Gestational weight gain in insulin-resistant pregnancies

J Perinatol. 2013 Dec;33(12):929-33. doi: 10.1038/jp.2013.100. Epub 2013 Aug 15.


Objective: To examine the Institute of Medicine (IOM) guidelines for gestational weight gain (GWG) in insulin-resistant pregnancy.

Study design: Secondary analysis of a prospective cohort of 435 women with type 2 or gestational diabetes from 2006 to 2010. The exposure was categorized as GWG less than, within or greater than the IOM recommendations for body mass index. The maternal outcome was a composite of preeclampsia, eclampsia, third- to fourth-degree laceration, readmission or wound infection. The neonatal outcome was a composite of preterm delivery, level 3 nursery admission, oxygen requirement >6 h, shoulder dystocia, 5-min Apgar3, umbilical cord arterial pH<7.1 or base excess <-12. Secondary outcomes were cesarean delivery (CD), macrosomia and small for gestational age (SGA).

Result: Incidence of the maternal outcome did not differ with GWG (P=0.15). Women gaining more than recommended had an increased risk of CD (relative risk (RR) 1.31, 95% confidence interval (CI) 1.01 to 1.69) and the neonatal outcome (RR 1.40, 95% CI 1.01 to 1.95) compared with women gaining within the IOM recommendations. Women gaining less than recommended had an increased risk of SGA (RR 3.29, 95% CI 1.09 to 9.91) without a decrease in the risk of the maternal outcome (RR 0.93, 95% CI 0.49 to 1.78) or CD (RR 0.74, 95% CI 0.40 to 1.37) compared with women gaining within the IOM recommendations.

Conclusion: Women with insulin resistance should be advised to gain within the current IOM guidelines.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Cesarean Section / statistics & numerical data
  • Diabetes Mellitus, Type 2 / complications
  • Diabetes Mellitus, Type 2 / physiopathology*
  • Diabetes, Gestational / physiopathology*
  • Female
  • Fetal Macrosomia / etiology
  • Guideline Adherence
  • Guidelines as Topic*
  • Humans
  • Infant, Small for Gestational Age
  • Insulin Resistance
  • Pregnancy
  • Pregnancy in Diabetics / physiopathology*
  • Prospective Studies
  • Weight Gain*