Division of Endocrinology, Diabetes and Metabolism, Centro Hospitalar Universitário do Porto, Porto, Portugal.
Division of Nutrition, Centro Hospitalar Universitário do Porto, Porto, Portugal.
Ann Med. 2023 Dec;55(1):207-214. doi: 10.1080/07853890.2022.2159063.
To evaluate the association between the dimension of deviation from appropriate gestational weight gain (GWG) and adverse maternofetal outcomes in women with gestational diabetes mellitus (GDM).
We performed a multicentric retrospective study based on the Portuguese GDM Database. Women were classified as within GWG, insufficient (IGWG) or excessive (EGWG) than the Institute of Medicine recommendations. EGWG and IGWG were calculated for each prepregnancy BMI category. Large-for-gestational-age (LGA) and macrosomia were defined as a birthweight more than the 90th percentile for the gestational age and newborn weight greater than 4000 g, respectively. Logistic regression models (adjusted odds ratio [aOR] plus 95% confidence interval [95%CI]) were derived to evaluate the association between EGWG or IGWG and adverse maternofetal outcomes.
A total of 18961 pregnant women were included: 39.7% with IGWG and 27.8% with EGWG. An EGWG over 3 kg was associated with a higher risk of LGA infants (aOR 1.95, 95%CI 1.17-3.26) and macrosomia (aOR 2.01, 95%CI 1.23-3.27) in prepregnancy normal weight women. An EGWG greater than 4 kg was associated with a higher risk of LGA infants (aOR 1.67, 95%CI 1.23-2.23) and macrosomia (aOR 1.90, 95%CI 1.38-2.61) in obese women. In overweight women, an EGWG above 3.5 kg was associated with a higher risk of LGA infants (aOR 1.65, 95%CI 1.16-2.34), macrosomia (aOR 1.85, 95%CI 1.30-2.64), preeclampsia (aOR 2.40, 95%CI 1.45-3.98) and pregnancy-induced hypertension (aOR 2.21, 95%CI 1.52-3.21). An IGWG below -3.1 kg or -3kg was associated with a higher risk of small-for-gestational-age [SGA] infants in women with normal (OR 1.40, 95%CI 1.03-1.90) and underweight (OR 2.29, 95%CI 1.09-4.80), respectively.
Inappropriate gestational weight gain seems to be associated with an increased risk for adverse maternofetal outcomes, regardless of prepregnancy BMI. Beyond glycemic control, weight management in women with GDM must be a focus of special attention to prevent adverse pregnancy outcomes.KEY MESSAGESThe dimension of deviation from appropriate gestational weight gain was associated with an increased risk for adverse maternofetal outcomes among women with gestational diabetes.Weight management must be a focus of special attention in women with gestational diabetes to prevent adverse pregnancy outcomes.
评估妊娠期糖尿病（GDM）女性在偏离适当增重（GWG）维度与不良母婴结局之间的关系。
我们进行了一项基于葡萄牙 GDM 数据库的多中心回顾性研究。女性被分为 GWG 范围内、不足（IGWG）或过多（EGWG）于医学研究所建议的范围。根据每个孕前 BMI 类别计算 EGWG 和 IGWG。巨大儿（LGA）和巨大儿分别定义为出生体重超过胎龄第 90 百分位和新生儿体重超过 4000g。得出逻辑回归模型（调整后的优势比[aOR]加 95%置信区间[95%CI]）来评估 EGWG 或 IGWG 与不良母婴结局之间的关联。
共纳入 18961 名孕妇：39.7%的孕妇 IGWG，27.8%的孕妇 EGWG。孕前体重正常的女性中，EGWG 超过 3kg 与 LGA 婴儿（aOR 1.95，95%CI 1.17-3.26）和巨大儿（aOR 2.01，95%CI 1.23-3.27）的风险增加相关。在肥胖女性中，EGWG 大于 4kg 与 LGA 婴儿（aOR 1.67，95%CI 1.23-2.23）和巨大儿（aOR 1.90，95%CI 1.38-2.61）的风险增加相关。在超重女性中，EGWG 大于 3.5kg 与 LGA 婴儿（aOR 1.65，95%CI 1.16-2.34）、巨大儿（aOR 1.85，95%CI 1.30-2.64）、子痫前期（aOR 2.40，95%CI 1.45-3.98）和妊娠高血压（aOR 2.21，95%CI 1.52-3.21）的风险增加相关。IGWG 低于-3.1kg 或-3kg 与正常体重（OR 1.40，95%CI 1.03-1.90）和体重不足（OR 2.29，95%CI 1.09-4.80）的女性 SGA 婴儿风险增加相关。
无论孕前 BMI 如何，不适当的妊娠体重增加似乎与母婴不良结局的风险增加有关。除了血糖控制之外，GDM 女性的体重管理必须是特别关注的焦点，以预防不良的妊娠结局。
妊娠期体重增加的偏离程度与妊娠期糖尿病女性的母婴不良结局风险增加有关。
体重管理必须是妊娠期糖尿病女性特别关注的焦点，以预防不良的妊娠结局。
