Excessive gestational weight gain and the risk of gestational diabetes: Comparison of Intergrowth-21st standards, IOM recommendations and a local reference

Abstract

Aims: To compare the abilities of Intergrowth-21st standards, Institute of Medicine (IOM) recommendations and a Chinese reference on gestational weight gain (GWG) to identify women at risk of gestational diabetes (GDM) and GDM-related adverse outcomes.

Methods: A retrospective cohort study was conducted on 13,366 women delivering live singleton infants between 2013 and 2017 in Tongzhou district of Beijing, China. Poisson regression with robust error estimates was used to estimate risk ratios (RRs) of GDM in different GWG groups according to three standards.

Results: There were 39.97%, 46.31% and 30.03% of women gaining weight above Intergrowth-21st standards, IOM recommendations and the Chinese reference respectively. Women with GWG above Intergrowth-21st standards and the Chinese reference had 27% (aRR, 1.27 95% CI, 1.18-1.37) and 30% (aRR, 1.30; 95% CI, 1.21-1.40) increased risks of GDM respectively, as compared to 22% (aRR, 1.22; 95% CI, 1.13-1.32) for IOM recommendations. GWG above either of these three standards was associated with macrosomia and cesarean delivery (P < 0.05).

Conclusion: Compared with IOM recommendations, GWG above Intergrowth-21st standards or the Chinese reference was associated with higher risks of GDM and GDM-related adverse outcomes. Furthermore, these two prospective standards could additionally assess the severity of abnormal GWG and are feasible for dynamic monitoring.

Keywords: Gestational diabetes; Gestational weight gain; IOM recommendations; Intergrowth-21st standards.