Meeting paper
SMFM paper
Effect of gestational weight gain on perinatal outcomes in women with type 2 diabetes mellitus using the 2009 Institute of Medicine guidelines

Presented as an abstract at the 31st Annual Meeting of the Society for Maternal-Fetal Medicine, San Francisco, CA, Feb. 7-12, 2011.
https://doi.org/10.1016/j.ajog.2011.06.028Get rights and content

Objective

We sought to examine associations between gestational weight gain according to the 2009 Institute of Medicine (IOM) guidelines and perinatal outcomes in overweight/obese women with type 2 diabetes mellitus (T2DM).

Study Design

This is a retrospective cohort study of 2310 women with T2DM enrolled in the California Diabetes and Pregnancy Program. Gestational weight gain was categorized by 2009 IOM guidelines. Perinatal outcomes were assessed using the χ2 test and multivariable logistic regression analysis.

Results

With excessive gestational weight gain, the odds of having large-for-gestational age (adjusted odds ratio [aOR], 2.00; 95% confidence interval [CI], 1.33–3.00) or macrosomic (aOR, 2.59; 95% CI, 1.56–4.30) neonates and cesarean delivery (aOR, 1.47; 95% CI, 1.03–2.10) was higher. Women with excessive gestational weight gain per week had increased odds of preterm delivery (aOR, 1.57; 95% CI, 1.11–2.20).

Conclusion

In overweight or obese women with T2DM, gestational weight gain greater than the revised IOM guidelines was associated with higher odds of perinatal morbidity, suggesting these guidelines are applicable to a diabetic population.

Section snippets

Materials and Methods

We conducted a retrospective cohort study of all women with T2DM who were cared for in the Sweet Success California Diabetes and Pregnancy Program (CDAPP) from 2001 through 2004. In California, Sweet Success is the clinical component of CDAPP, which provides technical support and education to providers involved in the care of high-risk pregnant women with preexisting diabetes and women who develop GDM. As a part of the Maternal, Child, and Adolescent Health Branch of the California Department

Results

Our study cohort consisted of 2310 women with T2DM who were either overweight or obese and met study inclusion/exclusion criteria. There were 241 (10.4%) women who lost weight, 537 (23.3%) who gained less weight than IOM guidelines, 594 (25.7%) who gained weight within IOM guidelines, and 938 (40.6%) who gained more weight than recommended. Nulliparous women were more likely to have excessive weight gain than multiparas (48.9% vs 39.1%, P = .008). Approximately 50% of African American and 43.7%

Comment

This study investigates the relationship between perinatal outcomes and gestational weight gain, as classified by category of compliance with the 2009 IOM guidelines for gestational weight gain, in women with T2DM who were either overweight or obese. This is the first study to investigate the interaction between high maternal prepregnancy BMI, gestational weight gain, and perinatal outcomes in women with T2DM.

Our findings suggest that the 2009 IOM guidelines are indeed applicable to women with

References (21)

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Y.W.C. is supported by the University of California, San Francisco, Women's Reproductive Health Research Career Development Award, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health (K12 HD001262).

The authors report no conflict of interest.

Cite this article as: Yee LM, Cheng YW, Inturrisi M, et al. Effect of gestational weight gain on perinatal outcomes in women with type 2 diabetes mellitus using the 2009 Institute of Medicine guidelines. Am J Obstet Gynecol 2011;205:257.e1-6.

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