Perinatal Outcomes in Pregnancies With Type 2 Diabetes and Weight Gain Less Than 5 Kilograms

To assess the relationship between restricted weight gain or weight loss (defined as weight gain <5 kg) and perinatal outcomes in pregnant individuals with type 2 diabetes.

This was a retrospective cohort study of 954 pregnant individuals with type 2 diabetes from two academic health centers. Maternal demographics, health care utilization, glycemia, and diabetes therapies were compared between groups. Weight gain <5 kg occurred in 327 (34.3%) of all pregnancies. Logistic regression analyses were used to compare perinatal outcomes between those with <5 kg weight gain and ≥5 kg weight gain, adjusted for covariates.

Weight gain <5 kg was associated with a significant reduction in the risk for multiple perinatal outcomes, including large-for-gestational-age birth weight (adjusted odds ratio [aOR] 0.42, 95% CI 0.29-0.59), neonatal intensive care unit admission (aOR 0.74, 95% CI 0.55-0.98), hypertensive disorders of pregnancy (aOR 0.56, 95%C CI 0.42-0.75), and cesarean delivery (aOR 0.66, 95% CI 0.48-0.91). We did not detect a significant increase in small-for-gestational-age birth weight (aOR 1.61, 95% CI 0.96-2.71) or preterm birth (aOR 0.92, 95% CI 0.67-1.25) in pregnancies with maternal weight gain <5 kg.

Weight gain <5 kg was associated with significantly lower rates of several adverse perinatal outcomes. Future interventional studies are needed to assess whether lifestyle or pharmacologic interventions can limit weight gain and improve both short- and long-term maternal and child outcomes in pregnant individuals with type 2 diabetes.