Clinical Data Center, Institute of Pediatrics, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, 9 Jinsui Road, Guangzhou, 510623, Guangdong, China.
Department of Obstetrics, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, 510623, Guangdong, China.
BMC Pregnancy Childbirth. 2022 May 20;22(1):424. doi: 10.1186/s12884-022-04762-4.
Controversial evidence regarding the applicability of the IOM's gestational weight gain (GWG) targets for women with gestational diabetes mellitus (GDM) has been reported. However, little is known about the weight gain rate (WGR) during the second and third trimesters. Moreover, previous studies failed to assess the effect modification of pre-pregnancy BMI because of the limited sample size. Therefore, we aimed to assess the applicability of the IOM recommendation for the WGR in women with GDM in different pre-pregnancy BMI categories.
We conducted this retrospective cohort study of 5275 women with GDM who delivered at Guangzhou Women and Children's Medical Center (GWCMC) between January 2017 and January 2021. Demographic and clinical information was collected from the electronic medical record system. The primary exposure was the WGR in the late second and third trimesters; they were classified as below, within, and above the IOM standard. The outcomes were fetal growth indicators, including large-for-gestational-age (LGA), macrosomia, small-for-gestational-age (SGA), and low birth weight (LBW). The associations between the WGR and such outcomes were assessed using multiple logistic regression.
A WGR below the IOM standard was associated with the decreased odds of LGA (adjusted OR 0.74; 95% CI 0.49-1.13) and macrosomia (adjusted OR 0.54, 95% CI 0.32-0.92) for women with GDM in the normal weight BMI class. Such decreases were observed greater for women with GDM in the overweight/obese class, with adjusted ORs of 0.34 (95% CI 0.09-0.88) for LGA and 0.31 (95% CI 0.01-0.84) for macrosomia, respectively. No significant difference was observed in the odds ratios of SGA and LBW across the different WGR groups.
LGA and macrosomia are the main outcomes associated with the WGR in the late second and third trimesters, and a WGR below the IOM standard was associated with a decreased odds of such outcomes compared with a WGR within the IOM standard in women with GDM in the normal weight and overweight/obese classes. Our findings suggest that a stricter WGR target than that of the current IOM standard may be more beneficial for women with GDM.
有争议的证据表明，IOM 的妊娠体重增加（GWG）目标对于患有妊娠糖尿病（GDM）的女性并不适用。然而，对于 GDM 女性在第二和第三个三个月期间的体重增加率（WGR）知之甚少。此外，由于样本量有限，之前的研究未能评估孕前 BMI 的效应修饰作用。因此，我们旨在评估 IOM 建议的 WGR 在不同孕前 BMI 类别的 GDM 女性中的适用性。
我们对 2017 年 1 月至 2021 年 1 月在广州妇女儿童医疗中心（GWCMC）分娩的 5275 名 GDM 女性进行了这项回顾性队列研究。从电子病历系统中收集了人口统计学和临床信息。主要暴露因素是第二和第三个三个月晚期的 WGR；他们被分为低于、等于和高于 IOM 标准。结果是胎儿生长指标，包括巨大儿（LGA）、巨大儿、小于胎龄儿（SGA）和低出生体重（LBW）。使用多因素逻辑回归评估 WGR 与这些结果之间的关联。
对于 BMI 正常的 GDM 女性，WGR 低于 IOM 标准与 LGA（调整后的 OR 0.74；95%CI 0.49-1.13）和巨大儿（调整后的 OR 0.54，95%CI 0.32-0.92）的几率降低有关。对于超重/肥胖的 GDM 女性，这种降低更为明显，LGA 的调整后的 OR 为 0.34（95%CI 0.09-0.88），巨大儿的调整后的 OR 为 0.31（95%CI 0.01-0.84）。在不同的 WGR 组中，SGA 和 LBW 的比值比没有差异。
LGA 和巨大儿是与第二和第三个三个月晚期 WGR 相关的主要结果，与 IOM 标准内的 WGR 相比，GDM 女性的 WGR 低于 IOM 标准与这些结果的几率降低有关。在 BMI 正常和超重/肥胖的 GDM 女性中，低于 IOM 标准的 WGR 目标可能更有益于 GDM 女性。
