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Gestational Weight Gain Associated with Infant Birth Weight in Type 1 Diabetes Mothers

 

Maternal weight gain is key to controlling infant birth weight….
Infants born to mothers with pregestational diabetes are more likely to experience adverse outcomes, especially an increased birth weight. Previous studies have shown the importance of strict maternal glycemic control to prevent fetal hyperinsulinemia and accelerated growth. Excessive gestational weight gain has also been identified as a risk for increasing infant birth weight.
In this retrospective study, researchers examined the association between excessive gestational weight gain and infant birth weight in type 1 diabetes patients. Patients with diabetic nephropathy and pre-eclampsia were excluded due to the potential restrictive nature on fetal growth the conditions could have. A total of 115 women were included in the study and were placed into one of three groups based on gestational weight gain: excessive, appropriate or insufficient weight gain.
Median birth weight was found to decrease across the three gestational weight gain groups. Excessive: 3,681g (range 2,374-4,500g) vs appropriate: 3,395g (range 2,910-4,322g) vs insufficient: 3,295g (range 2,766-4,430g) (P=0.02). Glycemic control as measured by HbA1c was comparable at week 8 (P=0.78) and week 36 (P=0.40) across the weight groups. Use of multiple linear regression analyses showed a positive association between infant birth weight and gestation weight gain when adjusted for BMI, HbA1c at week 36, smoking, parity and ethnicity (R2=0.15, β=19, P=0.02).
The results of this study show the association between gestational weight gain and increased infant birth weight. This was observed regardless of glycemic control and BMI. While glycemic control is often addressed in these patients, strict weight gains should also be closely monitored to ensure optimal outcomes for both mother and child. A potential limitation of this study was that those included had fairly well controlled diabetes with a median HbA1c of 6.6%. These results may not be applicable to those with less controlled diabetes.
Practice Pearls:
  • Type 1 mothers with pregestational diabetes are more likely to give birth to higher birth weight infants.
  • Previous studies have shown the importance of strict glycemic control to prevent increased birth weight.
  • The results of this study show the impact gestational weight gain has on infant birth weight.
  • Strict glycemic control and gestational weight gain should be stressed to expectant mothers with type 1 diabetes to ensure the best possible outcomes.
Secher AL, Parllada CB, Ringholm L, Asbjornsdottir B et al. Higher Gestational Weight Gain Is Associated With Increasing Offspring Birth Weight Independent of Maternal Glycemic Control in Women With Type 1 Diabetes. Diabetes Care. October 2014.