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 χ 2 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.
Obesity is a growing epidemic in the United States. In 2007 through 2008, nearly 60% of reproductive-age American women were reported to be overweight or obese, with the prevalence of obesity reported at approximately 30% across many demographic groups. Prepregnancy obesity is a risk factor for adverse maternal and neonatal outcomes, including spontaneous abortion, gestational diabetes mellitus (GDM), cesarean delivery, preeclampsia, neonatal macrosomia, and operative and anesthetic complications.
The Institute of Medicine (IOM) first established guidelines for weight gain during pregnancy in 1990. These guidelines, with weight based on Metropolitan Life Insurance tables, were based primarily on neonatal outcomes. In the 2 decades since these original guidelines were published, the American population has become considerably more obese. In 2009 the IOM published new guidelines for recommended gestational weight gain that take into consideration maternal morbidity ( Table 1 ). The revised guidelines categorize recommended weight gain based on the World Health Organization (WHO) body mass index (BMI) categories. They include more specific, narrower ranges of recommended weight gain for obese women, rather than an open-ended recommendation. It has been demonstrated that extremely low or high gestational weight gain is associated with adverse perinatal outcomes across all weight groups. Low gestational weight gain has been associated with increased likelihood of small-for-gestational-age (SGA) neonates and of preterm birth, whereas excessive gestational weight gain has been associated with multiple types of neonatal morbidity and mortality, including neonatal macrosomia, and increased cesarean delivery and maternal morbidity.
| Prepregnancy BMI | BMI, kg/m 2 | Total weight gain range, lb | Rates of weight gain, second and third trimesters, lb/wk (mean range) |
|---|---|---|---|
| Underweight | <18.5 | 28–40 | 1 (1–1.3) |
| Normal weight | 18.5–24.9 | 25–35 | 1 (0.8–1) |
| Overweight | 25.0–29.9 | 15–25 | 0.6 (0.5–0.7) |
| Obese | ≥30.0 | 11–20 | 0.5 (0.4–0.6) |
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