Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

Nutrition during the early life cycle

Estimated optimal gestational weight gain for pregnant women with gestational diabetes mellitus: a prospective cohort study in China

Abstract

Objectives

We aimed to evaluate the inter-hospital variability of gestational weight gain (GWG) among women with gestational diabetes mellitus (GDM) in China and explore GDM-specific optimal GWG relative to the National Academy of Medicine (NAM) targets.

Methods

A prospective multicenter University Hospital Advanced Age Pregnant Cohort study was conducted from March 2017 to June 2021 at eight hospitals in China. The range of mean GWG across hospitals and the intraclass correlation coefficient (ICC) were used to evaluate the inter-hospital variability of GWG. For normal-weight and overweight women with GDM, potential optimal GWGs were derived by minimizing the joint risk of small and large for gestational age (SGA and LGA), and the incidences of adverse perinatal outcomes were compared between women who met the optimal GWGs and those who met the NAM targets.

Results

A total of 3,013 women with GDM and 9,115 women without GDM were included. The GWG variation among hospitals was larger in women with GDM (range: 10.0–14.1 kg, ICC = 7.1%) than in women without GDM (range: 13.0–14.5 kg, ICC = 0.7%). The estimated optimal GWGs for women with GDM were lower than the NAM targets, as 9.5–14.0 kg for normal-weight and 3.0–7.5 kg for overweight women. Women with GDM who met the optimal GWGs had lower incidences of LGA and macrosomia compared to those who met the NAM targets, with no significant increase in the incidences of SGA, preterm birth, etc.

Conclusions

The marked variation of GWG among hospitals in women with GDM indicates the need to develop optimal GWGs for them. The potential optimal GWGs for women with GDM might be lower than the NAM targets, likely benefiting the perinatal outcomes.

This is a preview of subscription content, access via your institution

Access options

Buy article

Get time limited or full article access on ReadCube.

$32.00

All prices are NET prices.

Fig. 1: Predictive probability curves of SGA, LGA, and sum of SGA and LGA with respect to GWG.

Data availability

The data that support the findings of this study are available from the corresponding author upon reasonable request.

References

  1. Buchanan TA, Xiang A, Kjos SL, Watanabe R. What is gestational diabetes? Diabetes Care. 2007;30:S105–11.

    Article  CAS  PubMed  Google Scholar 

  2. Kc K, Shakya S, Zhang H. Gestational diabetes mellitus and macrosomia: a literature review. Ann Nutr Metab. 2015;66:14–20.

    Article  CAS  PubMed  Google Scholar 

  3. Thevarajah A, Simmons D. Risk factors and outcomes for neonatal hypoglycaemia and neonatal hyperbilirubinaemia in pregnancies complicated by gestational diabetes mellitus: a single centre retrospective 3-year review. Diabet Med. 2019;36:1109–17.

    Article  CAS  PubMed  Google Scholar 

  4. Vounzoulaki E, Khunti K, Abner SC, Tan BK, Davies MJ, Gillies CL. Progression to type 2 diabetes in women with a known history of gestational diabetes: systematic review and meta-analysis. BMJ. 2020;369:m1361.

    Article  PubMed  PubMed Central  Google Scholar 

  5. Scholtens DM, Kuang A, Lowe LP, Hamilton J, Lawrence JM, Lebenthal Y, et al. Hyperglycemia and Adverse Pregnancy Outcome Follow-up Study (HAPO FUS): maternal glycemia and childhood glucose metabolism. Diabetes Care. 2019;42:381–92.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  6. Zhu YY, Zhang CL. Prevalence of gestational diabetes and risk of progression to type 2 diabetes: a global perspective. Curr Diab Rep. 2016;16:7.

    Article  PubMed  PubMed Central  Google Scholar 

  7. International Diabetes Federation. IDF Diabetes Atlas 9th edition. 2019; https://diabetesatlas.org/atlas/ninth-edition/.

  8. Gao CH, Sun X, Lu L, Liu FW, Yuan J. Prevalence of gestational diabetes mellitus in mainland China: a systematic review and meta‐analysis. J Diabetes Investig. 2019;10:154–62.

    Article  CAS  PubMed  Google Scholar 

  9. Goldstein RF, Abell SK, Ranasinha S, Misso M, Boyle JA, Black MH, et al. Association of gestational weight gain with maternal and infant outcomes: a systematic review and meta-analysis. JAMA. 2017;317:2207–25.

    Article  PubMed  PubMed Central  Google Scholar 

  10. Barnes RA, Wong T, Ross GP, Griffiths MM, Smart CE, Collins CE, et al. Excessive weight gain before and during gestational diabetes mellitus management: what is the impact? Diabetes Care. 2020;43:74–81.

    Article  CAS  PubMed  Google Scholar 

  11. Black MH, Sacks DA, Xiang AH, Lawrence JM. The relative contribution of prepregnancy overweight and obesity, gestational weight gain, and IADPSG-defined gestational diabetes mellitus to fetal overgrowth. Diabetes Care. 2013;36:56–62.

    Article  PubMed  Google Scholar 

  12. Juan J, Yang HX. Prevalence, prevention, and lifestyle intervention of gestational diabetes mellitus in China. Int J Environ Res Pub Health. 2020;17:9517.

    Article  Google Scholar 

  13. Stewart ZA, Wallace EM, Allan CA. Patterns of weight gain in pregnant women with and without gestational diabetes mellitus: An observational study. Aust N. Z J Obstet Gynaecol. 2012;52:433–9.

    Article  PubMed  Google Scholar 

  14. Viecceli C, Remonti LR, Hirakata VN, Mastella LS, Gnielka V, Oppermann MLR, et al. Weight gain adequacy and pregnancy outcomes in gestational diabetes: a meta-analysis. Obes Rev. 2017;18:567–80.

    Article  CAS  PubMed  Google Scholar 

  15. IOM (Institute of Medicine). Weight gain during pregnancy: reexamining the guidelines. National Academies Press: Washington, DC, 2009.

  16. Cheng YW, Chung JH, Kurbisch-Block I, Inturrisi M, Shafer S, Caughey AB. Gestational weight gain and gestational diabetes mellitus: perinatal outcomes. Obstet Gynecol. 2008;112:1015–22.

    Article  PubMed  Google Scholar 

  17. Mastella LS, Weinert LS, Gnielka V, Hirakata VN, Oppermann MLR, Silveiro SP, et al. Influence of maternal weight gain on birth weight: a gestational diabetes cohort. Arch Endocrinol Metab. 2018;62:55–63.

    Article  PubMed  Google Scholar 

  18. Bogdanet D, Mustafa M, Khattak A, O’Shea PM, Dunne FP. Atlantic DIP: is weight gain less than that recommended by IOM safe in obese women with gestational diabetes mellitus? Int J Obes. 2021;45:1044–51.

    Article  Google Scholar 

  19. Bogdanet D, O’shea PM, Dunne FP. Is gestational weight gain below that recommended by IOM for obese women with insulin treated gestational diabetes safe? Diabetes. 2018;67:S1456-P.

    Article  Google Scholar 

  20. Xu QY, Ge ZJ, Hu J, Shen SM, Bi Y, Zhu DL. The association of gestational weight gain and adverse pregnancy outcomes in women with gestational diabetes mellitus. Endocr Pr. 2019;25:1137–50.

    Article  Google Scholar 

  21. Wong T, Barnes RA, Ross GP, Cheung NW, Flack JR. Are the Institute of Medicine weight gain targets applicable in women with gestational diabetes mellitus? Diabetologia. 2017;60:416–23.

    Article  PubMed  Google Scholar 

  22. Liu JM University Hospital Advanced Age Pregnant Cohort (UNIHOPE). 2017; https://clinicaltrials.gov/ct2/show/NCT03220750.

  23. Cheng ZH, Wei YM, Li HT, Yu HZ, Liu JM, Zhou YB. Gestational diabetes mellitus as an effect modifier of the association of gestational weight gain with perinatal outcomes: A prospective cohort study in China. Int J Environ Res Public Health. 2022;19:5615.

    Article  PubMed  PubMed Central  Google Scholar 

  24. International Association of Diabetes and Pregnancy Study Groups Consensus Panel. International association of diabetes and pregnancy study groups recommendations on the diagnosis and classification of hyperglycemia in pregnancy. Diabetes Care. 2010;33:676–82.

    Article  PubMed Central  Google Scholar 

  25. Zhou BF. Cooperative Meta-Analysis Group of the Working Group on Obesity in China. Predictive values of body mass index and waist circumference for risk factors of certain related diseases in Chinese adults-study on optimal cut-off points of body mass index and waist circumference in Chinese adults. Biomed Environ Sci. 2002;15:83–96.

    PubMed  Google Scholar 

  26. Goldstein RF, Abell SK, Ranasinha S, Misso ML, Boyle JA, Harrison CL, et al. Gestational weight gain across continents and ethnicity: systematic review and meta-analysis of maternal and infant outcomes in more than one million women. BMC Med. 2018;16:153.

    Article  PubMed  PubMed Central  Google Scholar 

  27. Hu JJ, Aris IM, Oken E, Ma YA, Ding N, Gao M, et al. Association of total and trimester-specific gestational weight gain rate with early infancy weight status: a prospective birth cohort study in China. Nutrients 2019;11:280.

    Article  PubMed Central  Google Scholar 

  28. Zhu L, Zhang R, Zhang SL, Shi WJ, Yan WL, Wang XL, et al. Chinese neonatal birth weight curve for different gestational age. Zhonghua Er Ke Za Zhi. 2015;53:97–103.

    PubMed  Google Scholar 

  29. Wang DY, Ding WJ, Ding CC, Chen HT, Zhao WH, Sun B, et al. Higher peripheral cholesterol and a positive correlation with risk for large-for-gestational-age neonates in pre-pregnancy underweight women. Front Endocrinol (Lausanne). 2021;12:760934.

    Article  Google Scholar 

  30. Farhat I, Moore L, Porgo TV, Assy C, Belcaid A, Berthelot S, et al. Interhospital variations in resource use intensity for in-hospital injury deaths: a retrospective multicenter cohort study. Ann Surg. 2022;275:e107–14.

    Article  PubMed  Google Scholar 

  31. Lenth RV. Least-squares means: the R package lsmeans. J Stat Softw. 2016;69:1–33.

    Article  Google Scholar 

  32. Raudenbush SW, Bryk AS. Hierarchical linear models: applications and data analysis methods. Sage Publications: London, 2002.

  33. Beyerlein A, Schiessl B, Lack N, von Kries R. Optimal gestational weight gain ranges for the avoidance of adverse birth weight outcomes: a novel approach. Am J Clin Nutr. 2009;90:1552–8.

    Article  CAS  PubMed  Google Scholar 

  34. He Y, Tam CH-T, Yuen LY, Catalano PM, Ma RC-W, Tam WH. Optimal gestational weight gain for Chinese women-analysis from a longitudinal cohort with childhood follow-up. Lancet Reg Health West Pac. 2021;13:100190.

    Article  PubMed  PubMed Central  Google Scholar 

  35. Muller CJ, MacLehose RF. Estimating predicted probabilities from logistic regression: different methods correspond to different target populations. Int J Epidemiol. 2014;43:962–70.

    Article  PubMed  PubMed Central  Google Scholar 

  36. LifeCycle Project-Maternal Obesity and Childhood Outcomes Study Group, Voerman E, Santos S, Inskip H, Amiano P, Barros H, et al. Association of gestational weight gain with adverse maternal and infant outcomes. JAMA 2019;321:1702.

    Article  PubMed Central  Google Scholar 

  37. Wu JN, Gu WR, Xiao XR, Zhang Y, Li XT, Yin CM. Gestational weight gain targets during the second and third trimesters of pregnancy for women with gestational diabetes mellitus in China. Eur J Clin Nutr. 2019;73:1155–63.

    Article  PubMed  Google Scholar 

  38. Nohr EA, Vaeth M, Baker JL, Sørensen TI, Olsen J, Rasmussen KM. Combined associations of prepregnancy body mass index and gestational weight gain with the outcome of pregnancy. Am J Clin Nutr. 2008;87:1750–9.

    Article  CAS  PubMed  Google Scholar 

  39. Yee LM, Cheng YW, Inturrisi M, Caughey AB. Gestational weight loss and perinatal outcomes in overweight and obese women subsequent to diagnosis of gestational diabetes mellitus. Obes (Silver Spring). 2013;21:e770–4.

    Article  Google Scholar 

  40. Gou BH, Guan HM, Bi YX, Ding BJ. Gestational diabetes: weight gain during pregnancy and its relationship to pregnancy outcomes. Chin Med J (Engl). 2019;132:154–160.

    Article  CAS  Google Scholar 

  41. Kiefer MK, Adebayo A, Cleary E, Klebanoff M, Costantine MM, Landon MB, et al. Gestational weight gain and adverse maternal and neonatal outcomes for pregnancies complicated by pregestational and gestational diabetes. Am J Perinatol. 2022;39:691–8.

    Article  PubMed  Google Scholar 

  42. Chasan-Taber L, Silveira M, Waring ME, Pekow P, Braun B, Manson JE, et al. Gestational weight gain, body mass index, and risk of hypertensive disorders of pregnancy in a predominantly Puerto Rican population. Matern Child Health J. 2016;20:1804–13.

    Article  PubMed  PubMed Central  Google Scholar 

  43. Allen VM, Joseph K, Murphy KE, Magee LA, Ohlsson A. The effect of hypertensive disorders in pregnancy on small for gestational age and stillbirth: a population-based study. BMC Pregnancy Childbirth. 2004;4:17.

    Article  PubMed  PubMed Central  Google Scholar 

  44. Emond JA, Karagas MR, Baker ER, Gilbert-Diamond D. Better diet quality during pregnancy is associated with a reduced likelihood of an infant born small for gestational age: an analysis of the prospective New Hampshire birth cohort study. J Nutr. 2018;148:22–30.

    Article  PubMed  PubMed Central  Google Scholar 

  45. Gete DG, Waller M, Mishra GD. Effects of maternal diets on preterm birth and low birth weight: a systematic review. Br J Nutr. 2020;123:446–61.

    Article  CAS  PubMed  Google Scholar 

  46. Hunt KJ, Schuller KL. The increasing prevalence of diabetes in pregnancy. Obstet Gynecol Clin North Am. 2007;34:173–99.

    Article  PubMed  PubMed Central  Google Scholar 

  47. Wan CS, Abell S, Aroni R, Nankervis A, Boyle J, Teede H. Ethnic differences in prevalence, risk factors, and perinatal outcomes of gestational diabetes mellitus: a comparison between immigrant ethnic Chinese women and Australian-born Caucasian women in Australia. J Diabetes. 2019;11:809–17.

    Article  PubMed  Google Scholar 

  48. Headen I, Cohen AK, Mujahid M, Abrams B. The accuracy of self-reported pregnancy-related weight: a systematic review. Obes Rev. 2017;18:350–69.

    Article  CAS  PubMed  Google Scholar 

Download references

Acknowledgements

The authors are grateful to all physicians, nurses, and other staff members from the University Hospital Advanced Age Pregnant Cohort. We are also indebted to all participants in the cohort.

Funding

This study was supported by grants from the National Key Research and Development Program of China (2016YFC1000401). The funders of the study had no role in study design, data collection, data analysis, data interpretation, or writing of the report.

Author information

Authors and Affiliations

Authors

Contributions

JL, YZ and HL conceived the study; ZC and YZ wrote the manuscript; ZC performed the statistical analysis; YW, HL and JL contributed to the critical review of the manuscript; YW, YZ, HL, ZC, HY and JL participated in the data acquisition; and JL had full access to all the data in the study, and takes responsibility for the integrity and analysis. All authors read and approved the final manuscript.

Corresponding authors

Correspondence to Yubo Zhou or Jianmeng Liu.

Ethics declarations

Competing interests

The authors declare no competing interests.

Ethical approval

The study was approved by the Institutional Review Board of Peking University Third Hospital (approval number: IRB00006761-2016145), and all participants provided informed consent.

Additional information

Publisher’s note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary information

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Cheng, Z., Wei, Y., Li, H. et al. Estimated optimal gestational weight gain for pregnant women with gestational diabetes mellitus: a prospective cohort study in China. Eur J Clin Nutr (2022). https://doi.org/10.1038/s41430-022-01238-8

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • DOI: https://doi.org/10.1038/s41430-022-01238-8

Search

Quick links