Excessive gestational weight gain prior to glucose screening and the risk of gestational diabetes: a meta-analysis

The influence of maternal gestational weight gain on adverse perinatal outcomes

Objective

To analyze the impact of maternal gestational weight gain (GWG) on adverse outcomes for mothers and infants.

Methods

A retrospective analysis was conducted, collecting relevant information on 9,058 singleton pregnancies and newborns from prenatal check-ups and deliveries at Guangdong Women and Children Hospital from 2017 to 2022. The subjects were grouped according to different GWG, and logistic regression was used to analyze the impact of GWG on adverse outcomes, including hypertensive disorders of pregnancy (HDP), gestational diabetes mellitus (GDM), large-for-gestational-age infants (LGA), small-for-gestational-age infants (SGA), and preterm births.

Results

Among the 9058 participants included in the study, there were 438 cases (4.8%) of HDP, including 266 cases (2.9%) of gestational hypertension and 172 cases (1.9%) of preeclampsia. Additionally, there were 2018 cases (22.3%) of GDM; Among the adverse birth outcomes for newborns, the prevalence was 9.7% for SGA, 9.9% for LGA, 1.4% for early/mid-term preterm births, and 4.2% for late preterm births. After adjusting for confounding factors, the results showed that, excessive GWG was a risk factor for HDP (OR=1.829, P<0.05) and LGA (OR=1.792, P<0.05) compared to the normal gestational weight gain group. Insufficient GWG increased the risk of GDM (OR=2.203, P<0.05), SGA (OR=1.474, P<0.05) and was also a risk factor for early/mid-term preterm infants (OR=3.326, P<0.05) and late preterm infants (OR=1.715, P<0.05).

Conclusion

Excessive GWG is a risk factor for the occurrence of HDP and LGA, while insufficient GWG increases the risk of GDM, SGA and preterm infants (especially early/mid-term preterm infants). Therefore, it is recommended to strengthen the monitoring of weight changes during pregnancy in women of childbearing age, guide nutritional management during pregnancy, and keep GWG within a reasonable range to prevent adverse outcomes for mothers and infants.

Multi-omics architecture of childhood obesity and metabolic dysfunction uncovers biological pathways and prenatal determinants

Childhood obesity poses a significant public health challenge, yet the molecular intricacies underlying its pathobiology remain elusive. Leveraging extensive multi-omics profiling (methylome, miRNome, transcriptome, proteins and metabolites) and a rich phenotypic characterization across two parts of Europe within the population-based Human Early Life Exposome project, we unravel the molecular landscape of childhood obesity and associated metabolic dysfunction. Our integrative analysis uncovers three clusters of children defined by specific multi-omics profiles, one of which characterized not only by higher adiposity but also by a high degree of metabolic complications. This high-risk cluster exhibits a complex interplay across many biological pathways, predominantly underscored by inflammation-related cascades. Further, by incorporating comprehensive information from the environmental risk-scape of the critical pregnancy period, we identify pre-pregnancy body mass index and environmental pollutants like perfluorooctanoate and mercury as important determinants of the high-risk cluster. Overall, our work helps to identify potential risk factors for prevention and intervention strategies early in the life course aimed at mitigating obesity and its long-term health consequences.

Osteopontin Levels in Maternal Serum, Cord Blood, and Breast Milk According to Gestational Diabetes Mellitus: A Case-Control Study

BACKGROUND/OBJECTIVES

The prevalence of gestational diabetes mellitus (GDM) is increasing, and GDM poses health risks for both mothers and newborns. This study investigated the association between GDM and two biomarkers, osteopontin (OPN) and betatrophin (ANGPTL8).

METHODS

This study involved face-to-face interviews with 165 participants-81 in the GDM group and 84 in the control group-to gather maternal-newborn data. Maternal serum OPN levels, along with cord serum OPN and ANGPTL8 levels, were measured at birth. OPN levels in breast milk were also measured between postnatal days 10-15. Statistical analysis included Student's t-test for comparing biomarker levels, chi-square tests for GDM incidence across OPN quartile levels, multiple logistic regression for assessing GDM frequency by OPN quartile levels, and the Pearson correlation coefficient to explore relationships between biomarker levels and maternal-newborn characteristics.

RESULTS

No significant differences in cord OPN or ANGPTL8 levels were detected between the groups. However, the OPN levels in maternal serum and breast milk were greater in the GDM group than in the control group. We found an association between increasing maternal serum and breast milk OPN levels in quartile groups and the risk of GDM. Additionally, there was a moderate correlation between cord OPN and both maternal serum OPN (r = 0.45) and breast milk OPN (r = 0.43).

CONCLUSIONS

The differences in OPN levels between the GDM and control groups suggest that OPN may reflect metabolic changes associated with GDM, possibly as a consequence of the condition itself or its treatment. Further research is necessary to validate these findings and uncover the underlying mechanisms involved.

A smartphone coaching program ("Bouge Grossesse") improves daily physical activity in pregnant women

BACKGROUND

Physical activity has been shown to reduce obstetrical risks however pregnant women reduce their physical activity and sedentary behaviors increase.

OBJECTIVE

Our aim was to evaluate the impact of a smartphone application developed to increase daily physical activity in pregnant women.

METHODS

We enrolled 250 pregnant women in a prospective randomized controlled study. These women were instructed to download either an intervention application called «Bouge Grossesse» (coaching program and a pedometer; n=125) or a Placebo application (pedometer only; n=125). Primary outcome was defined as a daily increase of 2000 steps/day between day 1 and day 90 or 10 000 steps/week between week 1 and week 12. Data was analyzed with intention to treat. Secondary outcomes were the number of steps at week 12 and the evolution of quality of life measured by WHO score, EIFEL score and SPIEGEL scale, and on maternal and fetal outcomes.

RESULTS

Patients were enrolled between August 2017 and February 2019. They were retrospectively registered after September 2018. We found a significant difference in the primary outcome between the two groups in favor of the intervention group (22.4% success vs 3.2% in the control group, P<.001) but only 43 women in the intervention group (34.4%) and 16 women in the placebo group (12.8%) completed the 12-week coaching program. There were no significant differences in the SPIEGEL, EIFEL and WHO scores. The mean number of daily steps at week 12 was significantly higher in the intervention group (6900.0 vs 4371.9, P<.001).

CONCLUSION

The mobile health intervention « Bouge Grossesse » significantly increased physical activity in pregnant women but we observed a high percentage of withdrawals from the 12-week program.

TRIAL REGISTRATION

This clinical trial was registered under the number NCT03688087 ClinicalTrials.gov.

Association between inadequate weight gain according to the institute of medicine 2009 guidelines and pregnancy outcomes in women with thyroid disorders

PURPOSE

Gestational weight gain (GWG) is an important contributor to pregnancy outcomes in the general obstetric population and different subgroups. The corresponding information in women with thyroid conditions is limited. We aimed to evaluate the relationship between GWG according to institute of medicine (IOM) and pregnancy outcomes in women with thyroid disorders.

METHODS

We performed a retrospective analysis of 620 pregnant women either treated with levothyroxine (N = 545) or attended because of hyperthyroidism during pregnancy (N = 75).

RESULTS

The associations between GWG according to IOM and pregnancy outcomes were present both in women treated with thyroid hormone and women followed by hyperthyroidism, most of them related to the fetal outcomes. In women treated with levothyroxine, insufficient GWG was associated with gestational diabetes mellitus (GDM) (odds ratio (OR) 2.32, 95% confidence interval (CI) 1.18, 4.54), preterm birth (OR 2.31, 95% CI 1.22, 4.36), small-for-gestational age newborns (OR 2.38, 95% CI 1.09, 5.22) and respiratory distress (OR 6.89, 95% CI 1.46, 32.52). Excessive GWG was associated with cesarean delivery (OR 1.66, 95% CI 1.10, 2.51) and macrosomia (OR 2.75, 95% CI 1.38, 5.49). Large-for-gestational age newborns were associated with both insufficient GWG (OR 0.25, 95% CI 0.11, 0.58) and excessive GWG (OR 1.80, 95% CI 1.11, 2.92). In women followed by hyperthyroidism, excessive GWG was associated with large-for-gestational age newborns (OR 5.56, 95% CI 1.03, 29.96).

CONCLUSION

GWG according to IOM is associated with pregnancy outcomes both in women treated with thyroid hormone and women followed by hyperthyroidism.

Mid-upper arm circumference predicts the risk of gestational diabetes in early pregnancy

BACKGROUND

The present work aimed to assess the value of mid-upper arm circumference (MUAC) at 8 to 12 weeks in predicting the occurrence of gestational diabetes mellitus (GDM).

METHODS

According to eligibility criteria, 328 women with singleton pregnancies who underwent routine antenatal check-ups at Qinhuangdao Maternal and Child Health Hospital from September 2017 to September 2020 were included. The patients were divided into the gestational diabetes mellitus (GDM) and non-GDM groups according to oral glucose tolerance test (OGTT) data from gestation weeks 24 to 28. Clinical data were compared between the two groups. Logistic regression analysis was performed to determine factors independently predicting GDM. Receiver operating characteristic (ROC) curve analysis was employed to analyze the value of MUAC in predicting the occurrence of GDM. The optimal cut-off points were calculated.

RESULTS

In logistic regression analysis, pre-pregnancy weight, waist circumference, MUAC, UA, TG, and HDL-C independently predicted the occurrence of GDM (P < 0.05). MUAC retained statistical significance upon adjustment for various confounders (OR = 8.851, 95%CI: 3.907-20.048; P < 0.001). ROC curve analysis revealed good diagnostic potential for MUAC in GDM (AUC = 0.742, 95%CI: 0.684-0.800, P < 0.001), with a cut-off of 28.5 cm, sensitivity and specificity were 61% and 77%, respectively.

CONCLUSION

Pregnant women with MUAC >28.5 cm are prone to develop GDM during pregnancy, indicating that MUAC as an important predictive factor of GDM in early pregnancy.

Association of prepregnancy body mass index and gestational weight gain trajectory with adverse pregnancy outcomes-a prospective cohort study in Shanghai

OBJECTIVES

The objective was to investigate the associations of maternal prepregnancy body mass index (BMI) and gestational weight gain (GWG) trajectories with adverse pregnancy outcomes (APOs).

DESIGN

This was a prospective cohort study.

SETTING

This study was conducted in Shanghai Pudong New Area Health Care Hospital for Women and Children, Shanghai, China.

PRIMARY AND SECONDARY OUTCOME MEASURES

A cohort study involving a total of 2174 pregnant women was conducted. Each participant was followed to record weekly weight gain and pregnancy outcomes. The Institute of Medicine classification was used to categorise prepregnancy BMI, and four GWG trajectories were identified using a latent class growth model.

RESULTS

The adjusted ORs for the risks of large for gestational age (LGA), macrosomia, gestational diabetes mellitus (GDM) and hypertensive disorders of pregnancy (HDP) were significantly greater for women with prepregnancy overweight/obesity (OR=1.77, 2.13, 1.95 and 4.24; 95% CI 1.3 to 2.42, 1.32 to 3.46, 1.43 to 2.66 and 2.01 to 8.93, respectively) and lower for those who were underweight than for those with normal weight (excluding HDP) (OR=0.35, 0.27 and 0.59; 95% CI 0.22 to 0.53, 0.11 to 0.66 and 0.36 to 0.89, respectively). The risk of small for gestational age (SGA) and low birth weight (LBW) was significantly increased in the underweight group (OR=3.11, 2.20; 95% CI 1.63 to 5.92, 1.10 to 4.41; respectively) compared with the normal-weight group; however, the risk did not decrease in the overweight/obese group (p=0.942, 0.697, respectively). GWG was divided into four trajectories, accounting for 16.6%, 41.4%, 31.7% and 10.3% of the participants, respectively. After adjustment for confounding factors, the risk of LGA was 1.54 times greater for women in the slow GWG trajectory group than for those in the extremely slow GWG trajectory group (95% CI 1.07 to 2.21); the risk of SGA and LBW was 0.37 times and 0.46 times lower for women in the moderate GWG trajectory group and 0.14 times and 0.15 times lower for women in the rapid GWG trajectory group, respectively; the risk of macrosomia and LGA was 2.65 times and 2.70 times greater for women in the moderate GWG trajectory group and 3.53 times and 4.36 times greater for women in the rapid GWG trajectory group, respectively; and the women in the other three trajectory groups had a lower risk of GDM than did those in the extremely slow GWG trajectory group, but there was not much variation in the ORs. Notably, different GWG trajectories did not affect the risk of HDP.

CONCLUSIONS

As independent risk factors, excessively high and low prepregnancy BMI and GWG can increase the risk of APOs.

Pre-pregnancy BMI, rate of gestational weight gain, and preterm birth among US Pacific Islander individuals

OBJECTIVE

The objective of this study was to examine the association between rate of gestational weight gain (GWG) and preterm birth (PTB) classified by pre-pregnancy BMI among Pacific Islander individuals in the United States.

METHODS

Pacific Islander mothers (n = 55,975) and singleton infants (22-41 gestational weeks) without congenital anomalies were included using data from the National Center for Health Statistics (2014-2018). PTB was compared by pre-pregnancy BMI among women in each stratum of rate of GWG using Cox proportional hazards models.

RESULTS

Compared with mothers with a rate of GWG within the guidelines, mothers with a rate of GWG below the guidelines and either pre-pregnancy underweight (adjusted hazard ratio [aHR] = 1.84, 95% CI: 1.10-3.06), healthy weight (aHR = 1.38, 95% CI: 1.15-1.65), obesity class I (aHR = 1.22, 95% CI: 0.97-1.52), or obesity class II (aHR = 1.43, 95% CI: 1.05-1.96) had an increased risk of PTB; mothers with a rate of GWG above the guidelines and either pre-pregnancy underweight (aHR = 1.57, 95% CI: 0.92-2.69) or obesity class II (aHR = 1.31, 95% CI: 0.98-1.76) had an increased risk of PTB.

CONCLUSIONS

The association between rate of GWG below or above the guidelines and PTB differs by pre-pregnancy BMI among Pacific Islander individuals.

Epigenome-wide association study of DNA methylation in maternal blood leukocytes with BMI in pregnancy and gestational weight gain

OBJECTIVES

We aimed to discover CpG sites with differential DNA methylation in peripheral blood leukocytes associated with body mass index (BMI) in pregnancy and gestational weight gain (GWG) in women of European and South Asian ancestry. Furthermore, we aimed to investigate how the identified sites were associated with methylation quantitative trait loci, gene ontology, and cardiometabolic parameters.

METHODS

In the Epigenetics in pregnancy (EPIPREG) sample we quantified maternal DNA methylation in peripheral blood leukocytes in gestational week 28 with Illumina's MethylationEPIC BeadChip. In women with European (n = 303) and South Asian (n = 164) ancestry, we performed an epigenome-wide association study of BMI in gestational week 28 and GWG between gestational weeks 15 and 28 using a meta-analysis approach. Replication was performed in the Norwegian Mother, Father, and Child Cohort Study, the Study of Assisted Reproductive Technologies (MoBa-START) (n = 877, mainly European/Norwegian).

RESULTS

We identified one CpG site significantly associated with GWG (p 5.8 × 10-8) and five CpG sites associated with BMI at gestational week 28 (p from 4.0 × 10-8 to 2.1 × 10-10). Of these, we were able to replicate three in MoBa-START; cg02786370, cg19758958 and cg10472537. Two sites are located in genes previously associated with blood pressure and BMI. DNA methylation at the three replicated CpG sites were associated with levels of blood pressure, lipids and glucose in EPIPREG (p from 1.2 × 10-8 to 0.04).

CONCLUSIONS

We identified five CpG sites associated with BMI at gestational week 28, and one with GWG. Three of the sites were replicated in an independent cohort. Several genetic variants were associated with DNA methylation at cg02786379 and cg16733643 suggesting a genetic component influencing differential methylation. The identified CpG sites were associated with cardiometabolic traits.

CLINICALTRIALS

GOV REGISTRATION NO

Not applicable.

Risk factors of late-onset gestational diabetes diagnosed during 24-28 weeks of gestation after normal early screening: a case-control study

Objective

To determine the risk factors associated with late-onset GDM (diagnosed between 24 and 28 weeks of gestation) after normal early screening.

Methods

A case-control study was conducted in 600 singleton pregnant women who started antenatal care before 20 weeks with normal early GDM screening. Repeat screening was performed at 24-28 weeks. Cases were 120 women with late-onset GDM and 480 controls were those without GDM. Risk factors for late-onset GDM were evaluated and pregnancy outcomes were compared.

Results

Cases were significantly older, and more likely to be overweight or obese. 50-g GCT of ≥ 160 mg/dL and abnormal 1 value of 100-g OGTT significantly increased the risk of late-onset GDM (p = 0.004 and < 0.001 respectively). Independent risk factors were abnormal 1 value of 100-g OGTT from first screening (adjusted OR 5.49, 95% CI 2.70-11.17, p < 0.001), age ≥ 30 years (adjusted OR 2.71, 95% CI 1.66-4.43, p < 0.001), DM in family (adjusted OR 1.76, 95% CI 1.07-2.88, p = 0.025), and BMI ≥ 25 kg/m2 (adjusted OR 1.86, 95% CI 1.17-2.97, p = 0.009). Late-onset GDM significantly increased the risk of preeclampsia, cesarean delivery, LGA, and macrosomia.

Conclusion

Independent factors associated with late-onset GDM included abnormal 1 value of 100-g OGTT from first screening, age ≥ 30 years, DM in family, and being overweight or obese.

A cost-effectiveness evaluation of a dietitian-delivered telephone coaching program during pregnancy for preventing gestational diabetes mellitus

BACKGROUND

This study aimed to evaluate the cost-effectiveness of a telehealth coaching intervention to prevent gestational diabetes mellitus (GDM) and to calculate the breakeven point of preventing GDM.

METHODS

Data to inform the economic evaluation model was sourced directly from the large quaternary hospital in Brisbane, where the Living Well during Pregnancy (LWdP) program was implemented, and further supplemented with literature-based estimates where data had not been directly collected in the trial. A cost-effectiveness model was developed using a decision tree framework to estimate the potential for cost savings and quality of life improvement. A total of 1,315 pregnant women (49% with a BMI 25-29.9, and 51% with a BMI ≥ 30) were included in the analyses.

RESULTS

The costs of providing routine care and routine care plus LWdP coaching intervention to pregnant women were calculated to be AUD 20,933 and AUD 20,828, respectively. The effectiveness of the LWdP coaching program (0.894 utility) was slightly higher compared to routine care (0.893). Therefore, the value of the incremental cost-effectiveness ratio (ICER) was negative, and it indicates that the LWdP coaching program is a dominant strategy to prevent GDM in pregnant women. We also performed a probabilistic sensitivity analysis using Monte Carlo simulation through 1,000 simulations. The ICE scatter plot showed that the LWdP coaching intervention was dominant over routine care in 93.60% of the trials using a willingness to pay threshold of AUD 50,000.

CONCLUSION

Findings support consideration by healthcare policy and decision makers of telehealth and broad-reach delivery of structured lifestyle interventions during pregnancy to lower short-term costs associated with GDM to the health system.

The association between gestational weight trajectories in women with gestational diabetes and their offspring's weight from birth to 40 months

AIMS

To identify the gestational weight gain (GWG) patterns in women with gestational diabetes mellitus (GDM) and evaluate their association with offspring weight status from birth to 40 months.

MATERIALS AND METHODS

This study included 2,723 GDM-mother-child pairs from the Beijing Birth Cohort Study. The association between GWG trajectories identified by the latent class model and offspring weight outcomes from birth to 40 months were evaluated, after adjustment for maternal age, parity, pre-pregnancy body mass index, maternal height, and blood glucose levels.

RESULTS

Three GWG rate groups, including the non-excessive GWG group (1,994/2,732), excessive GWG group (598 /2,732), and excessive early GWG group (140/2,732), were identified in women with GDM, respectively. Compared to the non-excessive GWG group, the adjusted OR (aOR) and 95% CI were 1.83 (1.35-2.47) and 1.79 (1.06-3.01) for macrosomia, 1.33 (1.07-1.66) and 1.48 (1.01-2.17) for large for gestational age (LGA) in the excessive GWG group and excessive early GWG group. Excessive GWG was also associated with an increased risk of BMI-for-age at 40 months (aOR = 1.66, 95% CI 1.14-2.42).

CONCLUSIONS

Both excessive GWG and excessive early GWG increased the risk of macrosomia and LGA in women with GDM, but only the excessive GWG was associated with childhood overweight/obesity. The results suggest the long-term impact of GWG on offspring weight status in women with GDM and the potential benefits of GWG restriction after GDM diagnosis.

Role of dietary food intake patterns, anthropometric measures, and multiple biochemical markers in the development of pregnancy-specific urinary incontinence in gestational diabetes mellitus

OBJECTIVES

The aim of this study was to assess maternal dietary food intake patterns, anthropometric measures, and multiple biochemical markers in women with gestational diabetes mellitus and pregnancy-specific urinary incontinence and to explore whether antedating gestational diabetes mellitus environment affects the pregnancy-specific urinary incontinence development in a cohort of pregnant women with gestational diabetes mellitus and pregnancy-specific urinary incontinence.

METHODS

Maternal dietary information and anthropometric measurements were collected. At 24 wk of gestation, with a fasting venipuncture sample, current blood samples for biochemical markers of hormones, vitamins, and minerals were analyzed. The groups were compared in terms of numerical variables using analysis of variance for independent samples followed by multiple comparisons.

RESULTS

Of the 900 pregnant women with complete data, pregnant women in the gestational diabetes mellitus pregnancy-specific urinary incontinence group had higher body mass index during pregnancy, arm circumference, and triceps skinfold than the non-gestational diabetes mellitus continent and non-gestational diabetes mellitus pregnancy-specific urinary incontinence groups, characterizing an obesogenic maternal environment. Regarding dietary food intake, significant increases in aromatic amino acids, branched-chain amino acids, dietary fiber, magnesium, zinc, and water were observed in pregnancy-specific urinary incontinence group compared with the non-gestational diabetes mellitus continent group. Serum vitamin C was reduced in the gestational diabetes mellitus pregnancy-specific urinary incontinence group compared with the non-gestational diabetes mellitus pregnancy-specific urinary incontinence group.

CONCLUSIONS

This study emphasizes the necessity for a comprehensive strategy for gestational diabetes mellitus women with pregnancy-specific urinary incontinence in terms of deviation in maternal adaptation trending toward obesity and maternal micronutrients deficiencies.

Early-life exposure to gestational diabetes mellitus predisposes offspring to pediatric nonalcoholic fatty liver disease

Nonalcoholic fatty liver disease (NAFLD) has emerged as the prevailing chronic liver disease in the pediatric population due to the global obesity pandemic. Evidence shows that prenatal and postnatal exposure to maternal abnormalities leads to a higher risk of pediatric NAFLD through persistent alterations in developmental programming. Gestational diabetes mellitus (GDM) is a hyperglycemic syndrome which has become the most prevalent complication in pregnant women. An increasing number of both epidemiologic investigations and animal model studies have validated adverse and long-term outcomes in offspring following GDM exposure in utero. Similarly, GDM is considered a crucial risk factor for pediatric NAFLD. This review aimed to summarize currently published studies concerning the inductive roles of GDM in offspring NAFLD development during childhood and adolescence. Dysregulations in hepatic lipid metabolism and gut microbiota in offspring, as well as dysfunctions in the placenta are potential factors in the pathogenesis of GDM-associated pediatric NAFLD. In addition, potentially effective interventions for GDM-associated offspring NAFLD are also discussed in this review. However, most of these therapeutic approaches still require further clinical research for validation.

Prediction of Gestational Diabetes Mellitus in the First Trimester of Pregnancy Based on Maternal Variables and Pregnancy Biomarkers

Gestational diabetes mellitus (GDM) is a significant health concern with adverse outcomes for both pregnant women and their offspring. Recognizing the need for early intervention, this study aimed to develop an early prediction model for GDM risk assessment during the first trimester. Utilizing a prospective cohort of 4917 pregnant women from the Third Department of Obstetrics and Gynecology, Aristotle University of Thessaloniki, Greece, the study sought to combine maternal characteristics, obstetric and medical history, and early pregnancy-specific biomarker concentrations into a predictive tool. The primary objective was to create a series of predictive models that could accurately identify women at high risk for developing GDM, thereby facilitating early and targeted interventions. To this end, maternal age, body mass index (BMI), obstetric and medical history, and biomarker concentrations were analyzed and incorporated into five distinct prediction models. The study's findings revealed that the models varied in effectiveness, with the most comprehensive model combining maternal characteristics, obstetric and medical history, and biomarkers showing the highest potential for early GDM prediction. The current research provides a foundation for future studies to refine and expand upon the predictive models, aiming for even earlier and more accurate detection methods.

Dietary interventions in pregnancy for the prevention of gestational diabetes: a literature review

The aim of this review is to provide an overview of dietary interventions delivered during pregnancy for the prevention of gestational diabetes mellitus (GDM). GDM increases the risk of adverse pregnancy and neonatal outcomes, and also increases future cardiometabolic risks for both the mother and the offspring. Carrying or gaining excessive weight during pregnancy increases the risk of developing GDM, and several clinical trials in women with overweight or obesity have tested whether interventions aimed at limiting gestational weight gain (GWG) could help prevent GDM. Most dietary interventions have provided general healthy eating guidelines, while some had a specific focus, such as low glycaemic index, increased fibre intake, reducing saturated fat or a Mediterranean-style diet. Although trials have generally been successful in attenuating GWG, the majority have been unable to reduce GDM risk, which suggests that limiting GWG may not be sufficient in itself to prevent GDM. The trials which have shown effectiveness in GDM prevention have included intensive face-to-face dietetic support, and/or provision of key foods to participants, but it is unclear whether these strategies could be delivered in routine practice. The mechanism behind the effectiveness of some interventions over others remains unclear. Dietary modifications from early stages of pregnancy seem to be key, but the optimum dietary composition is unknown. Future research should focus on designing acceptable and scalable dietary interventions to be tested early in pregnancy in women at risk of GDM.

Gestational weight gain charts for Latin American adolescents

Monitoring gestational weight gain (GWG) throughout pregnancy among adolescents is important for detecting individuals at risk and timely intervention. However, there are no specific tools or guidelines for GWG monitoring of this group. We aimed to construct GWG charts for pregnant adolescents (10-19 years old) according to pre-pregnancy body mass index (BMI) using a pooled dataset from nine Latin American countries. Datasets from Argentina, Brazil, Chile, Colombia, Mexico, Panama, Paraguay, Peru, and Uruguay collected between 2003 and 2021 were combined after data cleaning and harmonization. Adolescents free of diseases that could affect GWG and who gave birth to newborns weighing between 2,500-4,000 g and free of congenital malformations were included. Multiple imputation techniques were applied to increase the sample size available for underweight and obesity categories. Generalized Additive Models for Location, Scale, and Shape were used to construct the charts of GWG according to gestational age. Internal and external validation procedures were performed to ensure that models were not over-adjusted to the data. The cohort included 6,414 individuals and 29,414 measurements to construct the charts and 1,684 individuals and 8,879 measurements for external validation. The medians (and interquartile ranges) for GWG at 40 weeks according to pre-pregnancy BMI were: underweight, 14.9 (11.9-18.6); normal weight, 14.0 (10.6-17.7); overweight, 11.6 (7.7-15.6); obesity, 10.6 kg (6.7-14.3). Internal and external validation showed that the percentages above/below selected percentiles were close to those expected, except for underweight adolescents. These charts describe the GWG throughout pregnancy among Latin American adolescents and represent a significant contribution to the prenatal care of this group. GWG cut-offs based on values associated with lower risks of unfavorable outcomes for the mother-child binomial should be determined before implementing the charts in clinical practice.

Trends in Maternal Weight Disparities: Statewide Differences in Rural and Urban Minnesota Residents From 2012 to 2019

INTRODUCTION

Despite research showing substantial weight disparities along the rural-urban continuum, little work has attempted to identify differences in prepregnancy weight status or gestational weight gain (GWG) outcomes between rural and urban birthing people. As such, the goals of this research were to 1) document the prevalence of prepregnancy overweight and obesity and excessive GWG in rural and urban birthing people and 2) examine changes in rural and urban prepregnancy overweight or obesity and excessive GWG over time.

METHODS

Birth certificate data provided sociodemographic variables, prepregnancy body mass index, GWG, and rurality status on 465,709 respondents who gave birth in Minnesota from 2012 to 2019. A series of regression models estimated risk differences in 1) prepregnancy weight status and 2) excessive GWG between rural and urban respondents over time, controlling for relevant covariates.

RESULTS

Rural individuals had a 4.9 percentage-point (95% confidence interval, 4.5-5.3) higher risk of having prepregnancy overweight or obesity compared with urban individuals, and a 2.6 percentage-point (95% confidence interval, 1.9-3.3) higher risk of gaining excessive gestational weight. The disparities in prepregnancy overweight or obesity and excessive gestational weight between rural and urban individuals widened over time.

CONCLUSIONS

These findings contribute to accumulating evidence documenting notable health disparities between rural and urban individuals during the perinatal period and support the need to develop prevention and treatment efforts focused on improving the weight-related health of individuals living in rural communities.

I got frightened and felt strange. I even cried a lot after the diagnosis; the experiences on the screening and management of gestational diabetes mellitus among diagnosed women

INTRODUCTION

Understanding the experiences of women diagnosed with Gestational Diabetes Mellitus (GDM) can improve screening, management, and postpartum care. Therefore, this study sought to investigate experiences on the screening and management of GDM among diagnosed women.

METHODS

This was a facility-based explorative qualitative design among five purposively sampled women diagnosed with GDM who were receiving care from healthcare professionals. Women were asked about their reaction to being diagnosed with GDM, their experiences with care, training, self-monitoring, and challenges with the management of GDM, and data obtained were analysed using thematic analysis.

RESULTS

Based on the thematic analysis, three main themes and ten sub-themes were generated. They were emotional experience (prior information on GDM before being diagnosed, and feelings about the diagnosis and blood glucose measurement), information source and care experience (source of information on healthy diet, training on blood glucose measurement, experiences with follow-up, and general impressions on GDM care), and dietary and lifestyle experience ( perceptions on dietary approaches, difficulties in getting and adhering to dietary and lifestyle guidelines, alternative treatment methods patronized, and effectiveness of dietary and lifestyle approaches).

CONCLUSION

The themes generated had psycho-emotional underpinning, and underscores the importance of psychotherapy when disclosing disease status and initiating medical care. The findings of this study could be important for the optimisation of GDM care and services for affected women.

Maternal and child nutrition programme of investigation within the 100 Million Brazilian Cohort: study protocol

INTRODUCTION

There is a limited understanding of the early nutrition and pregnancy determinants of short-term and long-term maternal and child health in ethnically diverse and socioeconomically vulnerable populations within low-income and middle-income countries. This investigation programme aims to: (1) describe maternal weight trajectories throughout the life course; (2) describe child weight, height and body mass index (BMI) trajectories; (3) create and validate models to predict childhood obesity at 5 years of age; (4) estimate the effects of prepregnancy BMI, gestational weight gain (GWG) and maternal weight trajectories on adverse maternal and neonatal outcomes and child growth trajectories; (5) estimate the effects of prepregnancy BMI, GWG, maternal weight and interpregnancy BMI changes on maternal and child outcomes in the subsequent pregnancy; and (6) estimate the effects of maternal food consumption and infant feeding practices on child nutritional status and growth trajectories.

METHODS AND ANALYSIS

Linked data from four different Brazilian databases will be used: the 100 Million Brazilian Cohort, the Live Births Information System, the Mortality Information System and the Food and Nutrition Surveillance System. To analyse trajectories, latent-growth, superimposition by translation and rotation and broken stick models will be used. To create prediction models for childhood obesity, machine learning techniques will be applied. For the association between the selected exposure and outcomes variables, generalised linear models will be considered. Directed acyclic graphs will be constructed to identify potential confounders for each analysis investigating potential causal relationships.

ETHICS AND DISSEMINATION

This protocol was approved by the Research Ethics Committees of the authors' institutions. The linkage will be carried out in a secure environment. After the linkage, the data will be de-identified, and pre-authorised researchers will access the data set via a virtual private network connection. Results will be reported in open-access journals and disseminated to policymakers and the broader public.

Weight progression and adherence to weight gain target in women with vs. without gestational diabetes: a retrospective cohort study

BACKGROUND

Weight management has been an important component of the service in obstetric care offered to pregnant women. Current gestational weight gain recommendations were primarily for the general obstetric population, raising concern about the applicability to women with gestational diabetes mellitus (GDM). We aimed to assess the difference in weight progression and adherence to the recommended gestational weight gain targets between women with gestational diabetes mellitus (GDM) and women with normal glucose tolerance (NGT).

METHODS

This was a hospital-based retrospective study of 56,616 pregnant women (9,430 GDM women and 47,186 NGT women) from Guangzhou between 2017 and 2021. The average change in weight progression was estimated based on serial weight measurements throughout pregnancy, using a mixed effects model with a random intercept to account for repeated measures of the same individual.

RESULTS

Women with GDM gained less weight (12.07 [SD 5.20] kg) than women with NGT (14.04 [SD 5.04] kg) throughout pregnancy. Before OGTT, a small difference was observed in the average change in weight progression between the two groups (GDM, 0.44 kg/week vs. NGT, 0.45 kg/week, p < 0.001), however, this gap widened significantly after the test (0.34 vs. 0.50 kg/week, p < 0.001). GDM individuals were identified with an approximately 4-fold increased proportion of insufficient weight gain (41.1% vs. 10.4%) and a 2-fold decreased proportion of excessive weight gain (22.6% vs. 54.2%) compared to NGT individuals. These results were consistently observed across different BMI categories, including underweight (insufficient: 52.7% vs. 19.9%; excessive: 15.6% vs. 35.3%), normal weight (insufficient 38.2% vs. 7.4%; excessive: 22.2% vs. 57.3%), and overweight/obese (insufficient: 43.1% vs. 9.8%; excessive: 30.1% vs. 68.8%).

CONCLUSION

Weight progression varied significantly between GDM and NGT individuals, resulting in a substantial difference in identifying insufficient and excessive weight gain between the two groups under current gestational weight gain guidelines.

Gestational weight gain according to the Brazilian charts and its association with maternal and infant adverse outcomes

BACKGROUND

The lack of gestational weight gain (GWG) recommendations for low- and middle-income countries is a significant concern.

OBJECTIVES

To identify the ranges on the Brazilian GWG charts associated with lowest risks of selected adverse maternal and infant outcomes.

METHODS

Data from 3 large Brazilian datasets were used. Pregnant individuals aged ≥18, without hypertensive disorders or gestational diabetes were included. Total GWG was standardized to gestational age-specific z-scores according to Brazilian GWG charts. A composite infant outcome was defined as the occurrence of any of small-for-gestationa lage (SGA), large-forgestationa lage (LGA), or preterm birth. In a separate sample, postpartum weight retention (PPWR) was measured at 6 and/or 12 mo postpartum. Multiple logistic and Poisson regressions were performed with GWG z-scores as the exposure and individual and composite outcomes. GWG ranges associated with the lowest risk of the composite infant outcome were identified using noninferiority margins.

RESULTS

For the neonatal outcomes, 9500 individuals were included in the sample. For PPWR, 2602 and 7859 individuals were included at 6 and 12 mo postpartum, respectively. Overall, 7.5% of the neonates were SGA, 17.6% LGA, and 10.5% were preterm. Higher GWG z-scores were positively associated with LGA birth, whereas lower z-scores were positively associated with SGA births. The risk of the selected adverse neonatal outcomes were lowest (within 10% of lowest observed risk) when individuals with underweight, normal weight, overweight, or obesity gained between 8.8-12.6; 8.7-12.4; 7.0-8.9; and 5.0-7.2 kg, respectively. These gains correspond to probabilities of PPWR ≥5 kg at 12 mo of 30% for individuals with under and normal weight, and <20% for overweight and obesity.

CONCLUSIONS

This study provided evidence to inform new GWG recommendations in Brazil.

Acceptability and feasibility of a planned preconception weight loss intervention in women with long-acting reversible contraception: the Plan-it mixed-methods study

BACKGROUND

Women with overweight (a body mass index of ≥ 25 kg/m2) or obesity (a body mass index of ≥ 30 kg/m2) are at greater risk of experiencing complications during pregnancy and labour than women with a healthy weight. Women who remove their long-acting reversible contraception (i.e. coils or implants) are one of the few groups of people who contact services as part of their preparation for conception, creating an opportunity to offer a weight loss intervention.

OBJECTIVES

The objectives were to understand if routine NHS data captured the pathway from long-acting reversible contraception removal to pregnancy and included body mass index; to identify the suitable components of a preconception weight loss intervention; and to engage with key stakeholders to determine the acceptability and feasibility of asking women with overweight/obesity to delay the removal of their long-acting reversible contraception in order to take part in a preconception weight loss intervention.

DESIGN

This was a preparatory mixed-methods study, assessing the acceptability and feasibility of a potential intervention, using routine NHS data and purposefully collected qualitative data.

PARTICIPANTS

The NHS routine data included all women with a long-acting reversible contraception code. There were three groups of participants in the surveys and interviews: health-care practitioners who remove long-acting reversible contraception; weight management consultants; and women of reproductive age with experience of overweight/obesity and of using long-acting reversible contraception.

SETTING

UK-based health-care practitioners recruited at professional meetings; and weight management consultants and contraceptive users recruited via social media.

DATA SOURCES

Anonymised routine data from UK sexual health clinics and the Clinical Practice Research Datalink, including the Pregnancy Register; and online surveys and qualitative interviews with stakeholders.

RESULTS

The records of 2,632,871 women aged 16-48 years showed that 318,040 had at least one long-acting reversible contraception event, with 62% of records including a body mass index. Given the identified limitations of the routine NHS data sets, it would not be feasible to reliably identify women with overweight/obesity who request a long-acting reversible contraception removal with an intention to become pregnant. Online surveys were completed by 100 health-care practitioners, four weight management consultants and 243 contraceptive users. Ten health-care practitioners and 20 long-acting reversible contraception users completed qualitative interviews. A realist-informed approach generated a hypothesised programme theory. The combination of weight discussions and the delay of long-acting reversible contraception removal was unacceptable as an intervention to contraceptive users for ethical and practical reasons. However, a preconception health intervention incorporating weight loss could be acceptable, and one potential programme is outlined.

LIMITATIONS

There was very limited engagement with weight management consultants, and the sample of participating stakeholders may not be representative.

CONCLUSIONS

An intervention that asks women to delay long-acting reversible contraception removal to participate in a preconception weight loss intervention would be neither feasible nor acceptable. A preconception health programme, including weight management, would be welcomed but requires risk communication training of health-care practitioners.

FUTURE WORK

Work to improve routine data sets, increase awareness of the importance of preconception health and overcome health-care practitioner barriers to discussing weight as part of preconception care is a priority.

TRIAL REGISTRATION

This trial is registered as ISRCTN14733020.

FUNDING

This project was funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 27, No. 1.

Maternofetal outcomes in early-onset gestational diabetes: does weight gain matter?

AIM

Women with early-onset gestational diabetes mellitus (GDM) have overall lower gestational weight gain (GWG) compared to those with later-onset GDM, albeit with usually worse maternofetal outcomes. We intent to investigate the association between inadequate GWG and maternofetal outcomes in pregnant women with early-onset GDM.

METHODS

We performed a retrospective study of women with early-onset GDM based on the National Registry of GDM. Three study groups were defined according to the recommendations of the Institute of Medicine for GWG: excessive GWG (eGWG), adequate (aGWG) or insufficient (iGWG).

RESULTS

A total of 8040 pregnant women were included: 27% (n = 2170) eGWG, 31% (n = 2492) aGWG and 42% (n = 3378) iGWG. Preeclampsia (4.3 vs 3 vs 1.6%, p < 0.001), polyhydramnios (3.1 vs 2.3 vs 1.8%, p = 0.008) and cesarean section (37.4 vs 34.1 vs 29.5%, p < 0.001) were significantly more frequent among women with eGWG. Additionally, there was a higher frequency of macrosomia (8.1 vs 3.6 vs 2.4%, p < 0.001), large-for-gestational-age (8.2 vs 3.7 vs 2.6%, p < 0.001) and birth trauma (2.6 vs 1.5 vs 1.1%, p < 0.001) in this group. On the other hand, fetal death (0.2 vs 0.2 vs 0.5%, p = 0.04), small-for-gestational-age (9 vs 10.3 vs 14.9, p < 0.001) and preterm delivery (5.6 vs 7.1 vs 7.5%, p = 0.03) were more frequent in iGWG group.

CONCLUSIONS

Over two-thirds of pregnant women with early-onset GDM had inappropriate GWG, which was significantly associated with adverse maternofetal outcomes. Weight management must be a focus of special attention in women with early-onset GDM, beyond glycemic control, to achieve healthy pregnancy outcomes.

Effects of Initiating Raltegravir-Based Versus Efavirenz-Based Antiretroviral Regimens During Pregnancy on Weight Changes and Perinatal Outcomes: NICHD P1081

BACKGROUND

Integrase inhibitors have been associated with excess gestational weight gain that may lead to adverse pregnancy outcomes (APOs). This post hoc analysis of NICHD P1081 compared antepartum changes in weight and body mass index (BMI) in pregnant women initiating raltegravir- or efavirenz-based combined antiretroviral therapy (cART) and examined associations between rates of weight gain and APOs.

SETTING

NICHD P1081 enrolled antiretroviral-naive pregnant women living with HIV in the second and third trimester in Brazil, Tanzania, South Africa, Thailand, Argentina, and the United States.

METHODS

Two hundred eighty-one women enrolled between 20 and 31 gestational weeks were randomized to raltegravir- or efavirenz-based cART and followed for ≥4 weeks. A low rate of weight gain was defined as <0.18 kg/wk and high as >0.59 kg/wk. We compared weight gain and BMI increase between treatment arms using Kruskal-Wallis tests. Logistic regression was used to investigate the association between weight gain and APOs.

RESULTS

Raltegravir-based cART was associated with significantly higher antepartum weight gain (median 0.36 kg/wk versus 0.29 kg/wk, P = 0.01) and BMI increase (median 0.14 kg/m 2 /wk versus 0.11 kg/m 2 /wk, P = 0.01) compared with efavirenz-based treatment. Women on raltegravir had less low weight gain (18% versus 36%) and more high weight gain (21% versus 12%) ( P = 0.001). Women with low weight gain were more likely than those with normal weight gain to have small for gestational age infants or a composite of APOs.

CONCLUSIONS

A raltegravir-based antiretroviral regimen was associated with significantly higher antepartum rate of weight gain and BMI increase compared with efavirenz-based treatment in antiretroviral-naive pregnant women.

Development and testing of a reduced carbohydrate intervention for the management of obesity and reduction of gestational diabetes (RECORD): protocol for a feasibility randomised controlled trial

INTRODUCTION

Previous trials of dietary interventions to prevent gestational diabetes mellitus (GDM) have yielded only limited success. Low-carbohydrate diets have shown promise for the treatment of type 2 diabetes, but there is no evidence to support their use in pregnancy. The aim of this study is to explore the feasibility of a moderately reduced-carbohydrate dietary intervention delivered from mid-pregnancy alongside routine antenatal care.

METHODS AND ANALYSIS

This is a feasibility randomised controlled trial (RCT) with embedded qualitative study. Sixty women who are pregnant <20 weeks' gestation, with body mass index ≥30 kg/m2 at their antenatal booking appointment, will be randomised 2:1 intervention or control (usual care) and followed up until delivery. The intervention is a moderately reduced-carbohydrate diet (~130-150 g total carbohydrate/day), designed to be delivered alongside routine antenatal appointments. Primary outcomes are measures of adoption of the diet and retention of participants. Secondary outcomes include incidence of GDM, change in markers of glycaemic control, gestational weight gain, total carbohydrate and energy intake. Process outcomes will examine resources and management issues. Exploratory outcomes include further dietary changes, quality of life, maternal and neonatal outcomes, and qualitative measures.

ETHICS AND DISSEMINATION

This trial was reviewed and approved by the South-Central Oxford B Research Ethics Committee NHS National Research Ethics Committee and the Health Research Authority (Reference: 20/SC/0442). The study results will inform whether to progress to a full-scale RCT to test the clinical effectiveness of the RECORD programme to prevent GDM in women at high risk. The findings will be published in peer-reviewed journals and presented at conferences.

TRIAL REGISTRATION NUMBER

ISRCTN16235884.

Insufficient weight management in pregnant women with gestational diabetes mellitus

Objectives

This study investigated whether weight was managed appropriately in pregnant women with gestational diabetes mellitus (GDM) and examined the association between insufficient gestational weight gain (GWG) and adverse pregnancy outcomes.

Methods

The study included 235 pregnant women with GDM from the Korean Pregnancy Outcome Study. GWG from the second to the third trimester (kg/wk ) and total GWG (kg) were classified as insufficient, appropriate, or excessive according to the 2009 Institute of Medicine guidelines. Adverse pregnancy outcomes included maternal (hypertensive disorders of pregnancy, preterm birth, cesarean delivery, and delivery complications) and infant (low birth weight, high birth weight, neonatal intensive care unit admission, and congenital anomalies) outcomes.

Results

The proportion of pregnant women with GDM who had insufficient GWG from the second to the third trimester was 52.3%, and that of participants with total insufficient GWG was 48.1%. There were no significant associations between insufficient GWG from the second to the third trimester and adverse pregnancy outcomes. Participants with total insufficient GWG had a significantly lower risk of preterm birth (odds ratio [OR], 0.17; 95% confidence interval [CI], 0.05–0.60) and high birth weight (OR, 0.23; 95% CI, 0.07–0.80).

Conclusion

Our findings suggest the importance of appropriate weight management and the need for GWG guidelines for pregnant women with GDM.

Clinical management of pregnancy in women with polycystic ovary syndrome: An expert opinion

Polycystic ovary syndrome (PCOS) is associated with a higher risk for pregnancy and birth complications according to the specific features associated with PCOS. The features include obesity before and during pregnancy, hyperandrogenism, insulin resistance, infertility, cardiometabolic risk factors, and poor mental health. PCOS is not often recognized as a risk factor for poor pregnancy and birth outcomes in pregnancy care guidelines, while its associated features are. Pregnancy-related risk profile should ideally be assessed for modifiable risk factors (e.g., lifestyle and weight management) at preconception in women with PCOS. Hyperglycaemia should be screened using a 75-g oral glucose tolerance test at preconception or within the first 20 weeks of pregnancy if it has not been performed at preconception and should be repeated at 24-28 weeks of pregnancy. In the absence of evidence of benefit for strategies specific to women with PCOS, the international evidence-based guidelines for the assessment and management of PCOS recommend screening, optimizing, and monitoring risk profile in women with PCOS (at preconception, during and postpregnancy) consistent with the recommendations for the general population. Recommended factors include blood glucose, weight, blood pressure, smoking, alcohol, diet, exercise, sleep and mental health, emotional, and sexual health among women with PCOS. The guidelines recommend Metformin in addition to lifestyle for assisting with weight management and improving cardiometabolic risk factors, particularly in those with overweight or obesity. Letrozole is considered the first-line pharmacological treatment for anovulatory infertility in PCOS. Individualized approach should be considered in the management of pregnancy in PCOS.

Timing of gestational weight gain in association with birth weight outcomes: a prospective cohort study

Maternal gestational weight gain (GWG) is an important determinant of infant birth weight, and having adequate total GWG has been widely recommended. However, the association of timing of GWG with birth weight remains controversial. We aimed to evaluate this association, especially among women with adequate total GWG. In a prospective cohort study, pregnant women's weight was routinely measured during pregnancy, and their GWG was calculated for the ten intervals: the first 13, 14-18, 19-23, 24-28, 29-30, 31-32, 33-34, 35-36, 37-38 and 39-40 weeks. Birth weight was measured, and small-for-gestational-age (SGA) and large-for-gestational-age were assessed. Generalized linear and Poisson models were used to evaluate the associations of GWG with birth weight and its outcomes after multivariate adjustment, respectively. Of the 5049 women, increased GWG in the first 30 weeks was associated with increased birth weight for male infants, and increased GWG in the first 28 weeks was associated with increased birth weight for females. Among 1713 women with adequate total GWG, increased GWG percent between 14 and 23 weeks was associated with increased birth weight. Moreover, inadequate GWG between 14 and 23 weeks, compared with the adequate GWG, was associated with an increased risk of SGA (43 (13·7 %) v. 42 (7·2 %); relative risk 1·83, 95 % CI 1·21, 2·76). Timing of GWG may influence infant birth weight differentially, and women with inadequate GWG between 14 and 23 weeks may be at higher risk of delivering SGA infants, despite having adequate total GWG.

Excessive gestational weight gain is an independent risk factor for gestational diabetes mellitus in singleton pregnancies: Results from a French cohort study

OBJECTIVE

Increase in prevalence of maternal obesity worldwide raises concern among health professionals. Our purpose was to evaluate the impact of maternal obesity and of excessive gestational weight gain (GWG) on the course of singleton pregnancies in a French maternity ward.

STUDY DESIGN

3599 consecutive women who delivered from April 2013 to May 2015 at Brest University Hospital were included in HPP-IPF cohort study, a study designed to evaluate clinical and biological determinants of postpartum hemorrhage (PPH). Maternal obesity was defined by a pre-pregnancy Body Mass Index (BMI) ≥ 30 kg/m² and excessive GWG was defined according to the Institute of Medicine 2009 guidelines. Obstetric complications(including gestational diabetes mellitus (GDM), gestational hypertension, pre-eclampsia, venous thromboembolism, PPH, cesarean section (C-section) and macrosomia) were collected prospectively in a standardized case report form. For each complication, Odd Ratios (OR) according to pre-pregnancy BMI and GWG were calculated in univariable and multivariable analyses.

RESULTS

Out of the 3162 women analyzed for this report, 583 (18.4%) were overweight, 400 (12.7%) were obese and 36.6% had excessive GWG. In multivariable analysis, after adjustment for confounding factors, obese women were at increased risk of GDM (OR 5.83, 95%CI 4.37-7.79), PPH (OR 1.69, 95%CI 1.19-2.41), C-section (OR 2.50, 95%CI 1.92-3.26) and macrosomia (OR 1.90, 95%CI 1.31-2.76). Similarly, women with excessive GWG were at increased risk of GDM (OR 1.55, 95%CI 1.17-2.06), C-section (OR 1.46, 95%CI 1.16-1.83) and macrosomia (OR 2.09, 95%CI 1.50-2.91).

CONCLUSIONS

Maternal obesity and excessive GWG are independent risk factors for GDM, C-section and macrosomia in singleton pregnancies. Further studies are needed to evaluate if a lifestyle intervention aiming at avoiding excessive GWG could improve clinical outcomes in pregnant women.

Preventive Counseling in Routine Prenatal Care-A Qualitative Study of Pregnant Women's Perspectives on a Lifestyle Intervention, Contrasted with the Experiences of Healthcare Providers

Maternal lifestyle during pregnancy and excessive gestational weight gain can influence maternal and infant short and long-term health. As part of the GeMuKi intervention, gynecologists and midwives provide lifestyle counseling to pregnant women during routine check-up visits. This study aims to understand the needs and experiences of participating pregnant women and to what extent their perspectives correspond to the experiences of healthcare providers. Semi-structured interviews were conducted with 12 pregnant women and 13 multi-professional healthcare providers, and were analyzed using qualitative content analysis. All interviewees rated routine check-up visits as a good setting in which to focus on lifestyle topics. Women in their first pregnancies had a great need to talk about lifestyle topics. None of the participants were aware of the link between gestational weight gain and maternal and infant health. The healthcare providers interviewed attributed varying relevance regarding the issue of weight gain and, accordingly, provided inconsistent counseling. The pregnant women expressed dissatisfaction regarding the multi-professional collaboration. The results demonstrate a need for strategies to improve multi-professional collaboration. In addition, health care providers should be trained to use sensitive techniques to inform pregnant women about the link between gestational weight gain and maternal and infant health.

Effectiveness of a Brief Lifestyle Intervention in the Prenatal Care Setting to Prevent Excessive Gestational Weight Gain and Improve Maternal and Infant Health Outcomes

Research on perinatal programming shows that excessive gestational weight gain (GWG) increases the risk of overweight and obesity later in a child’s life and contributes to maternal weight retention and elevated risks of obstetrical complications. This study examined the effectiveness of a brief lifestyle intervention in the prenatal care setting, compared to routine prenatal care, in preventing excessive GWG as well as adverse maternal and infant health outcomes. The GeMuKi study was designed as a cluster RCT using a hybrid effectiveness implementation design and was conducted in the prenatal care setting in Germany. A total of 1466 pregnant women were recruited. Pregnant women in intervention regions received up to six brief counseling sessions on lifestyle topics (e.g., physical activity, nutrition, drug use). Data on GWG and maternal and infant outcomes were entered into a digital data platform by the respective healthcare providers. The intervention resulted in a significant reduction in the proportion of women with excessive GWG (OR = 0.76, 95% CI (0.60 to 0.96), p = 0.024). Gestational weight gain in the intervention group was reduced by 1 kg (95% CI (−1.56 to −0.38), p < 0.001). No evidence of intervention effects on pregnancy, birth, or neonatal outcomes was found.

Relationship between gestational body mass index change and the risk of gestational diabetes mellitus: a community-based retrospective study of 41,845 pregnant women

Background

Gestational diabetes mellitus (GDM) is associated with adverse health consequences for women and their offspring. It is associated with maternal body mass index (BMI) and may be associated with gestational weight gain (GWG). But due to the heterogeneity of diagnosis and treatment and the potential effect of GDM treatment on GWG, the association between the two has not been thoroughly clarified. Compared to body weight, BMI has the advantage that it considers height during the whole course of pregnancy. Understanding BMI changes during pregnancy may provide new evidence for the prevention of GDM.

Methods

This study investigated the BMI change of pregnant women based on a retrospective study covering all communities in Tianjin, China. According to the results of GDM screening at 24–28 weeks of gestation, pregnancies were divided into the GDM group and the non-GDM group. We compared gestational BMI change and GWG in the two groups from early pregnancy to GDM screening. GWG was evaluated according to the IOM guidelines. Logistic regression was applied to determine the significance of variables with GDM.

Results

A total of 41,845 pregnant women were included in the final analysis (GDM group, n = 4257 vs. non-GDM group, n = 37,588). BMI gain has no significant differences between the GDM and non-GDM groups at any early pregnancy BMI categories (each of 2 kg/m²), as well as weight gain (P > 0.05). Early pregnancy BMI was a risk factor for GDM (OR 1.131, 95% CI 1.122–1.139). And BMI gain was associated with a decreased risk of GDM in unadjusted univariate analysis (OR 0.895, 95% CI 0.869–0.922). After adjusting on early pregnancy BMI and other confounding factors, the effect of BMI gain was no longer significant (AOR 1.029, 95% CI 0.999–1.061), as well as weight gain (AOR 1.006, 95% CI 0.995–1.018) and GWG categories (insufficient: AOR 1.016, 95% CI 0.911–1.133; excessive: AOR 1.044, 95% CI 0.957–1.138).

Conclusions

BMI in early pregnancy was a risk factor for GDM, while BMI gain before GDM screening was not associated with the risk of GDM. Therefore, the optimal BMI in early pregnancy is the key to preventing GDM.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12884-022-04672-5.

Effect of individualized weight management intervention on excessive gestational weight gain and perinatal outcomes: a randomized controlled trial

It is unclear whether weight management is still effective for pregnant women with excessive weight gain in the second or third trimester in China. This study adopted individualized weight management intervention for pregnant women with abnormal weight gain in the second or third trimester, to analyze the effect of intervention by observing the gestational weight gain and perinatal outcomes. This randomized controlled trial was performed at Aerospace Center Hospital. The obstetrician determined whether the pregnant women gained too much weight in the second or third trimester according to the Institute of Medicine guidelines, and randomly divided the pregnant women who gained too much weight in the second or third trimester into the intervention group or the control group according to the inclusion and exclusion criteria. The pregnant women in the intervention group and in the control group all received routine prenatal examination and diet nutrition education by the doctors in the Department of Obstetrics and Gynecology. The intervention group underwent individualized weight management, including individualized diet, exercise, psychological assessment, cognitive intervention and continuous communication, the whole process is tracked and managed by professional nutritionists. The obstetrician collected the prenatal examination data and pregnancy outcome data of all enrolled pregnant women. The primary outcome measure was weight gain during pregnancy. A generalized linear model and a logistic regression model were used to compare the outcomes between the two groups. In total, 348 pregnant women participated in this study with 203 in the intervention group and 145 in the control group. The whole gestational weight gain in the intervention group (15.8 ± 5.4 Kg) was lower than that in the control group (17.5 ± 3.6 Kg; adjusted β =  - 1.644; 95% CI [-2.660--0.627]; P = 0.002). The percent of pregnant women with excessive weight gainbefore delivery was 54.2% (110/203) in the intervention group, which was lower than 69.7% (101/145) in the control group (adjusted RR = 0.468; 95% CI [0.284-0.769] P = 0.003). The pregnant women given the individualized weight management intervention from the second to the third trimester experienced less weight gain than that from the third trimester (15.5 ± 5.6 Kg vs. 16.2 ± 5.2 Kg), but without significant difference (P = 0.338). Lower rates of GDM, preeclampsia and gestational hypertension, higher rates of fetal distress and puerperal infection were observed in the intervention group than in the control group (all P < 0.05). Individualized weight management during the second or third trimesters is still beneficial for pregnant women who gain excessive weight and can decrease the associated adverse outcomes.

Gestational Diabetes in Twin Versus Singleton Pregnancies With Normal Weight or Overweight Pre-Pregnancy Body Mass Index: The Mediating Role of Mid-Pregnancy Weight Gain

BACKGROUND

Gestational diabetes might be more common in twin versus singleton pregnancies, yet the reasons for this are unclear. We evaluated the extent to which this relationship is explained by higher mid-pregnancy weight gain within normal weight and overweight pre-pregnancy body mass index (BMI) strata.

METHODS

We analyzed serial weights and glucose screening and diagnostic data abstracted from medical charts for twin (n = 1397) and singleton (n = 3117) pregnancies with normal or overweight pre-pregnancy BMI delivered from 1998 to 2013 at Magee-Womens Hospital in Pennsylvania. We used causal mediation analyses to estimate the total effect of twin versus singleton pregnancy on gestational diabetes, as well as those mediated (natural indirect effect) and not mediated (natural and controlled direct effects) by pathways involving mid-pregnancy weight gain.

RESULTS

Odds of gestational diabetes were higher among twin pregnancies [odds ratios (ORs) for total effect = 2.83 (95% CI = 1.54, 5.19) for normal weight and 2.09 (95% CI = 1.16, 3.75) for overweight pre pregnancy BMI], yet there was limited evidence that this relationship was mediated by mid-pregnancy weight gain [ORs for natural indirect effect = 1.21 (95% CI = 0.90, 1.24) for normal weight and 1.06 (95% CI = 0.92, 1.21) for overweight pre-pregnancy BMI] and more evidence of mediation via other pathways [ORs for natural direct effect = 2.34 (95% CI = 1.24, 4.40) for normal weight and 1.97 (95% CI = 1.08, 3.60) for overweight pre-pregnancy BMI].

CONCLUSIONS

While twin pregnancies with normal weight or overweight pre-pregnancy BMI experienced higher odds of gestational diabetes versus singletons, most of this effect was explained by pathways not involving mid-pregnancy weight gain.

Excessive gestational weight gain in early pregnancy and insufficient gestational weight gain in middle pregnancy increasing risk of gestational diabetes mellitus

Background:

Gestational weight gain (GWG) is associated with the risk of gestational diabetes mellitus (GDM). However, the effect of weight gain in different trimesters on the risk of GDM is unclear. This study aimed to evaluate the effect of GWG on GDM during different trimesters.

Methods:

A birth cohort study was conducted from 2017 to 2020 in Shenzhen, China. In total, 51,205 participants were included comprising two models (early pregnancy model and middle pregnancy model). Gestational weight (kg) was measured at each prenatal clinical visit using a standardized weight scale. Logistic regression analysis was used to assess the risk of GDM. Interaction analysis and mediation effect analysis were performed in the middle pregnancy model.

Results:

In the early pregnancy model, the risk of GDM was 0.858 times lower (95% confidence interval [CI]: 0.786, 0.937) with insufficient GWG (iGWG) and 1.201 times higher (95% CI: 1.097, 1.316) with excessive GWG after adjustment. In the middle pregnancy model, the risk of GDM associated with iGWG increased 1.595 times (95% CI: 1.418, 1.794) after adjustment; for excessive GWG, no significant difference was found (P = 0.223). Interaction analysis showed no interaction between GWG in early pregnancy (GWG-E) and GWG in middle pregnancy (GWG-M) (F = 1.268; P = 0.280). The mediation effect analysis indicated that GWG-M plays a partial mediating role, with an effect proportion of 14.9%.

Conclusions:

eGWG-E and iGWG-M are associated with an increased risk of GDM. Strict control of weight gain in early pregnancy is needed, and sufficient nutrition should be provided in middle pregnancy.

The association between weight gain at different stages of pregnancy and risk of gestational diabetes mellitus

AIMS/INTRODUCTION

Women with excessive gestational weight gain (GWG) are at a higher risk for complications during pregnancy, such as preeclampsia. However, the association between excessive GWG and gestational diabetes mellitus (GDM) remains unclear.

MATERIALS AND METHODS

We retrospectively reviewed 8,352 women from our obstetric database with singleton pregnancies who gave birth after 28 completed weeks of gestation between January 1, 2012, and December 31, 2016, excluding pregnancies complicated by fetal anomalies, fetal death, and overt diabetes. Diagnosis of GDM was based on the criteria recommended by the International Association of Diabetes and Pregnancy Study Groups. We used two classification methods to define excessive GWG: a weight gain above the 90th percentile of the population, or exceeding the upper range recommended by the Institute of Medicine, stratified by pre-pregnancy body mass index. Statistical analysis was performed using multiple logistic regression to determine the association between excessive GWG and the risk of GDM.

RESULTS

Overall, 1,129 women (13.5%) were diagnosed with GDM. There was no difference in GWG between women with and without GDM in the first trimester and before GDM screening. Women with GDM had significantly less GWG in the second trimester, after GDM screening, and throughout the whole gestation than women without GDM. No correlation was found between excessive GWG in the first and second trimesters, before GDM screening, and the later development of GDM.

CONCLUSIONS

Our results indicate that excessive GWG prior to GDM screening is not associated with an increased risk of GDM.

FT3/FT4 mediated the effect of pre-pregnancy body mass index or maternal weight gain during early pregnancy on gestational diabetes mellitus

OBJECTIVE

Maternal overweight or obesity during early pregnancy could increase the subsequent risk of gestational diabetes mellitus (GDM). However, whether these associations were mediated by thyroid hormones and their effect sizes were still unknown. This study aimed to identify the mediating effects of thyroid parameters between pre-pregnancy body mass index (BMI)/maternal weight gain during early pregnancy with subsequent risk of GDM.

METHODS

This prospective mother-infant cohort study was conducted from 2018 to 2019. A total of 2,772 singleton pregnant women were included for analysis. Questionnaire survey, anthropometric measures, and thyroid function testing were conducted in early pregnancy. Deiodinase activity was evaluated using free-triiodothyronine-to-free-thyroxine ratio (FT3/FT4). A standard 75 g oral glucose tolerance test was performed during 24-28 weeks of gestation to diagnose GDM. Mediation analysis was performed on PROCESS 3.5 to examine the mediating effects of thyroid parameters between pre-pregnancy BMI/maternal weight gain during early pregnancy and the subsequent GDM risk.

RESULTS

FT3/FT4 ratio was a significant mediator between pre-pregnancy BMI or maternal weight gain and GDM, accounting for 16.5% and 18.6% of total effects, respectively. FT3 also mediated the association of pre-pregnancy BMI with GDM, accounting for 3.3% of total effects. Thyroid-stimulating hormone suppressed the effects of pre-pregnancy BMI and maternal weight gain on GDM risk, and the proportions of total effects were 2.4% and 6.4%, respectively.

CONCLUSIONS

Deiodinase activity, as indicated by FT3/FT4 ratio, was the strongest mediator among thyroid parameters between pre-pregnancy BMI/maternal early weight gain and GDM.

Periconceptional diet quality is associated with gestational diabetes risk and glucose concentrations among nulliparous gravidas

BACKGROUND

Gestational diabetes mellitus (GDM) and elevated glucose concentrations below the threshold for GDM diagnosis have been associated with adverse pregnancy and offspring outcomes. Dietary interventions initiated during pregnancy have demonstrated inconsistent beneficial effects. Limited data exist regarding the effects of periconceptional diet on gestational glycemia.

OBJECTIVE

To evaluate independent associations between periconceptional diet quality with GDM frequency and glucose concentrations from GDM screening and diagnostic tests among nulliparous gravidas.

DESIGN

This is a secondary analysis of N=7997 participants from the NuMoM2b multicenter, prospective, observational cohort study of first pregnancies. The Alternative Healthy Eating Index (AHEI)-2010 was computed from food frequency questionnaires completed in early pregnancy (6-13 weeks), reporting usual dietary intake over the preceding 3 months. GDM screening was performed either by non-fasting 1-hour 50g glucose load (N=6845), followed by 3-hour 100g glucose tolerance test (GTT) for those with raised glucose concentrations (N=1116; at risk for GDM), or by a single 2-hour 75g GTT (N=569; all GDM risk levels). Logistic and linear regression were used to estimate the associations between the AHEI-2010 score with odds of GDM, having raised blood glucose on the 1-hour screening test, and continuous glucose concentrations on screening and diagnostic tests. All models were adjusted for a priori covariates: maternal age, race/ethnicity, early-pregnancy body mass index, smoking habits, rate of gestational weight gain, energy intake, nausea and vomiting in early pregnancy, study site.

RESULTS

Poorer periconceptional diet quality was observed among participants who were younger, with higher BMI, lower income levels, and of non-Hispanic Black or Hispanic ethnicity. The GDM rate was 4%. Each 1-point increase in AHEI-2010 score was associated with a 1% decrease in the odds of being diagnosed with GDM (beta=-0.015, p=0.022, OR=0.986, 95% CI 0.973 to 0.998). Diet quality was inversely associated with each post glucose load concentration on the non-fasting screening test and the 2-hour and 3-hour GTT.

CONCLUSION

Poor periconceptional diet quality is independently associated with an increased risk of GDM and with minor elevations in serum glucose concentrations on GDM screening and diagnostic tests, in a diverse cohort of nulliparas. Periconception intervention studies targeting diet quality are warranted.

How does antenatal lifestyle affect the risk for gestational diabetes mellitus? A secondary cohort analysis from the GeliS trial

OBJECTIVES

We aimed to investigate the predictive potential of early pregnancy factors such as lifestyle, gestational weight gain (GWG) and mental well-being on gestational diabetes mellitus (GDM) beyond established risk factors.

METHODS

GDM risk was investigated in the cohort of the German 'Gesund leben in der Schwangerschaft'/healthy living in pregnancy study. Women were recruited up to the 12th week of gestation. GDM was diagnosed with a 75 g oral glucose tolerance test between the 24th and 28th weeks of gestation. Pre-pregnancy age and weight, mental health and lifestyle were assessed via questionnaires. Maternal weight was measured throughout pregnancy. Early excessive GWG was defined based on the guidelines of the Institute of Medicine. The association between several factors and the odds of developing GDM was assessed using multiple logistic regression analyses.

RESULTS

Of 1694 included women, 10.8% developed GDM. The odds increased with pre-pregnancy BMI and age (women with obesity: 4.91, CI 3.35-7.19, p < 0.001; women aged 36-43 years: 2.84, CI 1.45-5.56, p = 0.002). Early excessive GWG, mental health and general lifestyle ratings were no significant risk factors. A 31% reduction in the odds of GDM was observed when <30% of energy was consumed from fat (OR 0.69, CI 0.49-0.96, p = 0.026). Vigorous physical activity tended to lower the odds without evidence of statistical significance (OR 0.59 per 10 MET-h/week, p = 0.076).

CONCLUSIONS

Maternal age and BMI stand out as the most important drivers of GDM. Early pregnancy factors like dietary fat content seem to be associated with GDM risk. Further evaluation is warranted before providing reliable recommendations.

Gestational diabetes in women with obesity; an analysis of clinical history and simple clinical/anthropometric measures

AIM

We assessed clinical risk factors, anthropometric measures of adiposity and weight gain to determine associations with development of GDM in a cohort of pregnant women with obesity.

METHODS

This was a secondary analysis of the UPBEAT trial of a complex lifestyle intervention in pregnant women with obesity (ISRCTN89971375). Clinical risk factors, and measures of adiposity and weight were assessed in the early 2nd trimester (mean 17 +0 weeks), and adiposity and weight repeated in the early 3rd trimester (mean 27 +5 weeks').

RESULTS

Of the 1117 women (median BMI 35.0 kg/m2) with complete data, 25.8% (n = 304) developed GDM (IADPSG criteria, OGTT 24-28weeks). Using multivariable analysis, early clinical risk factors associated with later development of GDM included age (adj OR 1.06 per year; 95% CI 1.04-1.09), previous GDM (3.27; 1.34-7.93) and systolic blood pressure (per 10mmHg, 1.34; 1.18-1.53). Anthropometric measures positively associated with GDM included second trimester (mean 17+0 weeks) subscapular skinfold thickness, (per 5mm, 1.12; 1.05-1.21), and neck circumference (per cm, 1.11; 1.05-1.18). GDM was not associated with gestational weight gain, or changes in skinfolds thicknesses or circumferences between visits.

CONCLUSIONS

In this cohort of women with obesity, we confirmed clinical risk factors for GDM, (age, systolic blood pressure) previously identified in heterogeneous weight women but add to these indices of adiposity which may provide a discriminatory approach to GDM risk assessment in this group. This study also underscores the need to focus on modifiable factors pre-pregnancy as an opportunity for GDM prevention, as targeting gestational weight gain and adiposity during pregnancy is likely to be less effective.

Effect of maternal body mass index on the steroid profile in women with gestational diabetes mellitus

OBJECTIVE

To explore the effect of maternal body mass index (BMI) on steroid hormone profiles in women with gestational diabetes mellitus (GDM) and those with normal glucose tolerance (NGT).

METHODS

We enrolled 79 women with NGT and 80 women with GDM who had a gestational age of 24-28 weeks. The participants were grouped according to their BMI. We quantified 11 steroid hormones profiles by liquid chromatography-tandem mass spectrometry and calculated the product-to-precursor ratios in the steroidogenic pathway.

RESULTS

Women with GDM and BMI<25kg/m² showed higher concentrations of dehydroepiandrosterone (DHEA) (p<0.001), testosterone (T) (p=0.020), estrone (E1) (p=0.010) and estradiol (E2) (p=0.040) and lower Matsuda index and HOMA-β than women with NGT and BMI<25kg/m². In women with GDM, concentrations of E1 (p=0.006) and E2 (p=0.009) declined, accompanied by reduced E2/T (p=0.008) and E1/androstenedione (A4) (p=0.010) in the BMI>25 kg/m² group, when compared to that in the BMI<25 kg/m² group. The values of E2/T and E1/A4 were used to evaluate the cytochrome P450 aromatase enzyme activity in the steroidogenic pathway. Both aromatase activities negatively correlated with the maternal BMI and positively correlated with the Matsuda index in women with GDM.

CONCLUSIONS

NGT women and GDM women with normal weight presented with different steroid hormone profiles. Steroidogenic pathway profiling of sex hormones synthesis showed a significant increase in the production of DHEA, T, E1, and E2 in GDM women with normal weight. Additionally, the alteration of steroid hormone metabolism was related to maternal BMI in women with GDM, and GDM women with overweight showed reduced estrogen production and decreased insulin sensitivity compared with GDM women with normal weight.

A Pragmatic Intervention Using Financial Incentives for Pregnancy Weight Management: Feasibility Randomized Controlled Trial

BACKGROUND

Excessive gestational weight gain (GWG) is common and can result in maternal and child health complications. Pragmatic behavioral interventions that can be incorporated into standard obstetric care are needed, and financial incentives are a promising approach.

OBJECTIVE

The aim of this study is to evaluate the feasibility of recruitment, randomization, and retention, as well as treatment engagement and intervention satisfaction, in a behavioral program. The program provided small incentives for meeting behavioral goals of self-weighing and physical activity as well as larger outcome incentives for meeting GWG goals.

METHODS

We recruited 40 adult women in their first trimester of pregnancy from February 2019 to September 2019 at an obstetric clinic. Participants were randomized to 3 intervention components using a 2×2×2 factorial design: daily incentives for self-weighing (lottery vs certain loss), incentives for adhering to the Institute of Medicine's GWG guidelines based on BMI category (monthly vs overall), and incentives for reaching physical activity goals (yes vs no). Participants were asked to complete daily weigh-ins using the Withings Body wireless scale provided by the study, as well as wear a physical activity tracker (Fitbit Flex 2). Feasibility outcomes of recruitment, randomization, and retention, as well as treatment engagement and intervention satisfaction, were assessed. Weight assessments were conducted at baseline, 32-week gestation, and 36-week gestation.

RESULTS

Participants were enrolled at, on average, 9.6 (SD 1.8) weeks' gestation. Of the 39 participants who were oriented to their condition and received the intervention, 24 (62%) were Black or African American, 30 (77%) were not married, and 29 (74%) had an annual household income of less than US $50,000. Of the 39 participants, 35 (90%) completed the follow-up data collection visit. Participants were generally quite positive about the intervention components, with a particular emphasis on the helpfulness of, and the enjoyment of using, the e-scale in both the quantitative and qualitative feedback. Participants who received the loss incentive, on average, had 2.86 times as many days of self-weighing as those who received the lottery incentive. Participants had a relatively low level of activity, with no difference between those who received a physical activity incentive and those who did not.

CONCLUSIONS

A financial incentive-based pragmatic intervention was feasible and acceptable for pregnant women for promoting self-weighing, physical activity, and healthy GWG. Participants were successfully recruited early in their first trimester of pregnancy and retained for follow-up data collection in the third trimester. Participants demonstrated promising engagement in self-weighing, particularly with loss-based incentives, and reported finding the self-weighing especially helpful. This study supports further investigation of pragmatic, clinic-based financial incentive-based interventions for healthy GWG behaviors.

TRIAL REGISTRATION

ClinicalTrials.gov NCT03834194; https://clinicaltrials.gov/ct2/show/NCT03834194.

Gestational weight gain and the risk of gestational diabetes mellitus: A latent class trajectory analysis using birth cohort data

AIMS

To explore trajectories of gestational weight gain (GWG) before diagnosis and its association with risk of gestational diabetes mellitus (GDM).

METHODS

A population-based retrospective cohort study including 37,060 women with live singleton was conducted between 2013 and 2019 in China. Latent class trajectory model (LCTM) was used to identify GWG trajectories, and Poisson regression with robust error estimates was used to estimate risk ratio (RR) of GDM.

RESULTS

Among total 37,060 participants, 25.47% of women were developed with GDM. Two trajectories of GWG were identified as non-excessive weight gain (94.31%) and excessive weight gain (5.69%) before diagnosis of GDM. Women with excessive GWG trajectory before diagnosis had significantly 32.8% (aRR = 1.328, 95 %CI: 1.252 ∼ 1.409, P < 0.001) increased risk of developing GDM compared with non-excessive GWG trajectory. Women with excessive GWG trajectory also had higher risk of macrosomia (aRR = 1.476, 95 %CI: 1.307 ∼ 1.666, P < 0.001) and cesarean delivery (aRR = 1.126, 95 %CI: 1.081 ∼ 1.174, P < 0.001). The impact of excessive GWG trajectory on GDM was greater among pre-pregnancy normal weight women compared with overweight/obese or underweight women.

CONCLUSION

Women with excessive GWG trajectory before diagnosis had significantly higher risk of GDM and GDM-related adverse outcomes, and pre-pregnancy normal weight women with excessive GWG trajectory should also be concerned.

Adolescent body mass index and changes in pre-pregnancy body mass index in relation to risk of gestational diabetes

BACKGROUND

Pregestational excessive body mass index (BMI) is linked to an increased risk for gestational diabetes mellitus (GDM), but less is known on the effect of adolescent BMI on GDM occurrence. The study aimed to investigate possible associations of adolescent BMI and changes in BMI experienced before first pregnancy, with gestational diabetes risk.

METHODS

This retrospective study was based on linkage of a military screening database of adolescent health status (Israel Defence Forces) including measured height and weight, with medical records (Maccabi Healthcare Services, MHS) of a state-mandated health provider. The latter covers about 25% of the Israeli population; about 90% of pregnant women undergo screening by the two-step Carpenter-Coustan method. Adolescent BMI was categorized according to Center of Disease Control and Prevention percentiles. Only first documented pregnanies were analyzed and GDM was the outcome.

FINDINGS

Of 190,905 nulliparous women, 10,265 (5.4%) developed GDM. Incidence proportions of GDM were 5.1%, 6.1%, 7.3%, and 8.9% among women with adolescent normal BMI, underweight, overweight, and obesity (p<0.001), respectively. In models that accounted for age at pregnancy, birth year, and sociodemographic variables, the adjusted odd ratios (aORs) for developing GDM were: 1.2 (95%CI, 1.1-1.3), 1.5 (1.4-1.6), and 1.9 (1.7-2.1) for adolescent underweight, overweight, and obesity (reference group, normal BMI). Adolescent BMI tracked with BMI notes in the pre-pregnancy period (r=63%). Resuming normal pre-pregnancy BMI from overweight or obesity in adolescence diminished GDM risk, but this diminished risk was not observed among those who returned to a normal per-pre-pregnancy BMI from being underweight in adolescence. Sustained overweight or obesity conferred an aOR for developing GDM of 2.5 (2.2-2.7); weight gain from adolescent underweight and normal BMI to pre-pregnancy excessive BMI conferred aORs of 3.1 (1.6-6.2) and 2.6 (2.2-2.7), respectively.

INTERPRETATION

Change in BMI status from adolescence to pre-pregnancy may contribute to GDM risk. Identifying at-risk populations is important for early preventive interventions.

FUNDING

None.

The safety and efficacy of supervised exercise on pregnant women with overweight/obesity: A systematic review and meta-analysis of randomized controlled trials

Behavioural modification through physical activity and dietary counselling has been shown to have beneficial effects on pregnant women with overweight/obesity. Whether exercise alone with supervision (ie, supervised exercise) may also benefit for pregnant women with overweight/obesity is still unknown. This systematic review and meta-analysis aimed to determine the safety and efficacy of supervised exercise on pregnant women with overweight/obesity. PubMed, Cochrane library, Embase (Ovid), CINAHL (EBSCO), and Web of Science were used to search publications using a combination of main keywords "obesity", "exercise", "pregnant women", and "randomised controlled trial". From a total of 740 publications, 11 randomized controlled trials were included. All studies reported no adverse effects of supervised exercise on pregnant women with overweight/obesity. Of interest, this meta-analysis showed gestational weight gain (GWG) was lower in the supervised exercise group as compared to control (Mean difference 0.88 kg, 95%CI -1.73 to -0.03, P = .04). There was a significant effect of supervised exercise on post-prandial blood glucose (MD: -0.24, 95%CI -0.47 to -0.01, P = .04) and insulin resistance (HOMA-IR) (MD: -0.18, 95%CI -0.30 to -0.05, P = .005). There were no differences in risk of gestational diabetes mellitus, pre-eclampsia/gestational hypertension, and newborn outcomes (eg, infants birth weight, preterm birth incident, and gestational age) (all P > .05). This meta-analysis might suggest beneficial effects of supervised exercise on pregnant women with overweight/obesity to prevent excessive GWG, attenuates insulin resistance, and the post-prandial blood glucose level.

Prevention of Gestational Diabetes: The Role of Dietary Intake, Physical Activity, and Weight before, during, and between Pregnancies

Gestational diabetes mellitus (GDM) is the most common complication of pregnancy and a significant clinical and public health problem with lifelong and intergenerational adverse health consequences for mothers and their offspring. The preconception, early pregnancy, and interconception periods represent opportune windows to engage women in preventive and health promotion interventions. This review provides an overview of findings from observational and intervention studies on the role of diet, physical activity, and weight (change) during these periods in the primary prevention of GDM. Current evidence suggests that supporting women to increase physical activity and achieve appropriate weight gain during early pregnancy and enabling women to optimize their weight and health behaviors prior to and between pregnancies have the potential to reduce rates of GDM. Translation of current evidence into practice requires further development and evaluation of co-designed interventions across community, health service, and policy levels to determine how women can be reached and supported to optimize their health behaviors before, during, and between pregnancies to reduce GDM risk.