Oral Presentation Australasian Diabetes in Pregnancy Society Annual Scientific Meeting 2019

Does the addition of multidisciplinary weight management to GDM management equate to better pregnancy outcomes? (#18)

Robyn A Barnes 1 2 , Tang Wong 1 3 4 , Glynis P Ross 1 4 , Michelle M Griffiths 1 , Megan Stephens 1 , Laura Kourloufas 1 , Carmel C.E.M Smart 2 5 , Clare E Collins 2 6 , Lesley MacDonald 2 6 , Jeff R Flack 1 3 7
  1. Bankstown-Lidcombe Hospital, Bankstown, NSW, Australia
  2. Faculty of Health and Medicine, University of Newcastle, Callaghan, Newcastle, NSW, Australia
  3. Faculty of Medicine, University of NSW, Sydney, NSW, Australia
  4. Faculty of Medicine, University of Sydney, Sydney, NSW, Australia
  5. Department of Paediatric Endocrinology and Diabetes, John Hunter Children’s Hospital, Newcastle, NSW, Australia
  6. Priority Research Centre in Physical Activity and Nutrition, University of Newcastle, Callaghan, Newcastle, NSW, Australia
  7. School of Medicine, Western Sydney University, Sydney, NSW, Australia

Background: Excessive gestational weight gain during GDM management is associated with greater insulin use, Large for Gestational Age (LGA) infants, caesarean section and assisted delivery (1).  

Aims: 1. Assess effectiveness of including weight gain advice and monitoring in GDM management 2. Investigate outcomes of women who achieved individualised weight targets compared to those who did not.

Methods: Prospectively collected data (March 2016-March 2019) (Bankstown-Lidcombe Hospital) from singleton GDM pregnancies diagnosed by IADPSG (2) criteria were included. On commencement of GDM management, women were provided with personalised weight gain targets for the remainder of pregnancy (GDM weight target). These were based on Institute of Medicine (IOM) maternal weight gain guidelines - calculated according to pre-pregnancy BMI, weeks’ gestation, and gestational weight already gained. Weight maintenance was recommended if women had already exceeded their maximum target weight (defined as ≤ 1 kg gained). Women were weighed each clinic (weekly to fortnightly). Exclusions: presenting >34 weeks gestation; last recorded weight >4 weeks before delivery; incomplete data.

Results: 1034 women met criteria. At presentation with GDM, 60.5% (n=626) had exceeded IOM weight gain targets for stage of pregnancy.  A total of 43.4% (n=449) achieved their GDM weight target, 29.2% (n=302) exceeded it, and 27.4% (n=283) gained below targets. The rate of LGA was lower in women who achieved their GDM weight target versus those who exceeded it (9.8%versus18.9%, p<0.0001). Insulin therapy initiation was lower in women who achieved their GDM weight target versus those who exceeded it (41.4%versus49.7% (p<0.03). Rates of caesarean section and neonatal hypoglycaemia were no different between groups.  Rates of Small for Gestational Age were only greater in women who gained below target weights versus those who achieved them (14.5%vs8.2%) (p<0.01)

Conclusions: Achievement of individualised weight targets during GDM management was associated with lower rates of LGA and insulin therapy initiation. However more intensive interventions are needed to optimise weight gain and clinical outcomes for mothers with GDM and their offspring.

  1. Aiken CE, Hone L, Murphy HR and Meek CL. Improving outcomes in gestational diabetes: does gestational weight gain matter? Diabet Med 2019; 36(2):167-176.
  2. 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(3):676-682.