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Gestational diabetes plus prepregnancy obesity increases risk for higher infant birth weight

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January 21, 2019

Excessive gestational weight gain and prepregnancy overweight or obesity among Japanese women with gestational diabetes was associated with higher infant birth weight, according to findings published in the Journal of Diabetes Investigation.

Gestational diabetes mellitus (GDM) frequently causes fetal disorders during pregnancy. ... Pregestational obesity is a risk factor for GDM and can provoke maternal complications,” Shigemitsu Yasuda, MD, of the department of endocrinology and diabetes at Saitama Medical University in Saitama, Japan, and colleagues wrote. “Furthermore, excessive gestational weight gain in mothers with GDM can lead to maternal complications (eg, hypertensive disorders of pregnancy and cesarean section) and is a risk factor for the delivery of [large for gestational age] infants.”

Yasuda and colleagues conducted a retrospective observational population-based study with a cohort of 101 women who developed gestational diabetes (mean age at delivery, 34.7 years; mean pregestational BMI, 24.7 kg/m2). All participants received medical care and gave birth at Saitama Medical University Hospital in Saitama, Japan, between 2011 and 2016.

Gestational diabetes was confirmed by a 75-g oral glucose tolerance test. Values of more than 92 mg/dL for fasting plasma glucose, 180 mg/dL for 1-hour plasma glucose and 153 mg/dL for 2-hour plasma glucose were used to diagnose gestational diabetes. Maternal age at delivery, gestational age, BMI at delivery and pregestational BMI were reported for all participants. The researchers divided infant birth weights into three groups based on percentile ranges of Japanese infants: small for gestational age (< 10th percentile), appropriate for gestational age (10th to 90th percentile) and large for gestational age (> 90th percentile).

The researchers found an inverse correlation between pregestational BMI and gestational weight change (P < .0001). In addition, for the entire cohort, there was an association between higher pregestational BMI and elevated infant birth weight (P < .001). Greater infant birth weights were also linked to larger gestational weight change (P = .007). The association between greater infant birth weight and greater gestational weight gain held its significance when researchers considered only those mothers with normal BMI (P = .039) and mothers with overweight/obesity (P = .007).

Using two different measures for excessive gestational weight gain, the researchers evaluated its effect on infant birth weight. The two measures characterized excessive gestational weight gain as either 16 kg or more or 12 kg or more. Infant birth weights for children of mothers who met the 16-kg threshold were higher than those of mothers who did not (P = .047). The same was true for the children of mothers who met the 12-kg cutoff (P = .018).

Lastly, the researchers found that the rate of infants born at large for gestational age was higher for mothers in the overweight/obesity group compared with the normal BMI group (P = .001). Specifically, 35.5% of mothers (n = 11) in the overweight/obesity group gave birth to infants deemed large for gestational age compared with 5.9% of mothers (n = 4) in the normal BMI group.

“To avoid the deliver[y] of large for gestational age infants, prepregnancy maternal weight should be appropriately controlled to be in the healthy weight range. Our study suggests the need to appropriately control the body weight of patients with GDM during pregnancy depending on the presence or absence of prepregnancy maternal overweight/obesity,” Yasuda told Endocrine Today. “Namely, gynecologists and obstetricians who treat patients with GDM should instruct women with a prepregnancy BMI [of less than] 25 kg/m2 not to experience an excessive weight gain during pregnancy and should initiate the appropriate control of prepregnancy body weight to achieve weight loss in women with a pregnancy BMI [of more than] 25 kg/m2.”by Phil Neuffer

Disclosure s : The authors report no relevant financial disclosures.

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