Pre-pregnancy weight, the rate of gestational weight gain, and the risk of early gestational diabetes mellitus among women registered in a tertiary care hospital in India.

BACKGROUND: The impact of pre-pregnancy weight and the rate of gestational weight gain (GWG) together on the risk of early GDM (< 24 weeks gestation; eGDM) has not been studied in the Indian context. We aimed to study the influence of (1) pre-pregnancy weight on the risk of eGDM diagnosed in two time intervals; and (2) in addition, the rate of GWG by 12 weeks on the risk of eGDM diagnosed in 19-24 weeks. METHOD: Our study utilized real-world clinical data on pregnant women routinely collected at an antenatal care clinic at a private tertiary hospital, in Pune, India. Women registering before 12 weeks of gestation (v1), with a singleton pregnancy, and having a follow-up visit between 19-24 weeks (v2) were included (n = 600). The oral glucose tolerance test was conducted universally as per Indian guidelines (DIPSI) at v1 and v2 for diagnosing eGDM. The data on the onset time of eGDM were interval censored; hence, we modeled the risk of eGDM using binomial regression to assess the influence of pre-pregnancy weight on the risk of eGDM in the two intervals. The rate of GWG by 12 weeks was added to assess its impact on the risk of eGDM diagnosed in v2. RESULT: Overall, 89 (14.8%) women (age 32 ± 4 years) were diagnosed with eGDM by 24 weeks, of which 59 (9.8%) were diagnosed before 12 weeks and 30 of 541 (5.5%) women were diagnosed between 19-24 weeks. Two-thirds (66%) of eGDM were diagnosed before 12 weeks of gestation. Women's pre-pregnancy weight was positively associated with the risk of GDM in both time intervals though the lower confidence limit was below zero in v1. The rate of GWG by 12 weeks was not observed to be associated with the risk of eGDM diagnosed between 19-24 weeks of gestation. These associations were independent of age, height, and parity. CONCLUSION: Health workers may focus on pre-pregnancy weight, a modifiable risk factor for eGDM. A larger community-based study measuring weight and GDM status more frequently may be warranted to deepen the understanding of the role of GWG as a risk factor for GDM.

Maternal early pregnancy body mass index, gestational weight gain and pregnancy outcomes among urban slum dwellers in Pune, India-A retrospective analysis.

Context: Studies on prepregnancy body mass index (BMI), gestational weight gain (GWG), and pregnancy outcomes among urban Indian slums are sparse. Aims: To study BMI during early pregnancy, GWG, and maternal and neonatal outcomes among slum-dwelling women in Pune, India. Design: A retrospective study among pregnant women attending antenatal care (ANC) facility. Methods and Material: Anthropometric and clinical data throughout pregnancy and pregnancy outcomes postdelivery were collected during hospitalization for delivery using ANC cards. Asian BMI cut-offs were used to define underweight (UW), normal weight (NW), overweight (OW), and obesity (OB). GWG was classified into insufficient, adequate, and excessive categories (2009 Institute of Medicine). Statistical analysis was performed using R (v 4.0). Results: Slum-dwelling pregnant women (n = 509, mean age 24 (3.6) years) were studied. Seventy-five percent of the women visited ANC clinics at least thrice during pregnancy. Only 17.5% (n = 89) of the women registered before 12 weeks of gestation, and higher education and being primiparous were the correlates. A total of 28% of the women were UW, whereas 25% of the women were OW/OB as per early pregnancy BMI. The highest percentage of preterm deliveries and cesarean/instrumental deliveries were observed in OW/OB categories. A total of 27% gained appropriate gestational weight. This cohort had 508 live births (mean BW- 2.8 kgs) and one stillbirth. One baby had macrosomia (BW >4 Kg), whereas 19% were low birth weight (LBW) (BW <2.5 Kg). Conclusions: Double burden of malnutrition (UW and OW) was observed among young slum-dwelling women. The proportion of slum-dwelling women attending ANC clinics during early pregnancy is still low. Increased uptake of government programs is required to enhance maternal and child health.