Tags

Type your tag names separated by a space and hit enter

Are the Institute of Medicine weight gain targets applicable in women with gestational diabetes mellitus?
Diabetologia 2017; 60(3):416-423D

Abstract

AIMS/HYPOTHESIS

Our aim was to study the relationship between excessive gestational weight gain (GWG) according to Institute of Medicine (IOM) targets and perinatal outcomes, and examine whether modifying targets may improve outcomes in women with gestational diabetes mellitus (GDM).

METHODS

This was a retrospective cohort study of all GDM pregnancies from 1992 to 2013. ORs were calculated for associations between excessive GWG (EGWG) using IOM targets and adverse pregnancy outcomes. ORs were then adjusted for maternal age, gestational age at diagnosis, prepregnancy BMI, gravidity, parity, ethnicity, antenatal fasting blood glucose level (BGL), 2 h BGL and HbA1c. BMI was categorised into underweight (<18.5 kg/m2), healthy weight (18.5-24.9 kg/m2), overweight (25-29.9 kg/m2) and obese (≥30 kg/m2). Large for gestational age (LGA) was defined as birthweight above the 90th percentile, small for gestational age (SGA) was birthweight below the 10th percentile, macrosomia was birthweight >4000 g, and preterm delivery was delivery prior to 37 weeks' gestation. Modified GWG targets were derived by: (1) subtracting 2 kg from the upper IOM target only; (2) subtracting 2 kg from both upper and lower targets; (3) using the interquartile range of maternal GWG of women with infants who were appropriate for gestational age per BMI category; and (4) restricting GWG to 0-4 kg in women with BMI ≥35 kg/m2.

RESULTS

Among 3095 GDM pregnancies, only 31.7% had GWG within IOM guidelines. Adjusted ORs for women who exceeded GWG were Caesarean section (1.5; 95% CI 1.2, 1.9), LGA (1.8; 95% CI 1.4, 2.4) and macrosomia (2.3; 95% CI 1.6, 3.3); there was a lower risk of SGA (adjusted OR 0.5; 95% CI 0.3, 0.7).

CONCLUSIONS/INTERPRETATION

EGWG according to IOM targets was associated with Caesarean section, LGA and macrosomia. Modification of IOM criteria, including more restrictive targets, did not improve perinatal outcomes.

Authors+Show Affiliations

Diabetes Centre, Bankstown-Lidcombe Hospital, 68 Eldridge Rd, Bankstown, NSW, 2200, Australia. drwongt@gmail.com. Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia. drwongt@gmail.com. Faculty of Medicine, University of Sydney, Sydney, NSW, Australia. drwongt@gmail.com.Diabetes Centre, Bankstown-Lidcombe Hospital, 68 Eldridge Rd, Bankstown, NSW, 2200, Australia. School of Health Sciences, Faculty of Health and Medicine, The University of Newcastle, Callaghan, NSW, Australia.Diabetes Centre, Bankstown-Lidcombe Hospital, 68 Eldridge Rd, Bankstown, NSW, 2200, Australia. Faculty of Medicine, University of Sydney, Sydney, NSW, Australia.Faculty of Medicine, University of Sydney, Sydney, NSW, Australia. Department of Diabetes and Endocrinology, Westmead Hospital, Westmead, NSW, Australia.Diabetes Centre, Bankstown-Lidcombe Hospital, 68 Eldridge Rd, Bankstown, NSW, 2200, Australia. Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia. School of Medicine, Western Sydney University, Sydney, NSW, Australia.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

27942798

Citation

Wong, Tang, et al. "Are the Institute of Medicine Weight Gain Targets Applicable in Women With Gestational Diabetes Mellitus?" Diabetologia, vol. 60, no. 3, 2017, pp. 416-423.
Wong T, Barnes RA, Ross GP, et al. Are the Institute of Medicine weight gain targets applicable in women with gestational diabetes mellitus? Diabetologia. 2017;60(3):416-423.
Wong, T., Barnes, R. A., Ross, G. P., Cheung, N. W., & Flack, J. R. (2017). Are the Institute of Medicine weight gain targets applicable in women with gestational diabetes mellitus? Diabetologia, 60(3), pp. 416-423. doi:10.1007/s00125-016-4173-3.
Wong T, et al. Are the Institute of Medicine Weight Gain Targets Applicable in Women With Gestational Diabetes Mellitus. Diabetologia. 2017;60(3):416-423. PubMed PMID: 27942798.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Are the Institute of Medicine weight gain targets applicable in women with gestational diabetes mellitus? AU - Wong,Tang, AU - Barnes,Robyn A, AU - Ross,Glynis P, AU - Cheung,Ngai W, AU - Flack,Jeff R, Y1 - 2016/12/09/ PY - 2016/08/22/received PY - 2016/11/16/accepted PY - 2016/12/13/pubmed PY - 2017/8/29/medline PY - 2016/12/13/entrez KW - Gestational diabetes mellitus KW - Gestational weight gain KW - Institute of Medicine KW - Large for gestational age KW - Perinatal outcomes KW - Pregnancy SP - 416 EP - 423 JF - Diabetologia JO - Diabetologia VL - 60 IS - 3 N2 - AIMS/HYPOTHESIS: Our aim was to study the relationship between excessive gestational weight gain (GWG) according to Institute of Medicine (IOM) targets and perinatal outcomes, and examine whether modifying targets may improve outcomes in women with gestational diabetes mellitus (GDM). METHODS: This was a retrospective cohort study of all GDM pregnancies from 1992 to 2013. ORs were calculated for associations between excessive GWG (EGWG) using IOM targets and adverse pregnancy outcomes. ORs were then adjusted for maternal age, gestational age at diagnosis, prepregnancy BMI, gravidity, parity, ethnicity, antenatal fasting blood glucose level (BGL), 2 h BGL and HbA1c. BMI was categorised into underweight (<18.5 kg/m2), healthy weight (18.5-24.9 kg/m2), overweight (25-29.9 kg/m2) and obese (≥30 kg/m2). Large for gestational age (LGA) was defined as birthweight above the 90th percentile, small for gestational age (SGA) was birthweight below the 10th percentile, macrosomia was birthweight >4000 g, and preterm delivery was delivery prior to 37 weeks' gestation. Modified GWG targets were derived by: (1) subtracting 2 kg from the upper IOM target only; (2) subtracting 2 kg from both upper and lower targets; (3) using the interquartile range of maternal GWG of women with infants who were appropriate for gestational age per BMI category; and (4) restricting GWG to 0-4 kg in women with BMI ≥35 kg/m2. RESULTS: Among 3095 GDM pregnancies, only 31.7% had GWG within IOM guidelines. Adjusted ORs for women who exceeded GWG were Caesarean section (1.5; 95% CI 1.2, 1.9), LGA (1.8; 95% CI 1.4, 2.4) and macrosomia (2.3; 95% CI 1.6, 3.3); there was a lower risk of SGA (adjusted OR 0.5; 95% CI 0.3, 0.7). CONCLUSIONS/INTERPRETATION: EGWG according to IOM targets was associated with Caesarean section, LGA and macrosomia. Modification of IOM criteria, including more restrictive targets, did not improve perinatal outcomes. SN - 1432-0428 UR - https://www.unboundmedicine.com/medline/citation/27942798/Are_the_Institute_of_Medicine_weight_gain_targets_applicable_in_women_with_gestational_diabetes_mellitus L2 - https://doi.org/10.1007/s00125-016-4173-3 DB - PRIME DP - Unbound Medicine ER -