Excessive Gestational Weight Gain in Early Pregnancy and Insufficient Gestational Weight Gain in Middle Pregnancy Increased Risk of Gestational Diabetes Mellitus

Excessive Gestational Weight Gain in Early Pregnancy and Insufficient Gestational Weight Gain in Middle Pregnancy Increased Risk of Gestational Diabetes Mellitus

Gestational diabetes mellitus (GDM) is a common complication during pregnancy, associated with adverse maternal and child outcomes. The prevalence of GDM has been increasing globally, including in China, where studies have shown a significant rise in recent years. Gestational weight gain (GWG) and prepregnancy body mass index (BMI) are known to influence the risk of adverse maternal and child outcomes. This study aimed to evaluate the effect of GWG during different trimesters on the risk of GDM, providing insights into the timing and extent of weight control during pregnancy.

The study was conducted as a birth cohort study in Shenzhen, China, from 2017 to 2020. A total of 51,205 participants were included, divided into two models: the early pregnancy model and the middle pregnancy model. Gestational weight was measured at each prenatal clinical visit using a standardized weight scale. Logistic regression analysis was used to assess the risk of GDM, with interaction and mediation effect analyses performed in the middle pregnancy model.

In the early pregnancy model, the risk of GDM was found to be 0.858 times lower with insufficient GWG (iGWG) and 1.201 times higher with excessive GWG (eGWG) after adjustment. In the middle pregnancy model, the risk of GDM associated with iGWG increased 1.595 times after adjustment, while no significant difference was found for eGWG. Interaction analysis showed no interaction between GWG in early pregnancy (GWG-E) and GWG in middle pregnancy (GWG-M). Mediation effect analysis indicated that GWG-M plays a partial mediating role, with an effect proportion of 14.9%.

The findings suggest that eGWG in early pregnancy and iGWG in middle pregnancy are associated with an increased risk of GDM. This highlights the importance of strict control of weight gain in early pregnancy and the provision of sufficient nutrition in middle pregnancy to mitigate the risk of GDM.

The study population included pregnant women from the Shenzhen Maternity and Child Healthcare Hospital, with data collected on general demographic and socioeconomic characteristics. Gestational weight was measured at each prenatal visit, and a 75 g oral glucose tolerance test (OGTT) was performed at 24 to 28 weeks of gestation to diagnose GDM. GWG was calculated based on the prepregnancy weight and gestational weight at specific weeks, with categories defined as insufficient, sufficient, and excessive according to the Institute of Medicine (IOM) recommendations.

Statistical analysis involved logistic regression to evaluate the effects of GWG on GDM, with adjustments for confounding variables such as maternal age, ethnicity, education, employment, assisted reproduction, and gravidity. Sensitivity analysis was performed to verify the robustness of the results, and interaction and mediation analyses were conducted to explore the relationships between GWG in different trimesters.

The results showed that in early pregnancy, iGWG was associated with a lower risk of GDM, while eGWG increased the risk. In middle pregnancy, iGWG was associated with a higher risk of GDM, while eGWG showed no significant difference. The interaction analysis confirmed no interaction between GWG-E and GWG-M, and the mediation analysis indicated that GWG-M partially mediates the effect of GWG-E on GDM.

The study’s findings have important implications for clinical practice. Excessive weight gain in early pregnancy may increase insulin resistance and weaken the secretion of islet beta cells, leading to GDM. Insufficient weight gain in middle pregnancy may increase the risk of fetal growth restriction, which in turn may increase maternal glucocorticoid exposure and the risk of GDM. Therefore, it is crucial to monitor and manage GWG during different trimesters to reduce the risk of GDM.

The study’s strengths include its large sample size and robust data from a birth cohort study. However, limitations include the self-reported prepregnancy weight, which may introduce bias, and the single-center design, which may limit the generalizability of the findings. Despite these limitations, the study provides valuable insights into the relationship between GWG and GDM, emphasizing the need for appropriate weight management during pregnancy.

In conclusion, eGWG in early pregnancy and iGWG in middle pregnancy are associated with an increased risk of GDM. Strengthening the control of weight gain during early pregnancy and ensuring sufficient nutrition in middle pregnancy are essential strategies to prevent the occurrence of GDM. Future research should explore the mechanisms underlying these associations and investigate the effectiveness of interventions to manage GWG during pregnancy.

doi.org/10.1097/CM9.0000000000001972

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