The impact of restricted gestational weight gain by dietary intervention on fetal growth in women with gestational diabetes mellitus

TY - JOUR

T1 - The impact of restricted gestational weight gain by dietary intervention on fetal growth in women with gestational diabetes mellitus

AU - Kurtzhals, Lise L.

AU - Nørgaard, Sidse K.

AU - Secher, Anna L.

AU - Nichum, Vibeke L.

AU - Ronneby, Helle

AU - Tabor, Ann

AU - McIntyre, H. David

AU - Damm, Peter

AU - Mathiesen, Elisabeth Reinhardt

PY - 2018/12/1

Y1 - 2018/12/1

N2 - Aims/hypothesis: We aimed to investigate the impact of maternal gestational weight gain (GWG) during dietary treatment on fetal growth in pregnancies complicated by gestational diabetes (GDM). Methods: This was a retrospective cohort study of 382 women consecutively diagnosed with GDM before 34 weeks’ gestation with live singleton births in our centre (Center for Pregnant Women with Diabetes, Rigshospitalet, Copenhagen, Denmark) between 2011 and 2017. The women were stratified into three groups according to restricted (53%), appropriate (16%) and excessive (31%) weekly GWG during dietary treatment (using the Institute of Medicine guidelines) to estimate compliance with an energy-restricted ‘diabetes diet’ (6000 kJ/day [1434 kcal/day], with approximately 50% of energy intake coming from carbohydrates with a low glycaemic index, and a carbohydrate intake of 175 g/day). Insulin therapy was initiated if necessary, according to local clinical guidelines. Results: Glucose tolerance, HbA 1c , weekly GWG before dietary treatment (difference between weight at GDM diagnosis and pre-pregnancy weight, divided by the number of weeks) and SD score for fetal abdominal circumference were comparable across the three groups at diagnosis of GDM at 27 6 ± 5 1  weeks (gestation time is given as weeks days ). The women were followed for 10 0 ± 5 1  weeks, during which 54% received supplementary insulin therapy and the average (mean) GWG during dietary treatment was 0 kg, 3 kg and 5 kg in the three groups, respectively. Excessive weekly GWG during dietary treatment, reflecting poor dietary adherence was associated with increasing HbA 1c (p = 0.014) from diagnosis of GDM to late pregnancy and infants with a birthweight-SD score of 0.59 ± 1.6. In contrast, restricted weekly GWG during dietary treatment, reflecting strict dietary adherence, was associated with decreasing HbA 1c (p = 0.001) from diagnosis of GDM to late pregnancy and infants with a birthweight-SD score of 0.15 ± 1.1, without increased prevalence of infants born small for gestational age. Excessive GWG during dietary treatment and late-pregnancy HbA 1c were identified as potentially modifiable clinical predictors of infant birthweight-SD score (p = 0.02 for both variables) after correction for confounders. Conclusions/interpretation: Restricted GWG during dietary treatment was associated with healthier fetal growth in women with GDM. GWG during dietary treatment and late-pregnancy HbA 1c were identified as potentially modifiable clinical predictors of infant birthweight-SD score.

AB - Aims/hypothesis: We aimed to investigate the impact of maternal gestational weight gain (GWG) during dietary treatment on fetal growth in pregnancies complicated by gestational diabetes (GDM). Methods: This was a retrospective cohort study of 382 women consecutively diagnosed with GDM before 34 weeks’ gestation with live singleton births in our centre (Center for Pregnant Women with Diabetes, Rigshospitalet, Copenhagen, Denmark) between 2011 and 2017. The women were stratified into three groups according to restricted (53%), appropriate (16%) and excessive (31%) weekly GWG during dietary treatment (using the Institute of Medicine guidelines) to estimate compliance with an energy-restricted ‘diabetes diet’ (6000 kJ/day [1434 kcal/day], with approximately 50% of energy intake coming from carbohydrates with a low glycaemic index, and a carbohydrate intake of 175 g/day). Insulin therapy was initiated if necessary, according to local clinical guidelines. Results: Glucose tolerance, HbA 1c , weekly GWG before dietary treatment (difference between weight at GDM diagnosis and pre-pregnancy weight, divided by the number of weeks) and SD score for fetal abdominal circumference were comparable across the three groups at diagnosis of GDM at 27 6 ± 5 1  weeks (gestation time is given as weeks days ). The women were followed for 10 0 ± 5 1  weeks, during which 54% received supplementary insulin therapy and the average (mean) GWG during dietary treatment was 0 kg, 3 kg and 5 kg in the three groups, respectively. Excessive weekly GWG during dietary treatment, reflecting poor dietary adherence was associated with increasing HbA 1c (p = 0.014) from diagnosis of GDM to late pregnancy and infants with a birthweight-SD score of 0.59 ± 1.6. In contrast, restricted weekly GWG during dietary treatment, reflecting strict dietary adherence, was associated with decreasing HbA 1c (p = 0.001) from diagnosis of GDM to late pregnancy and infants with a birthweight-SD score of 0.15 ± 1.1, without increased prevalence of infants born small for gestational age. Excessive GWG during dietary treatment and late-pregnancy HbA 1c were identified as potentially modifiable clinical predictors of infant birthweight-SD score (p = 0.02 for both variables) after correction for confounders. Conclusions/interpretation: Restricted GWG during dietary treatment was associated with healthier fetal growth in women with GDM. GWG during dietary treatment and late-pregnancy HbA 1c were identified as potentially modifiable clinical predictors of infant birthweight-SD score.

KW - Dietary treatment

KW - Fetal growth

KW - Gestational diabetes mellitus

KW - Gestational weight gain

KW - Glycaemic control

KW - Pregnancy

UR - http://www.scopus.com/inward/record.url?scp=85053871155&partnerID=8YFLogxK

U2 - 10.1007/s00125-018-4736-6

DO - 10.1007/s00125-018-4736-6

M3 - Journal article

C2 - 30255376

AN - SCOPUS:85053871155

SN - 0012-186X

VL - 61

SP - 2528

EP - 2538

JO - Diabetologia

JF - Diabetologia

IS - 12

ER -