Gestational weight gain in insulin-resistant pregnancies.
OBJECTIVE
To examine the Institute of Medicine (IOM) guidelines for gestational weight gain (GWG) in insulin-resistant pregnancy.


METHODS
Secondary analysis of a prospective cohort of 435 women with type 2 or gestational diabetes from 2006 to 2010. The exposure was categorized as GWG less than, within or greater than the IOM recommendations for body mass index. The maternal outcome was a composite of preeclampsia, eclampsia, third- to fourth-degree laceration, readmission or wound infection. The neonatal outcome was a composite of preterm delivery, level 3 nursery admission, oxygen requirement >6 h, shoulder dystocia, 5-min Apgar3, umbilical cord arterial pH<7.1 or base excess <-12. Secondary outcomes were cesarean delivery (CD), macrosomia and small for gestational age (SGA).


RESULTS
Incidence of the maternal outcome did not differ with GWG (P=0.15). Women gaining more than recommended had an increased risk of CD (relative risk (RR) 1.31, 95% confidence interval (CI) 1.01 to 1.69) and the neonatal outcome (RR 1.40, 95% CI 1.01 to 1.95) compared with women gaining within the IOM recommendations. Women gaining less than recommended had an increased risk of SGA (RR 3.29, 95% CI 1.09 to 9.91) without a decrease in the risk of the maternal outcome (RR 0.93, 95% CI 0.49 to 1.78) or CD (RR 0.74, 95% CI 0.40 to 1.37) compared with women gaining within the IOM recommendations.


CONCLUSIONS
Women with insulin resistance should be advised to gain within the current IOM guidelines.
Department of Obstetrics and Gynecology, University of Alabama at Birmingham School of Medicine, Birmingham, AL, USA.
L M
LM
Harper
A L
AL
Shanks
A O
AO
Odibo
R
R
Colvin
G A
GA
Macones
A G
AG
Cahill
D000328:Adult; D002585:Cesarean Section / Q000706:statistics & numerical data; D003924:Diabetes Mellitus, Type 2 / Q000150:complications / Q000503:physiopathology*; D016640:Diabetes, Gestational / Q000503:physiopathology*; D005260:Female; D005320:Fetal Macrosomia / Q000209:etiology; D019983:Guideline Adherence; D017408:Guidelines as Topic; D006801:Humans; D007236:Infant, Small for Gestational Age; D007333:Insulin Resistance; D011247:Pregnancy; D011254:Pregnancy in Diabetics / Q000503:physiopathology*; D011446:Prospective Studies; D015430:Weight Gain