Interpregnancy weight gain and cesarean delivery risk in women with a history of gestational diabetes.
OBJECTIVE
Along with the rising prevalence of obesity, rates of gestational diabetes mellitus (GDM) and associated adverse outcomes also have increased. We conducted a population-based, retrospective cohort study to assess the association of weight gain between pregnancies with cesarean delivery for the subsequent pregnancy among women with a history of GDM.


METHODS
Using linked birth-certificate data for women with at least two singleton births in Washington State during the period from 1992-2005, we identified 2,753 women with GDM who delivered vaginally at the baseline pregnancy (first pregnancy on record). The interpregnancy weight change (subsequent-baseline prepregnancy weight) for each woman was calculated and assigned to one of three categories: weight loss (more than 10 lb), weight stable (+/-10 lb), or weight gain (more than 10 lb). Multiple logistic regression was used to calculate the risk (odds ratio [OR]) of cesarean delivery at the subsequent pregnancy among the weight-gain and weight-loss groups relative to the weight-stable category.


RESULTS
Among 2,581 eligible women, 10.9% lost more than 10 lb between pregnancies, 54.0% were weight-stable, and 35.1% gained more than 10 lb. Women who gained more than 10 lb had an adjusted OR for subsequent cesarean delivery of 1.70 (95% confidence interval [CI] 1.16-2.49, 9.7% of women who gained weight), whereas the adjusted OR for women who lost weight was 0.55 (95% CI 0.28-1.10, 4.7% of women who lost weight).


CONCLUSIONS
Women with a history of GDM who gained more than 10 lb between pregnancies are at increased risk of future cesarean delivery. Appropriate weight management among women with a history of GDM may result in decreased cesarean delivery rates along with decreases in associated excess risks and costs.


METHODS
II.
Paramsothy
Pathmaja
P
From the Department of Internal Medicine, Division of Cardiology, the Departments of Pharmaceutics, and Epidemiology, and the Department of Internal Medicine, Division of Endocrinology, University of Washington, Seattle, Washington.
Lin
Yvonne S
YS
Kernic
Mary A
MA
Foster-Schubert
Karen E
KE
D000328:Adult; D015992:Body Mass Index; D002585:Cesarean Section / Q000706:statistics & numerical data*; D015331:Cohort Studies; D016001:Confidence Intervals; D036861:Delivery, Obstetric / Q000379:methods* / Q000706:statistics & numerical data; D016640:Diabetes, Gestational / Q000453:epidemiology*; D005260:Female; D006801:Humans; D016015:Logistic Models; D009765:Obesity / Q000150:complications* / Q000453:epidemiology; D016017:Odds Ratio; D010298:Parity; D011247:Pregnancy; D011248:Pregnancy Complications / Q000453:epidemiology / Q000209:etiology; D011256:Pregnancy Outcome; D012189:Retrospective Studies; D012307:Risk Factors; D015430:Weight Gain; D055815:Young Adult