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Gestational weight gain in insulin-resistant pregnancies

Journal of Perinatology volume 33, pages 929–933 (2013)Cite this article

Subjects

Abstract

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.

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Acknowledgements

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.

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Authors and Affiliations

  1. Department of Obstetrics and Gynecology, University of Alabama at Birmingham School of Medicine, Birmingham, AL, USA

    L M Harper

  2. Department of Obstetrics and Gynecology, Washington University in St Louis, St Louis, MO, USA

    A L Shanks, A O Odibo, R Colvin, G A Macones & A G Cahill

Authors
  1. L M Harper
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  2. A L Shanks
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  3. A O Odibo
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  4. R Colvin
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  5. G A Macones
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  6. A G Cahill
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Corresponding author

Correspondence to L M Harper.

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The authors declare no conflict of interest.

Additional information

This abstract was presented at the Society for Maternal Fetal Medicine, 11–16 February 2013, San Francisco, CA, USA.

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Harper, L., Shanks, A., Odibo, A. et al. Gestational weight gain in insulin-resistant pregnancies. J Perinatol 33, 929–933 (2013). https://doi.org/10.1038/jp.2013.100

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