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Gestational weight gain in insulin-resistant pregnancies
L M Harper1, A L Shanks, A O Odibo
1Department of Obstetrics and Gynecology, University of Alabama at Birmingham School of Medicine, Birmingham, AL, USA.
Summary
Adhering to Institute of Medicine (IOM) gestational weight gain (GWG) guidelines is crucial for pregnant women with insulin resistance. Gaining too much increases risks for cesarean delivery and adverse neonatal outcomes, while gaining too little raises the risk of small for gestational age infants.
Area of Science:
- Obstetrics and Gynecology
- Maternal-Fetal Medicine
- Endocrinology
Background:
- Insulin resistance in pregnancy, including type 2 and gestational diabetes, presents unique challenges for managing gestational weight gain (GWG).
- The Institute of Medicine (IOM) provides guidelines for GWG based on pre-pregnancy body mass index, but their applicability in insulin-resistant pregnancies requires examination.
Purpose of the Study:
- To evaluate the adherence and outcomes associated with Institute of Medicine (IOM) gestational weight gain (GWG) guidelines in pregnancies complicated by insulin resistance.
- To determine the impact of GWG deviations (less than, within, or greater than recommended) on maternal and neonatal composite outcomes.
Main Methods:
- A secondary analysis was conducted on a prospective cohort of 435 women with type 2 or gestational diabetes (2006-2010).
- Gestational weight gain (GWG) was categorized relative to IOM recommendations.
- Maternal and neonatal composite outcomes, along with secondary outcomes like cesarean delivery (CD), macrosomia, and small for gestational age (SGA) infants, were assessed.
Main Results:
- No significant difference in the composite maternal outcome was observed across GWG categories.
- Women gaining more than recommended GWG had increased risks of cesarean delivery (RR 1.31) and adverse neonatal outcomes (RR 1.40).
- Women gaining less than recommended GWG had a significantly increased risk of SGA infants (RR 3.29) without a reduction in maternal complications or CD rates.
Conclusions:
- Pregnant women with insulin resistance should be advised to maintain gestational weight gain within the current Institute of Medicine (IOM) guidelines.
- Deviating from IOM GWG recommendations in insulin-resistant pregnancies is associated with increased risks for specific adverse maternal and neonatal outcomes.
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