Diabetes plus excess weight in pregnancy bad combo

By Megan Rauscher

NEW YORK (Reuters Health) - Women diagnosed with gestational diabetes mellitus (GDM) who gain more than the Institute of Medicine-recommended amount of weight are at increased risk for undesirable outcomes, including preterm delivery and cesarean delivery, research shows. These women are also more likely to require medical therapy to control their diabetes.

A “paucity” of information exists about the association between pregnancy weight gain and outcome in women with GDM, diabetes that develops during pregnancy and resolves after delivery, the study team notes in the journal Obstetrics & Gynecology.

To investigate, Dr. Yvonne W. Cheng, from the University of California, San Francisco, and colleagues performed a study in which they reviewed the medical records of 31,074 women with GDM and single pregnancies.

The women were enrolled in the Sweet Success California Diabetes and Pregnancy Program, which provides comprehensive educational, nutritional, psychosocial, and medical services offered by a multidisciplinary team.

One third of the women had weight gain below the IOM guidelines, based on their prepregnancy weight; one third gained weight within the guidelines, and the remaining third gained weight above the guidelines.

According to Cheng and colleagues, the women who exceeded the recommended weight gain, were more likely to have a primary cesarean delivery compared with the women in the other two groups.

The results also showed that women who gained too much weight were more likely to deliver larger infants and to have preterm deliveries. They were also more apt to need medical therapy to control their blood sugar.

Women whose weight gain was below the guidelines were at higher risk of having a small for age infants and less likely to have a large for age infant. These women were also more likely to successfully manage their GDM through diet.

The investigators also noted a statistically significant reduction in both the rate of weight gain and the amount of weight gain after enrollment in the “Sweet Success” diabetes and pregnancy program.

“Currently, there are no specific recommendations regarding the ideal amount of weight gain for women diagnosed with GDM,” Cheng and colleagues point out. “We speculate that women with GDM may not require the same amount of weight gain as women without GDM,” they conclude.

SOURCE: Obstetrics & Gynecology, November 2008.

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