Pre-Pregnancy Obesity and Weight Gain During Pregnancy: Relationship To The Development Of Gestational Diabetes Mellitus and The Birth Of a Large For Gestational Age Neonate

Sunday, June 15, 2014

Title: Pre-Pregnancy Obesity and Weight Gain During Pregnancy: Relationship To The Development Of Gestational Diabetes Mellitus and The Birth Of a Large For Gestational Age Neonate

Shawana Gray, DNP, CRNP , Jefferson School of Nursing, Thomas Jefferson University, Philadelphia, PA
Erica Berggren, MD, MSCR , Obstetrics and Gynecology, Thomas Jefferson University Hospital, Philadelphia, PA
Lori Lauver, PhD, RN, CPN, CNE , Thomas Jefferson University, Danville, PA

Discipline: Childbearing (CB), Newborn Care (N)

Learning Objectives:
  1. Identify impact of maternal obesity and gestational weight gain
  2. Identify impact of early gestational weight gain on gestational diabetes diagnosis
  3. Identify impact of total gestational weight gain on delivery of large for gestational age neonate
Submission Description:
Objective: To compare the prevalence of gestational diabetes mellitus (GDM) and large for gestational (LGA) age neonates in pregnant obese women who gain below, within, and above the 2009 Institute of Medicine (IOM) recommended weight gain guidelines.

Design: A retrospective cohort study

Setting: Data from the University of North Carolina (UNC) Perinatal Database.

Sample: Women with singleton pregnancies and a body mass index (BMI kg/m2) ≥ 30 delivering between January 2012 and December 2012 who underwent routine screening for GDM at UNC Women’s Hospital.

Methods: We measured the association between early weight gain (EWG) and GDM diagnosis, and the association between total gestational weight gain (TWG) and LGA neonate. To determine EWG and TWG, respectively, we subtracted pre-pregnancy weight from weight at GDM screening or weight at last prenatal visit >37 weeks. We calculated and classified EWG as below, above, and within based on IOM guidelines for first trimester (1.1 pounds) and second trimester weekly weight gain (0.4-0.6 pounds; <0.4=below, 0.4-0.6=within, >0.6=above).  Women were separately classified as gaining below (< 11 pounds), within (11-20 pounds), and above (> 20 pounds) IOM guidelines for TWG. We compared maternal demographics and medical history data using Pearson Chi Square and t-test. We report unadjusted and adjusted risk ratios (RR, aRR) with 95% confidence intervals (95%CI) for GDM and LGA, with women gaining below IOM guidelines as reference. Final adjusted models include pre-pregnancy BMI, EWG within guidelines, and gestational age at one-hour screening.

Results: Among 778 obese women, 67% (524/778) had full data for EWG analysis; 33% (171/524) gained below, 17% (90/524) within, and 50% (263/524) above IOM recommendations. EWG adherence was not associated with a GDM diagnosis (P=0.9). 71% (549/778) had full data for TWG analysis; 24% (130/549) gained below, 20% (108/549) within, 55% (304/549) above IOM guidelines. Compared with women gaining below, those gaining within IOM guidelines were more likely to have an LGA neonate (RR 2.88 95% 1.05-7.95, aRR 95% 3.36 1.10 -10.31). Compared with women gaining below, those gaining above IOM recommendations were more likely to have an LGA neonate (RR 3.25 95% 1.30-8.08, aRR 3.54 95% 1.10-11.79).

Conclusion/Implications for nursing practice: Among obese women, EGW adherence to IOM guidelines does not impact GDM diagnosis in our data.  TGW gain within and above was associated with birth of LGA neonate. Using arenas of practice, health policy, and education nurses can assist in decreasing the incidence of LGA and GDM.

Keywords:  maternal, neonate, obesity, large for gestational age, gestational diabetes, gestational weight

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