TY - JOUR
T1 - Gestational weight gain in insulin-resistant pregnancies
AU - Harper, L. M.
AU - Shanks, A. L.
AU - Odibo, A. O.
AU - Colvin, R.
AU - Macones, G. A.
AU - Cahill, A. G.
N1 - Funding Information:
Dr Harper is supported by K12HD001258-13, NICHD, PI William W. Andrews. This work was supported by the Thrasher Foundation, NR-0024, Prediction of Neonatal Morbidity and Macrosomia in Diabetic Pregnancies, PI Alison G Cahill. This study was conducted at Washington University in St Louis Medical Center, St Louis, MO, USA.
PY - 2013/12
Y1 - 2013/12
N2 - OBJECTIVE:To examine the Institute of Medicine (IOM) guidelines for gestational weight gain (GWG) in insulin-resistant pregnancy.STUDY DESIGN:Secondary analysis of a prospective cohort of 435 women with type 2 or gestational diabetes from 2006 to 2010. The exposure was categorized as GWG less than, within or greater than the IOM recommendations for body mass index. The maternal outcome was a composite of preeclampsia, eclampsia, third- to fourth-degree laceration, readmission or wound infection. The neonatal outcome was a composite of preterm delivery, level 3 nursery admission, oxygen requirement >6 h, shoulder dystocia, 5-min Apgar≤3, umbilical cord arterial pH<7.1 or base excess <-12. Secondary outcomes were cesarean delivery (CD), macrosomia and small for gestational age (SGA).RESULT:Incidence of the maternal outcome did not differ with GWG (P=0.15). Women gaining more than recommended had an increased risk of CD (relative risk (RR) 1.31, 95% confidence interval (CI) 1.01 to 1.69) and the neonatal outcome (RR 1.40, 95% CI 1.01 to 1.95) compared with women gaining within the IOM recommendations. Women gaining less than recommended had an increased risk of SGA (RR 3.29, 95% CI 1.09 to 9.91) without a decrease in the risk of the maternal outcome (RR 0.93, 95% CI 0.49 to 1.78) or CD (RR 0.74, 95% CI 0.40 to 1.37) compared with women gaining within the IOM recommendations.CONCLUSION:Women with insulin resistance should be advised to gain within the current IOM guidelines.
AB - OBJECTIVE:To examine the Institute of Medicine (IOM) guidelines for gestational weight gain (GWG) in insulin-resistant pregnancy.STUDY DESIGN:Secondary analysis of a prospective cohort of 435 women with type 2 or gestational diabetes from 2006 to 2010. The exposure was categorized as GWG less than, within or greater than the IOM recommendations for body mass index. The maternal outcome was a composite of preeclampsia, eclampsia, third- to fourth-degree laceration, readmission or wound infection. The neonatal outcome was a composite of preterm delivery, level 3 nursery admission, oxygen requirement >6 h, shoulder dystocia, 5-min Apgar≤3, umbilical cord arterial pH<7.1 or base excess <-12. Secondary outcomes were cesarean delivery (CD), macrosomia and small for gestational age (SGA).RESULT:Incidence of the maternal outcome did not differ with GWG (P=0.15). Women gaining more than recommended had an increased risk of CD (relative risk (RR) 1.31, 95% confidence interval (CI) 1.01 to 1.69) and the neonatal outcome (RR 1.40, 95% CI 1.01 to 1.95) compared with women gaining within the IOM recommendations. Women gaining less than recommended had an increased risk of SGA (RR 3.29, 95% CI 1.09 to 9.91) without a decrease in the risk of the maternal outcome (RR 0.93, 95% CI 0.49 to 1.78) or CD (RR 0.74, 95% CI 0.40 to 1.37) compared with women gaining within the IOM recommendations.CONCLUSION:Women with insulin resistance should be advised to gain within the current IOM guidelines.
KW - gestational diabetes
KW - gestational weight gain
KW - type 2 diabetes
UR - http://www.scopus.com/inward/record.url?scp=84888644595&partnerID=8YFLogxK
U2 - 10.1038/jp.2013.100
DO - 10.1038/jp.2013.100
M3 - Article
C2 - 23949833
AN - SCOPUS:84888644595
SN - 0743-8346
VL - 33
SP - 929
EP - 933
JO - Journal of Perinatology
JF - Journal of Perinatology
IS - 12
ER -