Optimal gestational weight gain associated with improved perinatal outcomes in women with gestational diabetes mellitus: a population-based study in the United States.

BACKGROUND: Optimal gestational weight change (GWC) is little known among pregnant women with gestational diabetes mellitus (GDM). OBJECTIVE: This study aimed to explore the optimal GWC ranges for women with GDM and validate these ranges compared to the Institute of Medicine (IOM) guidelines. METHODS: A population-based cohort study using natality data from the National Center for Health Statistics (NCHS) in the United States included 1,338,460 mother-infant pairs with GDM from 2014 to 2020. Poisson regression models were performed to identify GWC ranges (GDM targets) associated with acceptable risks (< 10% increase) for a severity-weighted composite outcome including preterm birth (PTB) < 37 weeks, large for gestational age (LGA, birthweight > 90th percentile) and small for gestational age (SGA, birthweight < 10th percentile). These targets were validated in individual outcomes including PTB, LGA, SGA, hypertensive disorders of pregnancy, neonatal intensive care unit admission and neonatal respiratory morbidity and compared with the IOM guidelines using logistic regression models with population-attributable fractions (PAFs) calculated. RESULTS: The severity-weighted composite outcome had a U-shaped or a J-shaped relationship with GWC across body mass index (BMI) categories. The GDM targets were 14.1-20.3 kg, 9.0-17.0 kg, 4.8-13.8 kg, -0.8-10.8 kg, -2.4-8.2 kg, and -8.3-6.0 kg for underweight, normal weight, overweight, class 1 obesity, class 2 obesity, and class 3 obesity, respectively. GWC outside the GDM or the IOM targets was associated with increased adverse perinatal outcomes in validation analyses. PAFs indicated that the IOM guidelines reduced a similar or higher proportion of adverse perinatal outcomes compared to the GDM targets for women with GDM, with the exception of those with class 2 and 3 obesity. CONCLUSIONS: The IOM guidelines are generally applicable for women with GDM, with the exception of women with moderate and severe obesity. The optimal GWC ranges for women with GDM and moderate to severe obesity may be lower than the IOM guidelines.

Perinatal outcomes among twin pregnancies with gestational diabetes mellitus: A nine-year retrospective cohort study.

Objective: To compare the outcomes between gestational diabetes mellitus (GDM) vs. non-GDM twin gestations. Methods: A retrospective cohort study of 2,151 twin pregnancies was performed in a tertiary hospital in Foshan, China, 2012-2020. Pregnancy and neonatal outcomes were compared between women with vs. without GDM using 1:1 propensity score matching (PSM) and multivariable logistic models. For neonatal outcomes, generalized estimating equation (GEE) approach was used to address the intertwin correlation. Results: Of the 2,151 participants, 472 women (21.9%) were diagnosed with GDM. Women with GDM were older and more likely to be overweight or obese, and more likely have chronic hypertension, assisted pregnancies and dichorionic twins. In the PSM cohort of 942 pregnancies, there was no statistical difference when comparing GDM twin pregnancies and non-GDM in any of the perinatal outcomes, especially in terms of preterm birth (PTB) <37 weeks (P = 0.715), large for gestational age (LGA) (P = 0.521) and neonatal respiratory distress (NRDS) (P = 0.206). In the entire cohort, no significant adjusted ORs for these outcomes were obtained from logistic regression models adjusted for confounders (aOR for PTB < 37 weeks: 1.25, 95% CI: 0.98-1.58; aOR for LGA: 1.26, 95% CI: 0.88-1.82; and aOR for NRDS, 1.05, 95% CI: 0.68-1.64). Conclusion: Twin pregnancies with GDM and adequate prenatal care have comparable perinatal outcomes to those without.

Association of serum vitamin D status with gestational diabetes mellitus and other laboratory parameters in early pregnant women.

BACKGROUND: The association between serum 25-hydroxy vitamin D (25(OH)D) status and gestational diabetes mellitus (GDM) gained attention in recent years, however the conclusion is still controversial due to many interfering factors, such as region of living, environment, lifestyle, and food supplements. Other metabolites (laboratory parameters) are also important in reflecting gestational states. This study aimed to investigate the association of serum 25(OH)D status in early pregnancy with GDM and other laboratory parameters in pregnant women. METHODS: A total of 1516 pregnant women whose blood glucose were normal before pregnancy in the city of Foshan in Guangdong, China were enrolled in this study. GDM was diagnosed between 24 to 28 weeks of pregnancy following the guidelines from the American Diabetes Association. Maternal serum 25(OH)D and other laboratory parameters-including hematology, coagulation, chemistry, and bone density-were measured utilizing various analytical methods in clinical laboratory at gestational weeks 11 to 14. RESULTS: The average 25(OH)D concentration was 59.1 ± 12.6 nmol/L. None of the study subjects had 25(OH)D < 25 nmol/L; 434 (28.6%) women had 25(OH)D deficiency (< 50 nmol/L), 882 women (58.2%) had 25(OH)D insufficiency (50-74 mmol/L) and 200 women (13.2%) had 25(OH)D sufficiency (≥ 75 nmol/L). There were 264 (17.4%) women diagnosed with GDM. There was not, however, an association between serum 25(OH)D in early pregnancy and GDM. Interestingly, women with more parity and high serum alkaline phosphatase levels had higher serum 25(OH)D levels. There was a possible positive association between serum 25(OH)D and pre-albumin, and a possible negative association between serum 25(OH)D, creatinine, and thrombin time. This study did not find an association between serum 25(OH)D and bone density. CONCLUSIONS: There were no associations between maternal serum 25(OH)D concentration in early pregnancy and the risk of GDM or bone density. There were, however, correlations between serum 25(OH)D and parity, seasoning at sampling, serum alkaline phosphatase, creatinine, pre-albumin, and coagulation factor thrombin time, which need further study to explain their pathophysiology and clinical significance.