title: The impact of gestational weight gain in different trimesters of pregnancy on glucose challenge test and gestational diabetes.
abstract: OBJECTIVE
  Assessing the effects of excessive weight gain before pregnancy, in the first and second trimesters and in the month preceding glucose challenge test (GCT) on GCT results and gestational diabetes mellitus (GDM).
  
  
  METHODS
  This prospective cohort study evaluated 1279 pregnant women who were referred for their first prenatal visit in 2012-2015. Mother's body mass index (BMI) was recorded before pregnancy, during the first visit and every 4 weeks until 28 gestational weeks. All mothers underwent GCT at 28 weeks and when 1 h glucose ≥140 mg/dL (≥7.8 mmol/L), they were referred for a 100 g fasting glucose 3 h glucose tolerance test.
  
  
  RESULTS
  Obesity and being overweight prior to pregnancy were associated with 2.8-fold and 1.5-fold higher rates of developing GDM (p<0.001, p=0.04) and 1.9-fold and 1.8-fold higher rates of having false-positive GCT results (p<0.001). First-trimester excessive weight gain was significantly associated with false-positive GCT in women who were lean, overweight and obese before pregnancy (all p<0.001). When these women kept gaining excessive weight during the subsequent period the risk of developing GDM was significantly increased regardless of their pre-pregnancy BMI (p=0.03). When these women adhered to the recommended weight gain during the subsequent period, the risk of developing GDM was not increased, however the risk of having false-positive GCT remained high (p<0.001).
  
  
  CONCLUSIONS
  Elevated pre-pregnancy BMI independently increases the risk of GDM and false-positive GCT. First trimester weight gain is the most important predictor of GCT and GDM regardless of pre-pregnancy BMI. The weight gain during the subsequent period affects the risk of developing GDM only in women with excessive first-trimester weight gain.
authors.affiliation: Maternal, Fetal and Neonatal Research Center, Vali-asr Hospital, Tehran University of Medical Sciences, Tehran, Iran Breastfeeding Research Center, Vali-asr Hospital, Tehran University of Medical Sciences, Tehran, Iran.
authors.forename: Sedigheh
authors.initials: S
authors.lastname: Hantoushzadeh
authors.affiliation: Maternal, Fetal and Neonatal Research Center, Vali-asr Hospital, Tehran University of Medical Sciences, Tehran, Iran.
authors.forename: Mahdi
authors.initials: M
authors.lastname: Sheikh
authors.affiliation: Breastfeeding Research Center, Vali-asr Hospital, Tehran University of Medical Sciences, Tehran, Iran.
authors.forename: Zeynab
authors.initials: Z
authors.lastname: Bosaghzadeh
authors.affiliation: Maternal, Fetal and Neonatal Research Center, Vali-asr Hospital, Tehran University of Medical Sciences, Tehran, Iran.
authors.forename: Fahimeh
authors.initials: F
authors.lastname: Ghotbizadeh
authors.affiliation: Maternal, Fetal and Neonatal Research Center, Vali-asr Hospital, Tehran University of Medical Sciences, Tehran, Iran.
authors.forename: Azam
authors.initials: A
authors.lastname: Tarafdari
authors.affiliation: Maternal, Fetal and Neonatal Research Center, Vali-asr Hospital, Tehran University of Medical Sciences, Tehran, Iran.
authors.forename: Zahra
authors.initials: Z
authors.lastname: Panahi
authors.affiliation: Breastfeeding Research Center, Vali-asr Hospital, Tehran University of Medical Sciences, Tehran, Iran.
authors.forename: Mamak
authors.initials: M
authors.lastname: Shariat
mesh_terms: D000328:Adult; D015992:Body Mass Index; D015331:Cohort Studies; D016640:Diabetes, Gestational / Q000453:epidemiology*; D005189:False Positive Reactions; D005260:Female; D005951:Glucose Tolerance Test; D006801:Humans; D009765:Obesity / Q000453:epidemiology*; D050177:Overweight / Q000453:epidemiology; D011247:Pregnancy; D011248:Pregnancy Complications / Q000453:epidemiology; D011261:Pregnancy Trimester, First; D011262:Pregnancy Trimester, Second; D011446:Prospective Studies; D012307:Risk Factors; D015430:Weight Gain; D055815:Young Adult