Gestational weight gain and adverse perinatal outcomes among individuals with gestational diabetes

The relationship between gestational weight gain and perinatal outcomes in women with gestational diabetes remains inadequately studied, and specific weight gain recommendations are lacking for this population. We conducted a retrospective cross-sectional study by extracting natality data from the National Center for Health Statistics (NCHS) of the Centers for Disease Control and Prevention in the United States, including 1,368,789 record (2015–2020) as the main sample and 280,165 (2021) as the validation sample. The composite adverse outcome is defined as a composite of gestational hypertension or preeclampsia, primary cesarean delivery, maternal transfusion, maternal intensive care admission, preterm birth<37 weeks, small or large size for gestational age at birth and neonatal intensive care unit admission. Optimal gestational weight gain ranges were estimated for each pre-pregnancy body mass index category through multivariable logistic regression model to identify the odds ratio targets at which any adverse outcome decreased. Model discrimination was evaluated using area under the receiver operating characteristic curve. Adverse outcomes occur in 52.67% of pregnancies, with incidence rising substantially with body mass index (44.28% in normal weight vs 67.08% in class 3 obesity). The optimal gestational weight gain ranges are: underweight (12.0- < 20.0 kg), normal weight (8.0- < 16.0 kg), overweight (weight loss-<14 kg), class 1 obesity (weight loss-<10.0 kg) and obesity classes 2-3 (weight loss <8.0 kg). These ranges demonstrate low to moderate discrimination between affected and unaffected pregnancies (ranges of area under the receiver operating characteristic curve, 0.57–0.68). Minimal weight gain or weight loss is associated with a decreased risk of adverse perinatal outcomes among women with overweight or obesity complicated by gestational diabetes. Current pregnancy weight gain guidelines are not specific for women with gestational diabetes, who face high risks during childbirth. This study analyzed U.S. data from over 1.3 million pregnancies complicated by gestational diabetes to determine the optimal weight gain ranges based on pre-pregnancy body mass index. We found that for women with obesity and gestational diabetes, lower weight gain or even weight loss is associated with the lowest risk of pregnancy complications. Pre-pregnancy weight was a stronger predictor for the risk of complications than weight gain during pregnancy. These results suggest that more specific weight management guidance for women with obesity might be helpful for improvement in pregnancy outcomes for both mother and baby. Zhao, Su & Qi et al. propose optimal gestational weight gain ranges for women with gestational diabetes across all pre-pregnancy BMI categories. The study demonstrates that modest weight gain or even weight loss could reduce adverse outcomes in singleton GDM pregnancies complicated by overweight or obesity.