Endocrine Abstracts

Aim: The aim of this study was to evaluate the effect of pre-gestational body mass index (BMI) and gestational weight gain (GWG) on adverse pregnancy outcomes in women with gestational diabetes mellitus (GDM) controlled with medication.

Methods: We conducted a retrospective cohort study of women with singleton pregnancies, diagnosed with GDM and treated with glucose lowering agents that were followed and gave birth between 2005–2015 in the Assaf Harofeh medical center, Israel.

Results: There were 280 women who met inclusion criteria. Mean maternal age was 33.92±5.2; 64.8% had a family history of DM and 39.7% had a history of GDM in previous pregnancies. Classification and regression tree method identified four groups according to adverse outcomes, consisted of 74 women with pre-gestational BMI below 25, 98 women with BMI 25–31, 90 women 31–39 and 18 women above 39. Respectively, the mean GWG was 12 kg (8–16), 11 kg (8–15), 7.5 kg (3.75–11) and 5 kg (-1.5–11.5). Mean GWG was significantly (P<0.001) different between groups. The risk for composite maternal and neonatal adverse outcomes was higher in the groups of BMI 25–31 (73.5%) and 31–39 (83.3%) in comparison to BMI <25 (51.4%) and 39< (55.6%), P<0.001. In the subgroup of women with pre-gestational BMI of <25, weight gain of more than the median resulted in odds ratio of 2.75 (1.07–7.08, p=0.036) for adverse pregnancy outcomes compared with women who gained less than the Mean GWG. When adjusted for potential confounders, the odds ratio for adverse outcome in women with BMI <25 who gained above the median weight increased to 4.8 (1.6–14.5, P=<0.001). Maternal age was independently associated with adverse outcomes in women with BMI 25–39 but not above 39, though this subgroup was relatively small.

Conclusion: Maternal obesity is related to adverse pregnancy outcomes. Moreover, GDM women with normal pre-gestational BMI who gained weight according to latest institute of medicine recommendations still experienced adverse outcomes. It is possible that weight gain recommendations for this group are too liberal.