title: Interpregnancy weight gain and cesarean delivery risk in women with a history of gestational diabetes.
abstract: 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.
authors.affiliation: 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.
authors.forename: Pathmaja
authors.initials: P
authors.lastname: Paramsothy
authors.forename: Yvonne S
authors.initials: YS
authors.lastname: Lin
authors.forename: Mary A
authors.initials: MA
authors.lastname: Kernic
authors.forename: Karen E
authors.initials: KE
authors.lastname: Foster-Schubert
mesh_terms: 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