Association between gestational weight gain in women with gestational diabetes mellitus and adverse pregnancy outcomes: a retrospective cohort study

Background To examine association between gestational weight gain (GWG) in women with gestational diabetes mellitus (GDM) and adverse pregnancy outcomes (APOs). Methods This retrospective cohort study enrolled women with GDM who delivered at 2010-2020 in Changzhou, Jiangsu. Total GWG, rates of GWG in second trimester and third trimesters were stratified into three categories according to IOM guidelines: within, below, and above IOM guidelines. Univariable and multivariable logistic regression analyses were used. Results Overall, 1606 women with GDM fulfilled inclusion criteria. Compared with within IOM guidelines and after adjusting for confounders, total GWG above IOM guidelines in pregnancy was associated with an increased odds of caesarean delivery [adjusted odds ratio (aOR) = 1.34, 95% confidence interval (CI): 1.04-1.72], hypertensive disorders of pregnancy (HDP) (aOR = 2.00, 1.28-3.12), preeclampsia (aOR = 2.06, 1.01-3.12), macrosomia (aOR = 1.55, 1.13-2.13) and large for gestational age (LGA) (aOR = 2.82, 1.94-3.23), and a decreased odds of premature rupture of membrane (PROM) (aOR = 0.46, 0.36-0.60) and preterm birth (aOR = 0.35, 0.26-0.44); total GWG below IOM guidelines in pregnancy was associated with an increased risk of preterm birth (aOR = 1.96, 1.44-2.66), small for gestational age (SGA) (aOR = 1.32, 1.11-1.50) and a decreased odds of macrosomia (aOR = 0.35, 0.23-0.53) and LGA (aOR = 0.54, 0.42-0.72). Further, in both second and third trimesters of pregnancy, rates of GWG above IOM guidelines was found to be associated with a high odds of HDP (aOR = 2.55, 1.86-3.38; aOR = 1.93, 1.08-2.98), preeclampsia (aOR = 2.28, 1.21-3.81; aOR = 2.17, 1.35-4.37), macrosomia (aOR = 1.20, 1.02-1.82; aOR = 2.02, 1.51-2.64) and LGA (aOR = 1.42, 1.24-1.97; aOR = 1.79, 1.51-2.54). Rates of GWG above IOM guidelines in third trimester of pregnancy also increased odds of caesarean delivery (aOR = 1.48, 1.16-2.34) when compared with within IOM guidelines. While rates of GWG below IOM guidelines in both second and third trimesters of pregnancy was associated with a decreased odds of macrosomia (aOR = 0.66, 95% CI: 0.52-0.78; aOR = 0.52, 0.39-0.63) and LGA(aOR = 0.71, 0.51-0.82; aOR = 0.67, 0.55-0.79). In addition, rate of GWG below IOM guidelines in third trimester of pregnancy was associated with an increased odds of preterm birth (aOR = 1.52, 1.12-2.05) and SGA (aOR = 1.21, 1.10-1.69). Conclusion GWG, outside IOM guidelines has increased risks of APOs among women with GDM, implying that careful surveillance for GWG during different stages of pregnancy is warranted.