Clinical Epidemiology Division, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden.
Department of Obstetrics and Gynecology, University of British Columbia, Vancouver, Canada.
Acta Obstet Gynecol Scand. 2022 Nov;101(11):1253-1261. doi: 10.1111/aogs.14450. Epub 2022 Sep 7.
Gestational diabetes mellitus (GDM) is a common pregnancy complication associated with adverse consequences for the mother and offspring in both short and long term. The aim of this study was to investigate associations between risk of GDM and gestational weight gain in early pregnancy and before diagnosis.
Our population-based cohort study included 131 164 singleton pregnancies in the Stockholm-Gotland region in Sweden from 2008 through 2013. The exposures were weight gain in early pregnancy (<22 weeks) and weight gain before diagnosis, standardized into gestational age-specific z scores. The outcome was GDM. We used logistic regression models with a generalized estimating equations method to estimate odds ratios with 95% confidence intervals for GDM, stratified by early-pregnancy body mass index (BMI) category.
Above average weight gain before diagnosis (z score >0) was associated with increased risk of GDM among all BMI groups except for obese III. Early gestational weight gain above average was associated with increased risk for GDM in overweight women. Below average weight gain before diagnosis (z score <0) was only associated with decreased risk of GDM in obese III. Early gestational weight gain below average was associated with reduced risks of GDM in obese class I, II, and III women.
The risk of GDM increased with higher weight gain before diagnosis in all BMI groups except obese class III, whereas the risk was reduced with lower weight gain before diagnosis in obese III women only. The risk of GDM increased with higher early gestational weight gain in overweight women, while the risk was reduced with lower early gestational weight gain among obese women. Obese women may benefit from lower weight gain, especially in early pregnancy.
妊娠期糖尿病（GDM）是一种常见的妊娠并发症，与母婴的短期和长期不良后果有关。本研究旨在探讨妊娠早期和诊断前体重增加与 GDM 风险之间的关系。
我们的基于人群的队列研究包括 2008 年至 2013 年瑞典斯德哥尔摩-哥德堡地区的 131164 例单胎妊娠。暴露因素是妊娠早期（<22 周）和诊断前的体重增加，标准化为特定孕龄的 z 分数。结局是 GDM。我们使用逻辑回归模型和广义估计方程方法，估计了 GDM 的比值比及其 95%置信区间，按妊娠早期 BMI 类别分层。
除肥胖 III 组外，诊断前平均以上的体重增加（z 分数>0）与所有 BMI 组的 GDM 风险增加相关。超重妇女妊娠早期体重增加高于平均水平与 GDM 风险增加相关。诊断前平均以下的体重增加（z 分数<0）仅与肥胖 III 组的 GDM 风险降低相关。肥胖 I 、 II 和 III 组的诊断前平均以下的体重增加与 GDM 风险降低相关。
除肥胖 III 组外，所有 BMI 组的诊断前体重增加越高，GDM 的风险越高，而肥胖 III 组的诊断前体重越低，GDM 的风险越低。超重妇女妊娠早期体重增加越高，GDM 的风险越高，而肥胖妇女妊娠早期体重增加越低，GDM 的风险越低。肥胖妇女可能受益于体重减轻，尤其是在妊娠早期。
