Does interpregnancy weight change impact outcomes for women with recurrent Gestational Diabetes Mellitus? — ASN Events
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Does interpregnancy weight change impact outcomes for women with recurrent Gestational Diabetes Mellitus? (#127)

Stephanie Terry 1 , Robyn Barnes 1 , Ning Zhang 1 2 , Cunjing Li 1 , Androulla Georgiou 1 , Quynh Le 1 , Sarah Abdo 1 2 3 , Jeff R Flack 1 2 , Tang Wong 1 2 3 , Rekha Marimuthu 4
  1. Bankstown-Lidcombe Hospital, Bankstown, NSW, Australia
  2. University of New South Wales, Sydney
  3. Western Sydney University, Sydney
  4. Department of Diabetes and Endocrinology, Bankstown-Lidcombe Hospital, SWSLHD, Bankstown, NSW, Australia

Background: Healthy gestational weight gain (GWG) improves glycaemic control and pregnancy outcomes in women with Gestational Diabetes Mellitus (GDM). The impact of interpregnancy weight change (IPWC) is less clear.

Aim: To assess the effect of IPWC on outcomes in women with two GDM pregnancies.

Methods: Prospectively collected data (1992-2025) for women with two GDM pregnancies at Bankstown-Lidcombe Hospital were analysed. IPWC was defined as change in pre-pregnancy body mass index (BMI) between pregnancies, grouped as <1kg/m2 or ≥1kg/m2. Baseline characteristics and outcomes were compared. Outcomes included insulin use, pre-term delivery (<37 weeks), caesarean section, small for gestational age (SGA<10th percentile), large for gestational age (LGA>90th percentile), neonatal hypoglycaemia (<2.6mmol/L) and jaundice.

Exclusions were twins, missing weight data, and pre-existing diabetes. Paired t-tests and McNemar’s test assessed statistical significance for continuous and categorical data respectively (p<0.05 significant). Odds ratios were calculated from 2x2 contingency tables.

Results: Of 986 women, 483(49.0%) had IPWC <1kg/m2 and 503(51.0%) had IPWC ≥1kg/m2. GDM was diagnosed earlier in the second versus the index pregnancy across both groups (22.7±6.7vs25.2±5.7weeks, p<0.001 and 22.5±6.7vs26.6±5.4weeks, p<0.001). The <1kg/m2 group had lower pre-pregnancy BMI (26.0±5.7vs26.6±6.2kg/m2, p<0.001) but greater GWG (12.2±6.3vs11.0±5.6kg, p<0.001) in the second pregnancy. The ≥1kg/m2 group had higher pre-pregnancy BMI (29.0±6.3vs25.9±5.6kg/m2, p<0.001), but lower GWG (10.1±5.9vs14.7±6.2kg, p<0.001) and less excessive GWG (35.6%vs52.9%, p<0.001) in the second pregnancy.

Higher rates of insulin use were seen in the second pregnancy in both the <1kg/m2 (OR 1.97 95%CI 1.33-2.94, p<0.001) and ≥1kg/m2 groups (OR 3.22 95%CI 2.21-4.69, p<0.001). Similarly, higher insulin doses were seen in the second pregnancy in both groups (17.5±31.6vs11.1±21.6units, p<0.001 and 20.6±29.7vs11.4±20.9units, p<0.001).The ≥1kg/m2 group had significantly higher insulin use than the <1kg/m2 group (OR 1.37 95%CI 1.06–1.77, p<0.05). Unlike the <1kg/m2 group, in the second pregnancy, the ≥1kg/m2 group had increased rates of pre-term delivery (OR 1.88 95%CI 1.02-3.44, p<0.05), caesarean section (OR 5.00 95%CI 2.62-9.55, p<0.001), and LGA (OR 2.05 95%CI 1.23-3.41, p<0.01).

Conclusions: Interpregnancy weight gain was associated with increased insulin treatment and dose, pre-term delivery, caesarean section and LGA in the subsequent GDM pregnancy. Targeted postpartum strategies to optimise weight between pregnancies are needed.