Characterizing Gestational Weight Gain According to Institute of Medicine Guidelines in Women with Type 1 Diabetes Mellitus: Association with Maternal and Perinatal Outcome

Abstract

Objective This study aims to evaluate the association between gestational weight gain (GWG) defined by the current Institute of Medicine (IOM) guidelines and pregnancy outcomes in women with type 1 diabetes mellitus (DM).

Study design This is a secondary analysis of a cohort of 293 pregnancies of women with type 1 DM between 24 and 41 weeks' gestation. Women were categorized according to GWG per week over the second and third trimester: below, within, and above the IOM guidelines. Adjusted odds ratios (aORs) with 95% confidence intervals (CIs) were calculated for maternal and neonatal outcomes, controlling for covariates and confounders (referent: GWG within the IOM guidelines).

Results Of the 293 women, there were 49 women (16.7%) with the GWG below the IOM guidelines, 86 women (29.4%) with the GWG within the IOM guidelines, and 158 women (53.9%) with the GWG above the IOM guidelines. Women with the GWG above the IOM guidelines had a higher risk of macrosomia and neonatal hyperbilirubinemia (aOR: 2.78; 95% CI: 1.23–6.30 and 2.31; 1.22–4.35, respectively).

Conclusion GWG above the IOM guidelines is associated with an increased risk of macrosomia and neonatal hyperbilirubinemia. Maintaining GWG within the IOM guidelines may decrease the risk of excessive fetal growth and neonatal hyperbilirubinemia in infants of women with type 1 DM.

Keywords

gestational weight gain - neonatal hyperbilirubinemia - Institute of Medicine guidelines - macrosomia - type 1 diabetes

Note

The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH.

• References

• 1 Lethbridge-Cejku M, Schiller JS, Bernadel L. Summary health statistics for U.S. adults: National Health Interview Survey, 2002. Vital Health Stat 2004; 10 (222) 1-160
• 2 Martin JA, Hamilton BE, Sutton PD, Ventura SJ, Menacker F, Munson ML. Births: final data for 2002. Natl Vital Stat Rep 2003; 52 (10) 1-113
• 3 Egan AM, Dennedy MC, Al-Ramli W, Heerey A, Avalos G, Dunne F. ATLANTIC-DIP: excessive gestational weight gain and pregnancy outcomes in women with gestational or pregestational diabetes mellitus. J Clin Endocrinol Metab 2014; 99 (1) 212-219
• 4 Scifres CM, Feghali MN, Althouse AD, Caritis SN, Catov JM. Effect of excess gestational weight gain on pregnancy outcomes in women with type 1 diabetes. Obstet Gynecol 2014; 123 (6) 1295-1302
• 5 Reece EA, Sivan E, Francis G, Homko CJ. Pregnancy outcomes among women with and without diabetic microvascular disease (White's classes B to FR) versus non-diabetic controls. Am J Perinatol 1998; 15 (9) 549-555
• 6 Gordon M, Landon MB, Samuels P, Hissrich S, Gabbe SG. Perinatal outcome and long-term follow-up associated with modern management of diabetic nephropathy. Obstet Gynecol 1996; 87 (3) 401-409
• 7 Miodovnik M, Rosenn BM, Khoury JC, Grigsby JL, Siddiqi TA. Does pregnancy increase the risk for development and progression of diabetic nephropathy?. Am J Obstet Gynecol 1996; 174 (4) 1180-1189 , discussion 1189–1191
• 8 Remsberg KE, McKeown RE, McFarland KF, Irwin LS. Diabetes in pregnancy and cesarean delivery. Diabetes Care 1999; 22 (9) 1561-1567
• 9 Institute of Medicine (US) and National Research Council (US) Committee to Reexamine IOM Pregnancy Weight Guidelines. Rasmussen KM, Yaktine AL. Weight Gain During Pregnancy: Reexamining the Guidelines. Washington, DC: National Academies Press; 2009
• 10 Siegel AM, Tita A, Biggio JR, Harper LM. Evaluating gestational weight gain recommendations in pregestational diabetes. Am J Obstet Gynecol 2015; 213 (4) 563.e1-563.e5
• 11 Hillman N, Herranz L, Vaquero PM, Villarroel A, Fernandez A, Pallardo LF. Is pregnancy outcome worse in type 2 than in type 1 diabetic women?. Diabetes Care 2006; 29 (11) 2557-2558
• 12 McElvy SS, Miodovnik M, Rosenn B , et al. A focused preconceptional and early pregnancy program in women with type 1 diabetes reduces perinatal mortality and malformation rates to general population levels. J Matern Fetal Med 2000; 9 (1) 14-20
• 13 Rosenn B, Miodovnik M, Kranias G , et al. Progression of diabetic retinopathy in pregnancy: association with hypertension in pregnancy. Am J Obstet Gynecol 1992; 166 (4) 1214-1218
• 14 Kaplan LA, Cline D, Gartside P, Burstein S, Sperling M, Stein EA. Hemoglobin A1 in hemolysates from healthy and insulin-dependent diabetic children, as determined with a temperature-controlled minicolumn assay. Clin Chem 1982; 28 (1) 13-18
• 15 Simas TA, Waring ME, Liao X , et al. Prepregnancy weight, gestational weight gain, and risk of growth affected neonates. J Womens Health (Larchmt) 2012; 21 (4) 410-417
• 16 Brownfoot FC, Davey MA, Kornman L. Routine weighing to reduce excessive antenatal weight gain: a randomised controlled trial. BJOG 2016; 123 (2) 254-261
• 17 Jeffries K, Shub A, Walker SP, Hiscock R, Permezel M. Reducing excessive weight gain in pregnancy: a randomised controlled trial. Med J Aust 2009; 191 (8) 429-433
• 18 Muktabhant B, Lawrie TA, Lumbiganon P, Laopaiboon M. Diet or exercise, or both, for preventing excessive weight gain in pregnancy. Cochrane Database Syst Rev 2015; 6 (6) CD007145
• 19 Taffel SM, Keppel KG. Advice about weight gain during pregnancy and actual weight gain. Am J Public Health 1986; 76 (12) 1396-1399
• 20 Institute of Medicine (US) Committee on Nutritional Status During Pregnancy and Lactation. Nutrition During Pregnancy: Part I Weight Gain: Part II Nutrient Supplements. Washington, DC: National Academies Press; 1990
• 21 Peacock I. Glycosylated haemoglobin: measurement and clinical use. J Clin Pathol 1984; 37 (8) 841-851