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Epidemiology and Population Health

Atlantic DIP: is weight gain less than that recommended by IOM safe in obese women with gestational diabetes mellitus?



The Institute of Medicine (IOM) recommends gestational weight gain (GWG) of 5–9 kg in women with a body mass index (BMI) ≥ 30 kg/m2. Debate continues as to whether GWG less than that recommended is safe in women with gestational diabetes mellitus (GDM). The study objective was to examine maternal and infant outcomes for obese women with GDM who lost weight or gained 0–5 kg during pregnancy.


A 7-year retrospective cohort study of pregnancy outcomes for obese women with GDM recorded in the Atlantic Diabetes in Pregnancy database was conducted. We examined pregnancy outcomes for mothers with GDM and a BMI ≥ 30 who either lost weight or gained 0–5 kg (Group 1, n = 237) and women who gained 5–9 kg (Group 2, n = 77). We further divided groups 1 and 2 into women treated by diet only (GDM-D) (n = 120) and those requiring additional treatment with insulin (GDM-I) (n = 194).


GDM-D women in Group 1 were more likely to deliver earlier (38.9 vs 39.8 weeks, p < 0.01), to develop pregnancy induced hypertension (PIH) (15.4% v 0%; p = 0.02) or have a post-partum haemorrhage (PPH) (13.2% vs 0, p = 0.03) compared to women in Group 2. Rates of prematurity were higher in group 1 vs 2 (14.3% vs 0%, p = 0.03). However, further logistic regression analysis adjusted for smoking status, family history of diabetes, ethnicity and age determined no significant difference in maternal or infant outcomes for women in Group 1 compared to those in Group 2.


In our population, weight gain less than IOM guideline appears safe and is not associated with any further increase in adverse outcomes. However, validation through a prospective study with a larger obese GDM cohort is required before the findings presented here could be recommended for routine clinical use.

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Authors and Affiliations



DB, MM, AK, POS, and FPD designed the study. DB analysed the data and drafted the initial manuscript. All authors made substantial contributions to the acquisition and interpretation of data, revised the manuscript critically for important intellectual content and approved the final version to be published. DB is responsible for the integrity of the work as a whole.

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Correspondence to Delia Bogdanet.

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The authors declare that they have no conflict of interest.

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Ethical approval for this study was granted by the Clinical Research Ethics Committee, Galway University Hospitals. This study was conducted in accordance with the guidelines of the Declaration of Helsinki and Good Clinical Practice. Informed consent was obtained from all subjects.

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Bogdanet, D., Mustafa, M., Khattak, A. et al. Atlantic DIP: is weight gain less than that recommended by IOM safe in obese women with gestational diabetes mellitus?. Int J Obes 45, 1044–1051 (2021).

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