Gestational weight gain in women with gestational diabetes: implications of exceeding recommendations at diagnosis — ASN Events
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  Gestational weight gain in women with gestational diabetes: implications of exceeding recommendations at diagnosis (#141)

Naveena Sankaran 1 2 , Vincent Wong 1 3
  1. Diabetes and Endocrine Service, Liverpool Hospital, Liverpool, NSW, Australia
  2. Sydney Medical School, University of Sydney , Sydney, NSW, Australia
  3. Southwest Sydney Clinical School , University of New South Wales, Liverpool, NSW , Australia

Background

In 2009, the Institute of Medicine (IOM) published gestational weight gain recommendations based on pre-pregnancy body mass index (BMI). No specific guidelines exist for women with gestational diabetes (GDM), and the IOM recommendations are commonly applied in this population and help inform their medical nutritional therapy. The optimal management of women who have already exceeded recommended weight gain at the time of gestational diabetes diagnosis remains unclear.

Aim and Methods

This retrospective cohort study included women diagnosed with GDM after 24 weeks’ gestation. Gestational weight gain was assessed at diagnosis and at delivery to determine whether IOM recommendations were exceeded at each time point. Pregnancy outcomes were compared between groups using chi-square testing.

Results

Between 2000 and 2025, 985 women were diagnosed with GDM after 24 weeks’ gestation. At diagnosis, 199 women (20.2%) had already exceeded total gestational weight gain recommendations. This proportion increased with pre-pregnancy BMI: 7.4% (<25.0 kg/m²), 25.1% (25.0–29.9 kg/m²), and 32.6% (≥30.0 kg/m²).  Amongst these 199 women, only 6 (3.0%) achieved the IOM weight gain targets by the end of their pregnancy.  For those who already exceeded weight gain targets at GDM diagnosis, 15.6% had macrosomia (birthweight >4000g) compared to 7.0% for those who did not (p<0.001).  However, there was no difference in pre-eclampsia (4.2 vs 2.7%), caesarean section (38.1 vs 38.6%), neonatal hypoglycaemia (glucose<2.6mmol/L) (16.8 vs 14.4%), need for neonatal intensive care support (14.7 vs 11.5%) or pre-maturity (delivery <37 weeks) (7.5 vs 5.6%).

Conclusion

Exceeding gestational weight gain recommendations at the time of gestational diabetes diagnosis is common and rarely reversed. While associated with an increased risk of macrosomia, it was not associated with other significant adverse pregnancy outcomes. Further research on weight management for women with GDM is needed.