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Previous studies have shown that women who have minimal to no weight gain have a higher incidence of gestational diabetes (GDM). This is likely an example of reverse causality resulting from dietary counseling once the diagnosis of GDM is made. In general, weight restriction is not advocated in pregnancy. However, given that better dietary intake among gestational diabetics may result in weight loss, its impact on adverse pregnancy outcomes warrants investigation.
This is a retrospective cohort study using linked birth certificate and discharge diagnosis data (All-California, Rapid-Cycle, Maternal/Infant Database) from the year 2007. Inclusion criteria: singleton gestation, GDM, known prepregnancy BMI and gestational weight gain. Subjects were divided into categories based on change in pregnancy BMI: BMI loss (<−0.5), no change (−0.5 to 0.5), minimal (0.6 to 5), moderate (5.1 to 10), excessive (>10). Odds ratios (OR) and 95% confidence intervals (CI) for adverse pregnancy outcomes were calculated. No change in pregnancy BMI served as the reference group.
There were 28,534 women in the study. While the odds of gestational hypertension and preeclampsia were only increased among gestational diabetics with excessive BMI change (aOR, 1.83; 95% CI, 1.33-2.51), cesarean delivery was increased in those with both moderate (aOR, 1.39; 95% CI, 1.19-1.61) and excessive BMI change (aOR, 2.47; 95% CI, 2.02-3.02). Birthweight >4000g was increased with any positive change in BMI: minimal (aOR 1.42; 95% CI, 1.09-1.85), moderate (aOR 2.26; 95% CI, 1.73-2.95), excessive (aOR, 4.83; 95% CI, 3.57-6.54). When accounting for shorter duration of pregnancy among those with premature births, the odds of preterm delivery and low birthweight were as high or higher in women with excessive BMI gain as they were among women with BMI loss.
Weight restriction among gestational diabetics may not be harmful and may improve outcomes among this cohort of women.