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The Institute of Medicine (IOM) does not make recommendations for gestational weight gain (GWG) specific to diabetic women. We aimed to assess the impact of GWG outside the IOM recommendations on pregnancy outcomes in diabetic women.
Secondary analysis of a prospective, 4-year cohort of women with gestational or Type 2 diabetes. Women were approached for enrollment at entry to care & excluded for Type 1 DM, multiple gestation, fetal anomalies, unknown body mass index (BMI), unknown GWG & incomplete delivery records. Primary neonatal outcomes were fetal growth restriction (FGR), defined as birthweight <10th percentile on Alexander growth standard, & macrosomia, defined as birthweight >4000g. Maternal outcomes were cesarean delivery (CD) & preeclampsia. Secondary neonatal outcome was a composite of: delivery <37 wks, admission to level 3 nursery, respiratory distress syndrome, shoulder dystocia, 5-minute Apgar≤3, cord pH<7.1, & cord base excess <−12. Women were classified as GWG within (WITHIN), less than (LESS), or greater (MORE) than IOM recommendations for BMI. GWG within IOM recommendations was the reference group.
Of 345 subjects, 82 (23.8%) gained within IOM recommendations, 60 (17.4%) gained less than recommended, and 203 (58.8%) gained more than recommended. LESS was significantly more likely to have FGR than WITHIN (18.3% vs 4.9%, relative risk (RR) 3.76, 95% confidence interval (CI) 1.26-11.23) & less likely to have macrosomia (3.3% vs 15.9%, RR 0.21, 95% CI 0.05-0.90). The risk of FGR & macrosomia was similar in the MORE & WITHIN groups. Other neonatal outcomes were similar between groups. The risk of preeclampsia was similar between groups. The risk of CD was higher in MORE compared to WITHIN (65.5% vs 44.4%, RR 1.47, 95% CI 1.13-1.92).
Diabetic women who gained less than the IOM recommendations were at greater risk for FGR but at lower risk for macrosomia. Until further research is available, diabetic women should be encouraged to gain within the IOM guidelines for the BMI category.