TOPLINE:

Birth weight and odds of macrosomia were higher for women with excessive gestational weight gain (GWG) than with adequate GWG and significantly higher for those with both excessive GWG and suboptimal glycemic control. 

METHODOLOGY:

• Hyperglycemia in pregnancy is linked to increased risks for maternal hypertension, fetal overgrowth, and long-term metabolic and cardiovascular diseases. Nevertheless, optimal GWG targets remain controversial, and few studies have examined the association between glycemic control or hyperglycemia severity and fetal outcomes.
• Researchers conducted a multicenter retrospective study of 1642 pregnant women with T2D to determine whether maternal glycemic levels modify the association between GWG and pregnancy outcomes.
• Women with singleton pregnancies that resulted in live births were stratified by third‑trimester A1c levels into two groups: 940 with optimal glycemic control (A1c levels < 6%; mean age, 33.2 years; mean BMI, 25) and 702 with suboptimal glycemic control (A1c levels > 6%; mean age, 33.4 years; mean BMI, 26.7).
• Associations between excessive GWG and outcomes such as birth weight, macrosomia, cesarean delivery, and postpartum hemorrhage were examined; excessive GWG was defined according to Chinese BMI‑stratified GWG recommendations for singleton pregnancies.

TAKEAWAY:

• Excessive GWG was associated with increased birth weight and increased odds of macrosomia in all women; the effects were more pronounced in women with suboptimal glycemic control than in those with optimal glycemic control (P = .007 for increased birth weight and P =.002 for increased odds of macrosomia).
• Compared with optimal glycemic control and adequate GWG, suboptimal glycemic control and excessive GWG were each independently associated with similar increases in birth weight (125.57 g and 123.67 g, respectively) and similar adjusted odds ratios (aORs) for macrosomia (aOR, 2.62 and aOR, 2.64, respectively).
• When suboptimal glycemic control and excessive GWG were combined, their association with fetal overgrowth was amplified, yielding a mean birth weight increase of 514.04 g (95% CI, 426.54-601.54) and an aOR for macrosomia of 11.13 (95% CI, 5.88-21.05).
• The rates of cesarean delivery were higher among women with excessive GWG than among those with adequate GWG in both glycemic control groups; the difference between the two groups was not significant.

IN PRACTICE:

“The association between [excessive] GWG and fetal overgrowth in type 2 diabetes-complicated pregnancies is exacerbated with suboptimal glycemic control. This finding warrants stringent weight management, with caution if hyperglycemia is not well controlled,” the authors of the study wrote.

SOURCE:

This study was led by Xinyu Shu, Peking University First Hospital, Beijing, China. It was published online in Diabetes Care.

LIMITATIONS:

This study may have been subject to selection bias because no data for third-trimester A1c levels were available for 32% of the participants. By excluding pregnancies with normal glucose levels, the study did not evaluate whether pregnant women with hyperglycemia needed different GWG recommendations. Additionally, key outcomes such as shoulder dystocia, birth trauma, and long-term implications of gestational glycemic control on postpartum outcomes were not assessed.

DISCLOSURES:

This study was supported by the National High Level Hospital Clinical Research Funding, National Natural Science Foundation of China, and Beijing Nova Program. The authors reported having no relevant conflicts of interest.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.