Department of Obstetrics, Cambridge University Hospitals, Rosie Hospital, Cambridge, UK.
University of Cambridge, Cambridge, UK.
Diabet Med. 2019 Feb;36(2):167-176. doi: 10.1111/dme.13767. Epub 2018 Jul 11.
Excessive gestational weight gain increases risk of gestational diabetes mellitus (GDM) but it remains unclear whether weight control after GDM diagnosis improves outcomes. We assessed whether: (1) total gestational weight gain during pregnancy (0-36 weeks); (2) early gestational weight gain (0-28 weeks, before GDM diagnosis); or (3) late gestational weight gain (28-36 weeks, after diagnosis) are associated with maternal-fetal outcomes.
Some 546 women with GDM who delivered viable singleton infants at a single UK obstetric centre (October 2014 to March 2017) were included in this retrospective observational study.
Higher total gestational weight gain was associated with Caesarean section [n = 376; odds ratio (OR) 1.05; confidence intervals (CI) 1.02-1.08, P < 0.001] and large for gestational age (OR 1.08; CI 1.03-1.12, P < 0.001). Higher late gestational weight gain (28-36 weeks; n = 144) was associated with large for gestational age (OR 1.17; CI 1.01-1.37, P < 0.05), instrumental deliveries (OR 1.26; CI 1.03-1.55, P < 0.01), higher total daily insulin doses (36 weeks; beta coefficient 4.37; CI 1.92-6.82, P < 0.001), and higher post-partum 2-h oral glucose tolerance test concentrations (beta coefficient 0.12; CI 0.01-0.22, P < 0.05). Women who avoided substantial weight gain after GDM diagnosis had 0.7 mmol/l lower postnatal 2-h glucose and needed half the amount of insulin/day at 36 weeks compared with women with substantial weight gain after diagnosis. There were no significant associations between early gestational weight gain (0-28 weeks) and pregnancy outcomes.
These findings suggest that controlling gestational weight gain should be a priority following GDM diagnosis to optimize pregnancy outcomes and improve maternal postnatal glucose homeostasis. The period after diagnosis of GDM (often 28 weeks gestation) is not too late to offer lifestyle advice or intervention to improve weight management and pregnancy outcomes.
过度的妊娠期体重增加会增加妊娠糖尿病（GDM）的风险，但 GDM 诊断后体重控制是否能改善结局尚不清楚。我们评估了以下情况：（1）整个孕期（0-36 周）的体重增加量；（2）GDM 诊断前（0-28 周）的早期妊娠体重增加量；或（3）诊断后（28-36 周）的晚期妊娠体重增加量是否与母婴结局相关。
这项回顾性观察研究纳入了 2014 年 10 月至 2017 年 3 月在英国一家产科中心分娩的 546 名 GDM 并分娩活产单胎婴儿的女性。
较高的总妊娠期体重增加与剖宫产有关[n=376；比值比（OR）1.05；95%置信区间（CI）1.02-1.08，P<0.001]和巨大儿（OR 1.08；95%CI 1.03-1.12，P<0.001）。较高的晚期妊娠体重增加（28-36 周；n=144）与巨大儿（OR 1.17；95%CI 1.01-1.37，P<0.05）、器械分娩（OR 1.26；95%CI 1.03-1.55，P<0.01）、每日总胰岛素剂量较高（36 周；β系数 4.37；95%CI 1.92-6.82，P<0.001）和产后 2 小时口服葡萄糖耐量试验浓度较高（β系数 0.12；95%CI 0.01-0.22，P<0.05）相关。与 GDM 诊断后体重显著增加的女性相比，GDM 诊断后避免体重显著增加的女性产后 2 小时血糖水平低 0.7mmol/L，孕 36 周时每天需要的胰岛素量减少一半。早期妊娠体重增加（0-28 周）与妊娠结局之间无显著关联。
这些发现表明，控制妊娠期体重增加应成为 GDM 诊断后的首要任务，以优化妊娠结局并改善产妇产后血糖稳态。在 GDM 诊断后（通常为 28 周妊娠），提供生活方式建议或干预措施以改善体重管理和妊娠结局并不为时过晚。
