Is the Gestational Weight Gain Recommended by the National Academy of Medicine Guidelines Suitable for Chinese Twin-Pregnant Women with Gestational Diabetes Mellitus?

 

 Permissions and Reprints

Abstract

Objectives This study aimed to assess the applicability of the National Academy of Medicine (NAM) interim guidelines for twin pregnancies to the specific population of gestational diabetes mellitus by exploring the relationship between gestational weight gain and adverse pregnancy outcomes in Chinese twin-pregnant women with gestational diabetes mellitus.

Study Design This was a retrospective cohort study of women diagnosed with diabetes in pregnancy between July 2017 and December 2020 at the Maternal and Child Health Hospital in Chongqing, China. The primary variable of interest was maternal total gestational weight gain. The primary outcomes were perinatal outcomes, which included: preeclampsia, small for gestational age, large for gestational age, low birth weight, neonatal pneumonia, neonatal respiratory distress syndrome, and neonatal intensive unit admission, etc. The association between inappropriate gestational weight gain and adverse pregnancy outcomes was estimated using multiple logistic regression analysis.

Results A total of 455 twin-pregnant women who had gestational diabetes mellitus were analyzed. Women with low gestational weight gain had reduced risk of preeclampsia (adjusted odds ratio [aOR], 0.32; 95% CI or confidence interval, 0.17–0.63; p = 0.001) and their infants had higher risks of small for gestational age (aOR, 1.93; 95% CI, 1.04–3.58; p = 0.037), low birth weight (aOR, 2.27; 95% CI, 1.32–3.90; p = 0.003), neonatal intensive unit admission (aOR, 3.29; 95% CI, 1.10–5.78; p = 0.038), pneumonia (aOR, 2.41; 95% CI, 1.08–5.33; p = 0.031), and neonatal respiratory distress syndrome (aOR, 2.29; 95% CI, 1.10–4.78; p = 0.027); the infants of women with excessive gestational weight gain had a higher risk of large for gestational age (aOR, 3.76; 95% CI, 1.42–9.96; p = 0.008).

Conclusion Gestational weight gain controlled within the range recommended by the NAM could reduce the risk of perinatal adverse outcomes. The 2009 NAM gestational weight gain recommendations can be used for Chinese twin-pregnant women with gestational diabetes mellitus.

Key Points

• Inappropriate gestational weight gain can lead to adverse perinatal outcomes in twin pregnancies.

• Gestational weight gain controlled within recommended range could reduce the risk of poor perinatal outcomes.

• The National Academy of Medicine recommendations are suitable for Chinese twin-pregnant women with GDM.

Ethical Statement

The study was approved by the Ethics Committee of Chongqing Women's and Children's Health Centre. ([2020] Trial [Division] No. 022)

Authors' Contributions

Y.L. and X.C. contributed toward the concept and design. J.D. and X.F. drafted the manuscript. J.D., X.F., R.T., J.X., L.P., and Y.C. did the statistical analysis. Y.L., X.C., and Z.Z. provided the administrative, technical, or material support. J.H. and J.B. did the supervision. All authors did the critical revision of the manuscript for important intellectual content. They had full access to all the data in the study and took responsibility for the integrity, accuracy, acquisition, analysis, and interpretation of the data.

Note

The funder had no role in the design and conduct of the study, collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.

^* Jiamiao Dai and Xiaoxiao Fan contributed equally and share the first authorship.

Publication History

Received: 05 January 2022

Accepted: 03 June 2022

Article published online:
16 September 2022

© 2022. Thieme. All rights reserved.

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

• References

• 1 Villani MT, Morini D, Spaggiari G. et al. Are sperm parameters able to predict the success of assisted reproductive technology? A retrospective analysis of over 22,000 assisted reproductive technology cycles. Andrology 2022; 10 (02) 310-321
  CrossrefPubMedGoogle Scholar
• 2 Zhong W, Fan X, Hu F, Chen M, Zeng F. Gestational weight gain and its effects on maternal and neonatal outcome in women with twin pregnancies: a systematic review and meta-analysis. Front Pediatr 2021; 9: 674414
  CrossrefPubMedGoogle Scholar
• 3 Ornoy A, Becker M, Weinstein-Fudim L, Ergaz Z. Diabetes during pregnancy: a maternal disease complicating the course of pregnancy with long-term deleterious effects on the offspring. a clinical review. Int J Mol Sci 2021; 22 (06) 2965
  CrossrefPubMedGoogle Scholar
• 4 Wang C, Yang HX. Diagnosis, prevention and management of gestational diabetes mellitus. Chronic Dis Transl Med 2016; 2 (04) 199-203
  PubMedGoogle Scholar
• 5 McGrath RT, Hocking SL, Scott ES, Seeho SK, Fulcher GR, Glastras SJ. Outcomes of twin pregnancies complicated by gestational diabetes: a meta-analysis of observational studies. J Perinatol 2017; 37 (04) 360-368
  CrossrefPubMedGoogle Scholar
• 6 Su RN, Zhu WW, Wei YM. et al. Maternal and neonatal outcomes in multiple pregnancy: a multicentre study in the Beijing population. Chronic Dis Transl Med 2015; 1 (04) 197-202
  PubMedGoogle Scholar
• 7 Zheng W, Huang W, Liu C. et al. Weight gain after diagnosis of gestational diabetes mellitus and its association with adverse pregnancy outcomes: a cohort study. BMC Pregnancy Childbirth 2021; 21 (01) 216
  CrossrefPubMedGoogle Scholar
• 8 Goldstein RF, Abell SK, Ranasinha S. et al. Association of gestational weight gain with maternal and infant outcomes: a systematic review and meta-analysis. JAMA 2017; 317 (21) 2207-2225
  CrossrefPubMedGoogle Scholar
• 9 Institute of Medicine, National Research Council Committee to Reexamine IOM Pregnancy Weight Guidelines. The National Academies Collection: Reports funded by National Institutes of Health. Washington, DC: National Academies Press (US),; 2009
  Google Scholar
• 10 Lin D, Fan D, Wu S. et al. The effect of gestational weight gain on perinatal outcomes among Chinese twin gestations based on Institute of Medicine guidelines. BMC Pregnancy Childbirth 2019; 19 (01) 262
  CrossrefPubMedGoogle Scholar
• 11 Teshome AA, Li Q, Garoma W. et al. Gestational diabetes mellitus, prepregnancy body mass index and gestational weight gain predicts fetal growth and neonatal outcomes. Clin Nutr ESPEN 2021; 42: 307-312
  CrossrefPubMedGoogle Scholar
• 12 Bodnar LM, Himes KP, Abrams B. et al. Gestational weight gain and adverse birth outcomes in twin pregnancies. Obstet Gynecol 2019; 134 (05) 1075-1086
  CrossrefPubMedGoogle Scholar
• 13 Bodnar LM, Pugh SJ, Abrams B, Himes KP, Hutcheon JA. Gestational weight gain in twin pregnancies and maternal and child health: a systematic review. J Perinatol 2014; 34 (04) 252-263
  CrossrefPubMedGoogle Scholar
• 14 Pécheux O, Garabedian C, Drumez E. et al. Maternal and neonatal outcomes according to gestational weight gain in twin pregnancies: are the Institute of Medicine guidelines associated with better outcomes?. Eur J Obstet Gynecol Reprod Biol 2019; 234: 190-194
  CrossrefPubMedGoogle Scholar
• 15 Lal AK, Kominiarek MA. Weight gain in twin gestations: are the Institute of Medicine guidelines optimal for neonatal outcomes?. J Perinatol 2015; 35 (06) 405-410
  CrossrefPubMedGoogle Scholar
• 16 Shimura M, Obata S, Misumi T, Miyagi E, Aoki S. Are the Institute of Medicine guidelines for optimal gestational weight gain in twin pregnancies applicable to Japanese women?. J Obstet Gynaecol Res 2021; 47 (01) 337-342
  CrossrefPubMedGoogle Scholar
• 17 Grantz KL, Kawakita T, Lu Y-L, Newman R, Berghella V, Caughey A. SMFM Research Committee. SMFM special statement: state of the science on multifetal gestations: unique considerations and importance. Am J Obstet Gynecol 2019; 221 (02) B2-B12
  CrossrefPubMedGoogle Scholar
• 18 American Diabetes Association. 2. Classification and diagnosis of diabetes: Standards of Medical Care in Diabetes-2021 . Diabetes Care 2021; 44 (Suppl. 01) S15-S33
  CrossrefPubMedGoogle Scholar
• 19 Wang YN, Wei T, Xi YM, Yang MY, Niu L, Wang XL. The relationship between body mass index and adult acute myeloid leukemia. Zhongguo Shi Yan Xue Ye Xue Za Zhi 2021; 29 (03) 677-684
  PubMedGoogle Scholar
• 20 Lipworth H, Melamed N, Berger H. et al; Diabetes, Obesity, and Hypertension In Pregnancy Research Network Investigators. Maternal weight gain and pregnancy outcomes in twin gestations. Am J Obstet Gynecol 2021; 225 (05) 532.e1-532.e12
  CrossrefPubMedGoogle Scholar
• 21 Wong T, Barnes RA, Ross GP, Cheung NW, Flack JR. Are the institute of medicine weight gain targets applicable in women with gestational diabetes mellitus?. Diabetologia 2017; 60 (03) 416-423
  CrossrefPubMedGoogle Scholar
• 22 Zhang B, Cao Z, Zhang Y. et al. Birth Weight percentiles for twin birth neonates by gestational age in China. Sci Rep 2016; 6: 31290
  CrossrefPubMedGoogle Scholar
• 23 Dai L, Deng C, Li Y. et al. Population-based birth weight reference percentiles for Chinese twins. Ann Med 2017; 49 (06) 470-478
  CrossrefPubMedGoogle Scholar
• 24 Chen Y, Liu Y, Zhang Y. et al. Gestational weight gain per prepregnancy body mass index and birth weight in twin pregnancies: a cohort study in Wuhan, China. Sci Rep 2018; 8 (01) 12496
  CrossrefPubMedGoogle Scholar
• 25 Fox NS, Saltzman DH, Kurtz H, Rebarber A. Excessive weight gain in term twin pregnancies: examining the 2009 Institute of Medicine definitions. Obstet Gynecol 2011; 118 (05) 1000-1004
  CrossrefPubMedGoogle Scholar
• 26 Kato N. Reference birth weight range for multiple birth neonates in Japan. BMC Pregnancy Childbirth 2004; 4 (01) 2-9
  CrossrefPubMedGoogle Scholar
• 27 Yu DM, Zhao LY, Liu AD. et al. Incidence of low birth weight of neonates and the influencing factors in China. Zhonghua Yu Fang Yi Xue Za Zhi 2007; 41 (suppl): 150-154
  PubMedGoogle Scholar
• 28 Li M, Zhang CY, Yue CY. Effects of prepregnancy BMI and gestational weight gain on adverse pregnancy outcomes and complications of GDM. J Obstet Gynaecol 2022; 42 (04) 630-635
  CrossrefPubMedGoogle Scholar
• 29 Maeda Y, Ogawa K, Morisaki N, Sago H. The association between gestational weight gain and perinatal outcomes among underweight women with twin pregnancy in Japan. Int J Gynaecol Obstet 2022; (e-pub ahead of print) DOI: 10.1002/ijgo.14122.
  CrossrefPubMedGoogle Scholar
• 30 Yan J, Tang L, Xu M. Is adherence to the provisional institute of medicine guidelines of weight gain associated with better perinatal outcomes? A retrospective cohort study of twin pregnancies in Southwest China. Asia Pac J Public Health 2022; 34 (01) 44-50
  CrossrefPubMedGoogle Scholar
• 31 Redman CWG, Sargent IL. Placental stress and preeclampsia: a revised view. Placenta 2009; 30 (suppl A): S38-S42
  CrossrefPubMedGoogle Scholar
• 32 Pettit KE, Lacoursiere DY, Schrimmer DB, Alblewi H, Moore TR, Ramos GA. The association of inadequate mid-pregnancy weight gain and preterm birth in twin pregnancies. J Perinatol 2015; 35 (02) 85-89
  CrossrefPubMedGoogle Scholar
• 33 Greenan CW, Newman RB, Wojciechowski B, Christensen CJ. Achievement of body mass index specific weight gain recommendations: impact on preterm birth in twin pregnancies. Am J Perinatol 2017; 34 (13) 1293-1301
  Article in Thieme ConnectPubMedGoogle Scholar
• 34 Paola A, Francesca P, Davide Paolo B. et al. Influence of weight gain, according to Institute of Medicine 2009 recommendation, on spontaneous preterm delivery in twin pregnancies. BMC Pregnancy Childbirth 2018; 18 (01) 1-7
  PubMedGoogle Scholar
• 35 Gandhi M, Gandhi R, Mack LM. et al. Impact of changes in maternal body composition on birth weight and neonatal fat mass in dichorionic twin pregnancies. Am J Clin Nutr 2018; 108 (04) 716-721
  CrossrefPubMedGoogle Scholar
• 36 Gandhi M. Why pregnancy weight gain guidelines need to differ for multiple versus single pregnancies. Curr Nutr Rep 2020; 9 (02) 101-106
  CrossrefPubMedGoogle Scholar
• 37 Jiang X, Liu M, Song Y. et al. The Institute of Medicine recommendation for gestational weight gain is probably not optimal among non-American pregnant women: a retrospective study from China. J Matern Fetal Neonatal Med 2019; 32 (08) 1353-1358
  CrossrefPubMedGoogle Scholar

• Supplementary Material