We sought to determine the impact of maternal weight gain on fetal growth in gestational diabetes (GDM) in relation to treatment modality, body mass index (BMI) and glycemic control. 2454 GDMs were evaluated. Obesity was defined as BMI >29; good glycemic control ≤ 100 mg/dl; maternal age < and >30 years; parity ±1; large for gestational age (LGA) >90th percentile and small for gestational age (SGA) <10th percentile. SGA rates were similar in all groups. Obese/overweight diet-treated in glycemic control showed a 4-fold higher rate of LGA compared to insulin treated women. A 36 lb. weight gain in insulin treated patients had a 6-fold higher risk. In poor glycemic control, LGA rates were higher in all BMI/weight gain categories. Logistic regressions for LGA/SGA revealed that level of glycemia, weight gain, parity, obesity and treatment (for LGA only) were significant. Different thresholds used for different maternal BMI categories in addition to the achievement of glycemic control and pharmacological therapy will enhance pregnancy outcome.
Key words: Weight gain in gestational diabetes, pre-pregnancy BMI, glycemic control, treatment modality.
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