and Korean women. While Koreans and non-Koreans with GDM share pathophysiology and complications, there may be differences in the role of obesity and thus the effectiveness of interventions targeting obesity in GDM women. Further investigations of the effectiveness of weight loss interventions and pharmacotherapy specifically among Korean women are needed. Dietary and other lifestyle data from Korean populations could inform prevention and treatment strategies in other countries which suffer from significantly higher prevalences of GDM.
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Affiliation(s)
- Catherine Kim
- Department of Medicine, University of Michigan Medical School, Ann Arbor, MI, USA
- Department of Obstetrics and Gynecology, University of Michigan Medical School, Ann Arbor, MI, USA
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Abstract
Gestational diabetes is associated with adverse pregnancy outcomes, increased costs, and long-term risk of type 2 diabetes mellitus (T2DM) in the mother. Observational data have shown an association between reduced weight gain, healthy eating, and physical activity and reduced rates of gestational diabetes mellitus (GDM). Despite this, most randomized controlled trials of lifestyle interventions to prevent GDM have been negative. Dietary approaches appear to be more successful than exercise or a combination of diet and exercise at decreasing GDM. Reasons for negative studies may include lack of power, lack of intervention uptake, and severity of placenta mediated insulin resistance. Future studies should be powered for a reduction in GDM, monitor lifestyle changes closely, and include a psychological component in the intervention.
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Affiliation(s)
- Ilana J Halperin
- Division of Endocrinology, Department of Medicine, Sunnybrook Health Sciences Center, University of Toronto, Toronto, Canada,
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Yee LM, Cheng YW, Inturrisi M, Caughey AB. Gestational weight loss and perinatal outcomes in overweight and obese women subsequent to diagnosis of gestational diabetes mellitus. Obesity (Silver Spring) 2013; 21:E770-4. [PMID: 23613187 PMCID: PMC3758809 DOI: 10.1002/oby.20490] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2012] [Accepted: 03/25/2013] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To investigate whether gestational weight loss (GWL) after the diagnosis of gestational diabetes mellitus (GDM) in overweight and obese women is associated with improved perinatal outcomes. Obesity and GDM are risk factors for adverse perinatal outcomes, but few studies have investigated weight loss during pregnancy in women with these comorbidities. DESIGN AND METHODS Retrospective cohort study of 26,205 overweight and obese gestational diabetic women enrolled in the California Diabetes and Pregnancy Program. Women with GWL during program enrollment were compared to those with weight gain. Perinatal outcomes were assessed using chi-square test and multivariable logistic regression analysis. RESULTS About 5.2% of women experienced GWL. GWL was associated with decreased odds of macrosomia (aOR 0.63, 95% CI 0.52-0.77), NICU admission (aOR 0.51, 95% CI 0.27-0.95), and cesarean delivery (aOR 0.81, 95% CI 0.68-0.97). Odds of SGA status (aOR 1.69, 95% CI 1.32-2.17) and preterm delivery <34 weeks (aOR 1.71, 95% CI 1.23-2.37) were increased. CONCLUSIONS In overweight and obese women with GDM, third trimester weight loss is associated with some improved maternal and neonatal outcomes, although this effect is lessened by increased odds of SGA status and preterm delivery. Further research on weight loss and interventions to improve adherence to weight guidelines in this population is recommended.
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Affiliation(s)
- Lynn M. Yee
- Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine
| | - Yvonne W. Cheng
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco
| | - Maribeth Inturrisi
- Department of Family Health, School of Nursing, University of California, San Francisco
| | - Aaron B. Caughey
- Department of Obstetrics and Gynecology; Oregon Health & Science University
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Wong VW, Russell H. Weight gain during pregnancy in women with gestational diabetes: How little is too little? Diabetes Res Clin Pract 2013; 102:e32-4. [PMID: 24095156 DOI: 10.1016/j.diabres.2013.09.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2013] [Revised: 08/27/2013] [Accepted: 09/09/2013] [Indexed: 10/26/2022]
Abstract
We evaluated maternal weight gain in women with gestational diabetes, and assessed their compliance with the Institute of Medicine (IOM) weight gain targets. Only 28% of women achieved the IOM targets, with 40% gaining inadequate weight. Those who gained inadequate weight did not suffer any increase in adverse pregnancy outcomes.
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Affiliation(s)
- Vincent W Wong
- Diabetes and Endocrine Service, Liverpool Hospital, Sydney, NSW, Australia; University of New South Wales, Sydney, NSW, Australia.
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Horosz E, Bomba-Opon DA, Szymanska M, Wielgos M. Maternal weight gain in women with gestational diabetes mellitus. J Perinat Med 2013; 41:523-8. [PMID: 23492551 DOI: 10.1515/jpm-2012-0254] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2012] [Accepted: 02/25/2013] [Indexed: 11/15/2022]
Abstract
OBJECTIVE The aim of the study was to examine the perinatal outcomes in gestational diabetes in women with body mass index (BMI)-adjusted gestational weight gain (GWG) according to the Institute of Medicine (IOM) 2009 recommendations. MATERIAL AND METHODS The clinic's database was used to analyze 675 singleton GDM pregnancy outcomes. GWG for the entire pregnancy was compared to IOM recommendations and adjusted for prepregnancy BMI categories: underweight <18.5; normal 18.5-24.9; overweight 25-29.9; and obese >30. The study group was divided into three categories: below IOM limits, within IOM limits and above IOM limits. RESULTS Only 37% of women achieved the proper weight gain (n=256). Almost 30% of women with GDM (n=196) had an excessive weight gain. GWG above limits was associated with a significantly higher neonatal measurements and a higher rate of large-for-gestational-age neonates. In underweight and normal-prepregnancy-weight women, no relation between GWG and birth-weight percentile was noted. For the overweight and obese women, a positive significant correlation between GWG until GDM diagnosis and birth-weight percentile was noted (P=0.002), which was not present when GWG until delivery was considered. CONCLUSIONS Limited weight gain in overweight and obese women with gestational diabetes mellitus results in favourable pregnancy outcomes.
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Affiliation(s)
- Edyta Horosz
- First Department of Obstetrics and Gynaecology, Medical University of Warsaw, Poland.
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Gestational diabetes is associated with high energy and saturated fat intakes and with low plasma visfatin and adiponectin levels independent of prepregnancy BMI. Eur J Clin Nutr 2013; 67:196-201. [PMID: 23385969 DOI: 10.1038/ejcn.2012.207] [Citation(s) in RCA: 64] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND/OBJECTIVES Gestational diabetes mellitus (GDM) risk factors are well established for Caucasians, but not for Asians. We hypothesized that nutrient intakes, plasma adipokines and/or gestational hormones might be linked to GDM development among pregnant Korean women. This study sought to identify new risk factors for GDM and adverse pregnancy outcomes according to body weight at prepregnancy. SUBJECTS/METHODS All subjects were pregnant women visiting the Cheil General Hospital and Women's Healthcare Center between June 2006 and March 2009. Non-GDM (n=531) and GDM (n=215) participants were divided into normal-weight and overweight groups according to prepregnancy body mass index (BMI) above or below 23 kg/m(2) at 24-28th week of gestation. At that time, glucose tolerance, insulin resistance as homeostatic model assessment for insulin resistance, insulin secretory capacity as homeostatic model assessment for β-cell function, anthropometric measurement, nutrient intakes, and plasma levels of adipokines and gestational hormones were determined. RESULTS GDM women gained more weight in early pregnancy than non-GDM among normal-weight women. GDM was mainly associated with increased insulin resistance in overweight women and decreased insulin secretory capacity in normal-weight women. Plasma visfatin and adiponectin were lower and progesterone levels higher in GDM than non-GDM independent of BMI while plasma resistin levels were higher in non-GDM, but not GDM, overweight women. Energy and saturated fat intakes were higher in GDM independent of body weight, whereas taurine intakes were lower in GDM than non-GDM only in normal-weight women. CONCLUSIONS Low visfatin and adiponectin and high progesterone levels in the circulation and high energy and saturated fat intakes were common risk factors for GDM and pregnancy outcome such as large for gestational age. Daily reference intakes for energy and fat during pregnancy need to be re-evaluated according to prepregnancy BMI.
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Current world literature. Curr Opin Obstet Gynecol 2012; 24:470-8. [PMID: 23154665 DOI: 10.1097/gco.0b013e32835ae910] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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