Abstract
Objective This study aimed to investigate the association between excess and less than recommended
gestational weight gain (GWG) and adverse maternal and neonatal outcomes in women
with pregestational and gestational diabetes.
Study Design We conducted a secondary analysis of the National Institute of Child Health and Human
Development (NICHD) Consortium on Safe Labor (CSL) study. We included deliveries >23
weeks of nonanomalous singletons with either pregestational or gestational diabetes.
The exposure was GWG greater than or less than compared with the U.S. Institute of
Medicine recommendations for total pregnancy weight gain per prepregnancy body mass
index. Consistent with the 2020 Delphi outcome for diabetes in pregnancy, maternal
outcomes included cesarean delivery and preeclampsia and neonatal outcomes included
small for gestational age (SGA), large for gestational age (LGA), macrosomia >4,000 g,
preterm birth <37 weeks, stillbirth, and neonatal death. We modeled both absolute
GWG and GWG z-scores, standardized for gestational duration. Multivariable logistic regression
with generalized estimating equations was used, adjusting for age, race/ethnicity,
parity, prior cesarean delivery, chronic hypertension, tobacco use, U.S. region, and
delivery year.
Results Of 8,322 deliveries (n = 8,087 women) complicated by pregestational or gestational diabetes, 47% were in
excess, 27% were within, and 26% were less than GWG recommendations. Deliveries with
excess absolute GWG were at higher adjusted odds of cesarean delivery, preeclampsia,
LGA, and macrosomia, compared with those within recommendations. Similar results were
observed when using standardized GWG z-scores, in addition to higher likelihood of preterm birth and neonatal death. Less
than recommended GWG was associated with a lower likelihood of these adverse outcomes
but higher SGA. Additionally, less GWG by z-score was associated with a lower likelihood of stillbirth.
Conclusion Excess GWG increases the risk of adverse maternal and neonatal outcomes for women
with pregestational and gestational diabetes. Less GWG than recommended may decrease
this risk.
Key Points
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Understanding the impact of GWG modeled using both absolute and standardized measures
is needed.
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Among pregnant women with diabetes, excess GWG was common and increased the risk of
adverse outcomes and less than recommended GWG may decrease the risk of adverse outcomes,
including stillbirth.
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Current recommendations may require revision for women with diabetes in pregnancy.
Keywords
gestational weight gain - pregnancy - adverse outcomes - obesity - diabetes - gestational
diabetes
