Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, The Ohio State University, Columbus, Ohio.
Department of Obstetrics and Gynecology, The Ohio State University, Columbus, Ohio.
Am J Perinatol. 2022 May;39(7):691-698. doi: 10.1055/s-0041-1739512. Epub 2021 Nov 28.
This study aimed to investigate the association between excess and less than recommended gestational weight gain (GWG) and adverse maternal and neonatal outcomes in women with pregestational and gestational diabetes.
We conducted a secondary analysis of the National Institute of Child Health and Human Development (NICHD) Consortium on Safe Labor (CSL) study. We included deliveries >23 weeks of nonanomalous singletons with either pregestational or gestational diabetes. The exposure was GWG greater than or less than compared with the U.S. Institute of Medicine recommendations for total pregnancy weight gain per prepregnancy body mass index. Consistent with the 2020 Delphi outcome for diabetes in pregnancy, maternal outcomes included cesarean delivery and preeclampsia and neonatal outcomes included small for gestational age (SGA), large for gestational age (LGA), macrosomia >4,000 g, preterm birth <37 weeks, stillbirth, and neonatal death. We modeled both absolute GWG and GWG -scores, standardized for gestational duration. Multivariable logistic regression with generalized estimating equations was used, adjusting for age, race/ethnicity, parity, prior cesarean delivery, chronic hypertension, tobacco use, U.S. region, and delivery year.
Of 8,322 deliveries ( = 8,087 women) complicated by pregestational or gestational diabetes, 47% were in excess, 27% were within, and 26% were less than GWG recommendations. Deliveries with excess absolute GWG were at higher adjusted odds of cesarean delivery, preeclampsia, LGA, and macrosomia, compared with those within recommendations. Similar results were observed when using standardized GWG -scores, in addition to higher likelihood of preterm birth and neonatal death. Less than recommended GWG was associated with a lower likelihood of these adverse outcomes but higher SGA. Additionally, less GWG by -score was associated with a lower likelihood of stillbirth.
Excess GWG increases the risk of adverse maternal and neonatal outcomes for women with pregestational and gestational diabetes. Less GWG than recommended may decrease this risk.
· Understanding the impact of GWG modeled using both absolute and standardized measures is needed.. · Among pregnant women with diabetes, excess GWG was common and increased the risk of adverse outcomes and less than recommended GWG may decrease the risk of adverse outcomes, including stillbirth.. · Current recommendations may require revision for women with diabetes in pregnancy..
本研究旨在探讨孕前和妊娠期糖尿病妇女中，体重增长过多和不足与不良母婴结局的关系。
我们对美国国立儿童健康与人类发育研究所（NICHD）安全分娩联盟（CSL）研究进行了二次分析。我们纳入了 23 周以上、非异常单胎、且患有孕前或妊娠期糖尿病的分娩。暴露因素为体重增长超过或低于美国医学研究所（IOM）针对孕前体重指数的总孕期体重增长建议值。与 2020 年妊娠糖尿病 Delphi 结局一致，产妇结局包括剖宫产和子痫前期，新生儿结局包括小于胎龄儿（SGA）、大于胎龄儿（LGA）、出生体重>4000g、早产<37 周、死胎和新生儿死亡。我们对绝对体重增长和标准化体重增长评分（按孕周标准化）都进行了建模。采用广义估计方程的多变量逻辑回归，调整了年龄、种族/民族、产次、既往剖宫产、慢性高血压、吸烟、美国区域和分娩年份。
在 8322 例（8087 名女性）患有孕前或妊娠期糖尿病的分娩中，47%的孕妇体重增长过多，27%的孕妇体重增长在建议范围内，26%的孕妇体重增长不足。与建议范围内的孕妇相比，体重增长过多的孕妇剖宫产、子痫前期、LGA 和巨大儿的调整后比值比更高。当使用标准化体重增长评分时，观察到了类似的结果，同时还增加了早产和新生儿死亡的可能性。体重增长不足与这些不良结局的发生可能性较低相关，但 SGA 发生率较高。此外，体重增长评分越低，死胎的发生可能性越低。
对于患有孕前和妊娠期糖尿病的女性，体重增长过多会增加不良母婴结局的风险。体重增长不足可能会降低这种风险。
· 了解使用绝对和标准化测量方法建模的 GWG 影响是必要的。
· 在患有糖尿病的孕妇中，体重增长过多很常见，增加了不良结局的风险，而建议范围内的体重增长不足可能会降低不良结局的风险，包括死胎。
· 当前的建议可能需要针对妊娠糖尿病患者进行修订。
