title: Evaluating gestational weight gain recommendations in pregestational diabetes.
abstract: OBJECTIVE
  The Institute of Medicine (IOM) does not provide recommendations for gestational weight gain (GWG) specific to women with pregestational diabetes. We aimed to assess the impact of GWG outside the IOM recommendations on perinatal outcomes.
  
  
  METHODS
  We performed a retrospective cohort study of all singletons with pregestational diabetes from 2008 through 2013. Women were classified as GWG within, less than, or greater than IOM recommendations for body mass index per week of pregnancy. Maternal outcomes examined were cesarean delivery, preeclampsia, and percentage of visits with glycemic control (>50% blood sugars at goal). Neonatal outcomes were birthweight, small for gestational age (<10th percentile), large for gestational age (LGA) (>90th percentile), macrosomia (>4000 g), preterm delivery (<37 weeks), and birth injury (shoulder dystocia, fracture, brachial plexus injury, cephalohematoma). Groups were compared using analysis of variance and χ(2) test, as appropriate. Backwards stepwise logistic regression was used to adjust for confounding factors.
  
  
  RESULTS
  Of 340 subjects, 37 (10.9%) were within, 64 (18.8%) less than, and 239 (70.3%) greater than IOM recommendations. The incidence of cesarean delivery, preeclampsia, glycemic control, preterm delivery, and birth injury were not significantly different between GWG groups. The incidence of LGA and macrosomia increased as GWG category increased (adjusted odds ratio [AOR], 3.08; 95% confidence interval [CI], 1.13-8.39 and AOR, 4.02; 95% CI, 1.16-13.9, respectively) without decreasing the incidence of small for gestational age (AOR, 0.34; 95% CI, 0.10-1.19). Increases in the risk in LGA and macrosomia were not explained by differences in glycemic control by GWG groups.
  
  
  CONCLUSIONS
  Women with pregestational diabetes mellitus should be counseled to gain within the IOM recommendations to avoid LGA and macrosomic newborns.
authors.affiliation: Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Center for Women's Reproductive Health, University of Alabama at Birmingham School of Medicine, Birmingham, AL. Electronic address: asiegel@uabmc.edu.
authors.forename: Anne M
authors.initials: AM
authors.lastname: Siegel
authors.affiliation: Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Center for Women's Reproductive Health, University of Alabama at Birmingham School of Medicine, Birmingham, AL.
authors.forename: Alan
authors.initials: A
authors.lastname: Tita
authors.affiliation: Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Center for Women's Reproductive Health, University of Alabama at Birmingham School of Medicine, Birmingham, AL.
authors.forename: Joseph R
authors.initials: JR
authors.lastname: Biggio
authors.affiliation: Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Center for Women's Reproductive Health, University of Alabama at Birmingham School of Medicine, Birmingham, AL.
authors.forename: Lorie M
authors.initials: LM
authors.lastname: Harper
mesh_terms: D000328:Adult; D001720:Birth Injuries / Q000453:epidemiology; D001786:Blood Glucose / Q000378:metabolism; D002585:Cesarean Section / Q000706:statistics & numerical data; D015331:Cohort Studies; D003922:Diabetes Mellitus, Type 1; D003924:Diabetes Mellitus, Type 2; D005260:Female; D005320:Fetal Macrosomia / Q000453:epidemiology; D006801:Humans; D007231:Infant, Newborn; D007236:Infant, Small for Gestational Age; D016015:Logistic Models; D017410:Practice Guidelines as Topic; D011225:Pre-Eclampsia / Q000453:epidemiology; D011247:Pregnancy; D011254:Pregnancy in Diabetics; D047928:Premature Birth / Q000453:epidemiology; D012189:Retrospective Studies; D015430:Weight Gain; D055815:Young Adult
chemical_list: D001786:Blood Glucose
keywords: gestational weight gain; pregestational diabetes; pregnancy; type 1 diabetes; type 2 diabetes