Endocrine Abstracts

Background and aims: Maternal BMI and weight gain are associated with maternal and fetal complications in gestational diabetes (GD), but their relative contribution is not clearly defined. Our aim was to determine the influence of BMI and weight gain in the evolution of GD.

Material and methods: Multicenter, retrospective study of women diagnosed with GD at the medical centers of the Portuguese Group for the Study of Diabetes and Pregnancy in 2011. We used the diagnostic criteria of the International Association of Diabetes and Pregnancy Study Groups and excluded multiple pregnancies and cases with lack of information about maternal BMI. The χ², Mann–Whitney U, Kruskall–Wallis, and one-way ANOVA tests were used for statistical analysis.

Results: We included 1577 patients, with mean age 33.1±5.3 years. Sixty percent were overweight/obese and 38.7% were treated with insulin. The mean weight gain in pregnancy was 9.9±5.5 kg and 27.9% had an excessive weight gain for their BMI. Maternal BMI was associated with multiparity (P<0.001), previous GD (P=0.005), previous fetal macrosomia (P<0.001), treatment with insulin (P<0.001), and excessive weight gain (P<0.001). Compared with women with normal BMI, obese women were diagnosed (P<0.001) and started insulin therapy (P=0.007) earlier, were treated with higher insulin dose (P<0.001), had higher mean HbA1c in the third trimester (P<0.001), heavier newborns (P<0.001) and had a smaller absolute weight increase (P<0.001). Women with excessive weight gain were younger (P=0.003), had a later diagnosis (P<0.001), needed higher insulin dose (P=0.009), had higher HbA1c in the third trimester (P<0.001) and gave birth to heavier newborns (P<0.001).

Conclusion: In our population, women with higher BMI and those with excessive weight gain had a more severe GD evolution and might need a more intensive treatment approach.