Department of Endocrinology, Hospital Pedro Hispano, Matosinhos Local Health Unit, Rua Dr. Eduardo Torres, 4464-513, Senhora da Hora, Matosinhos, Portugal.
Centro de Estudos de Comunicação e Sociedade, Instituto de Ciências Sociais, Universidade do Minho, Campus de Gualtar, 4710-057, Braga, Braga, Portugal.
Diabetes Metab Syndr. 2021 Jan-Feb;15(1):419-424. doi: 10.1016/j.dsx.2021.01.020. Epub 2021 Feb 8.
Both obesity and gestational diabetes mellitus (GDM) are independent risk factors for adverse maternal and fetal outcomes. The Institute of Medicine (IOM) recommends different targets for an adequate gestational weight gain (GWG), depending on the prepregnancy body mass index, but they have been questioned. We aim to compare obese pregnant women with GDM according to GWG stratification (insufficient, adequate and excessive) with regard to maternal and neonatal outcomes and to clarify whether insufficient GWG can be associated with better outcomes.
A multicenter observational study with prospectively collected data of obese singleton pregnant women with GDM was conducted. GWG was expressed according to the 2009 IOM's recommendations.
Of 4563 obese women with GDM, 34.5%, 30.4% and 35.2% registered insufficient, adequate and excessive GWG, respectively. Multiple logistic regression analysis revealed that women with insufficient GWG had lower odds of gestational hypertension, preeclampsia, caesarean section, large for gestational age (LGA) neonates and prediabetes in postpartum. Despite the higher incidence of small for gestational age (SGA) neonates, they were not associated with adverse outcomes. Women with excessive GWG had higher odds of caesarean section, macrosomic and LGA neonates.
Insufficient GWG in obese women with GDM was beneficial due to better maternal and neonatal outcomes. In clinical practice, we should be strict with regard to weight gain in obese pregnant women with GDM and encourage a reduced GWG, provided an adequate fetal growth is guaranteed.
肥胖和妊娠期糖尿病（GDM）都是不良母婴结局的独立危险因素。医学研究所（IOM）根据孕前体重指数，为适当的妊娠体重增加（GWG）推荐了不同的目标，但这些目标受到了质疑。我们旨在根据 GWG 分层（不足、充足和过多）比较患有 GDM 的肥胖孕妇，评估其母婴结局，并阐明不足的 GWG 是否可以与更好的结局相关。
进行了一项多中心前瞻性观察研究，纳入了患有 GDM 的肥胖单胎孕妇的前瞻性数据。GWG 根据 2009 年 IOM 的建议进行表达。
在 4563 名患有 GDM 的肥胖妇女中，分别有 34.5%、30.4%和 35.2%的孕妇 GWG 不足、充足和过多。多变量逻辑回归分析显示，GWG 不足的孕妇发生妊娠期高血压、先兆子痫、剖宫产、胎儿过大（LGA）和产后糖尿病的几率较低。尽管 SGA 新生儿的发生率较高，但与不良结局无关。GWG 过多的孕妇发生剖宫产、巨大儿和 LGA 新生儿的几率较高。
患有 GDM 的肥胖妇女 GWG 不足有益，因为这可以改善母婴结局。在临床实践中，我们应该严格控制患有 GDM 的肥胖孕妇的体重增加，并鼓励减少 GWG，前提是保证胎儿的生长发育充足。
