Excessive gestational weight gain in the first trimester is associated with risk of gestational diabetes mellitus: a prospective study from Southwest China.

OBJECTIVE: To evaluate the effects of gestational weight gain (GWG) in the first trimester (GWG-F) and the rate of gestational weight gain in the second trimester (RGWG-S) on gestational diabetes mellitus (GDM), exploring the optimal GWG ranges for the avoidance of GDM in Chinese women. DESIGN: A population-based prospective study was conducted. Gestational weight was measured regularly in every antenatal visit and assessed by the Institute of Medicine (IOM) criteria (2009). GDM was assessed with the 75-g, 2-h oral glucose tolerance test at 24-28 weeks of gestation. Multivariable logistic regression was performed to assess the effects of GWG-F and RGWG-S on GDM, stratified by pre-pregnancy BMI. In each BMI category, the GWG values corresponding to the lowest prevalence of GDM were defined as the optimal GWG range. SETTING: Southwest China. PARTICIPANTS: Pregnant women (n 1910) in 2017. RESULTS: After adjusting for confounders, GWG-F above IOM recommendations increased the risk of GDM (OR; 95 % CI) among underweight (2·500; 1·106, 5·655), normal-weight (1·396; 1·023, 1·906) and overweight/obese women (3·017; 1·118, 8·138) compared with women within IOM recommendations. No significant difference was observed between RGWG-S and GDM (P > 0·05) after adjusting for GWG-F based on the previous model. The optimal GWG-F ranges for the avoidance of GDM were 0·8-1·2, 0·8-1·2 and 0·35-0·70 kg for underweight, normal-weight and overweight/obese women, respectively. CONCLUSIONS: Excessive GWG in the first trimester, rather than the second trimester, is associated with increased risk of GDM regardless of pre-pregnancy BMI. Obstetricians should provide more pre-emptive guidance in achieving adequate GWG-F.

[Moderate-to-vigorous Physical Activities and Gestational Weight Gains during the Second and Last Trimesters of Pregnancy].

OBJECTIVE: To determine the level of moderate-to-vigorous physical activities (MVPA) and its relationship with gestational weight gains (GWG) in the second and the last trimesters of pregnancy. METHODS: A prospective study was conducted in Chengdu on 362 healthy pregnant women at the 24-28 gestation weeks who delivered a singleton. Demographic data and pre-pregnancy body mass were collected using a questionnaire. Weight gains at the gestation weeks of 24-28 and 32-36 were measured for the first two trimesters and the last trimester of pregnancy. The Denmark self-reported physical activity scale was used for measuring the duration and intensity of physical activities. Multiple linear regression models were established to determine the relationship between MVPA and GWG. RESULTS: The last trimester had lower average daily MVPA 〔(0.76±0.93) h〕 compared with the second trimester 〔(1.61±1.61) h, t=9.056, P<0.001〕. About 74.6% of the participants met the PA recommendations for the second trimester, compared with 60.5% for the last trimester (χ2=16.387, P<0.001). The participants experienced an average GWG of (7.36±3.78) kg during the first two trimesters, and (5.80±2.57) kg during the last trimester, corresponding to a growth rate of (0.30±0.15) kg/week for the first two trimesters and (0.51±0.22) kg/week for the last trimester. Compared with the most inactive group, the participants with medium PA experienced less GWG 〔(5.34±2.91) kg vs.(6.26±2.54) kg, P<0.05〕 and a lower GWG rate 〔(0.48±0.26) kg/week vs.(0.56±0.20) kg/week, P<0.05〕 during the last trimester. Age, gestational week, ethnicity, pre-pregnant BMI, GDM, pre-pregnant smoking and employment were associated with GWG and the GWG rates during the first two trimesters and the third trimester (P<0.05). Compared with the most inactive group, low 〔-0.358(-0.691--0.026)〕 and medium 〔-0.762(-1.486- -0.037)〕 PA were associated with lower GWG during the last trimester. Moderate PA was associated with a lower GWG rate 〔-0.071(-0.133--0.008)〕 after adjustment for gestational age, energy intake, pre-pregnancy BMI and other potential confounders. CONCLUSIONS: Insufficient physical activities are a serious problem in the pregnant women of Chengdu over the last two trimesters. Appropriate MVPA in the last trimester of pregnancy may reduce GWG and GWG rates.

[Effect of Sleep in Early Pregnancy on Gestational Diabetes: a Prospective Study.]

OBJECTIVES: To investigate the influence of sleep status in early pregnant women on the occurrence of gestational diabetes mellitus (GDM). METHODS: In this prospective study,542 pregnant women in early pregnancy were selected as subjects.The sleep time,insomnia,pre-gestational body mass and basic information of the subjects were collected by the trained investigators through questionnaire.At the 24th to 28th pregnant week,the body mass of each subject was measured and oral glucose tolerance test (OGTT) was conducted.The diagnosis of GDM was followed the guidelines of diagnose and treatment of gestational diabetes mellitus in China (2014).A non-conditional logistic regression method was adopted to analyze the correlation between sleep status of early pregnant women and the occurrence of GDM. RESULTS: The numbers of subjects in sleep deficiency group,sleep sufficiency group and sleep excessive group were 16 (2.95%),268 (49.45%) and 258 (47.60%),respectively.The incidences of GDM for sleep deficiency group,sleep sufficient group,and sleep excessive group were 62.50%(10/16),25.75%(69/268) and 22.09% (57/258),respectively,the difference was statistically significant (χ2=11.280,P<0.05).Compared with either sleep sufficiency or sleep excessive group,sleep deficiency group had higher GDM occurrence rate with statistically significant (χ2=8.410,11.218,P<0.017).Insomnia subjects in early pregnancy were 137 (25.28%).The incidences of GDM in insomnia group and normal group were 32.12% and 22.72% respectively,the difference was statistically significant (χ2=4.813, P<0.05).After adjusting the confounding factors [age,education,pre-pregnant body mass index (BMI),gained body mass in early and medium pregnancy,family history of type-2 diabetes,gravidity,parity,smoke,drink,exercise and occupation],non-conditional logistic regression results show that sleep deficiency for early pregnant women was an independent risk factor for the occurrence of GDM [odds ratio (OR)=7.38,95% confidence interval (CI): 2.25-24.17].However,the association between insomnia and the occurrence of GDM was not found. CONCLUSIONS: Sleep deficiency in early pregnancy may be a risk factor for the occurrence of GDM.