OBJECTIVE Conventional gestational diabetes mellitus (GDM) management focuses on managing blood glucose in order to prevent adverse outcomes. We hypothesized that excessive weight gain at first presentation with GDM (excessive gestational weight gain [EGWG]) and continued EGWG (cEGWG) after commencing GDM management would increase the risk of adverse outcomes, despite treatment to optimize glycemia. RESEARCH DESIGN AND METHODS Data collected prospectively from pregnant women with GDM at a single institution were analyzed. GDM was diagnosed on the basis of Australasian Diabetes in Pregnancy Society 1998 guidelines (1992-2015). EGWG means having exceeded the upper limit of the Institute of Medicine-recommended target ranges for the entire pregnancy, by GDM presentation. The relationship between EGWG and antenatal 75-g oral glucose tolerance test (oGTT) values and adverse outcomes was evaluated. Relationships were examined between cEGWG, insulin requirements, and large-for-gestational-age (LGA) infants. RESULTS Of 3,281 pregnant women, 776 (23.6%) had EGWG. Women with EGWG had higher mean fasting plasma glucose (FPG) on oGTT (5.2 mmol/L [95% CI 5.1-5.3] vs. 5.0 mmol/L [95% CI 4.9-5.0]; P < 0.01), after adjusting for confounders, and more often received insulin therapy (47.0% vs. 33.6%; P < 0.0001), with an adjusted odds ratio (aOR) of 1.4 (95% CI 1.1-1.7; P < 0.01). aORs for each 2-kg increment of cEGWG were a 1.3-fold higher use of insulin therapy (95% CI 1.1-1.5; P < 0.001), an 8-unit increase in final daily insulin dose (95% CI 5.4-11.0; P < 0.0001), and a 1.4-fold increase in the rate of delivery of LGA infants (95% CI 1.2-1.7; P < 0.0001). CONCLUSIONS The absence of EGWG and restricting cEGWG in GDM have a mitigating effect on oGTT-based FPG, the risk of having an LGA infant, and insulin requirements.

中文翻译：

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妊娠期糖尿病治疗前后体重增加过多：有什么影响？

目的常规妊娠糖尿病（GDM）管理的重点是控制血糖，以防止不良后果。我们假设在开始使用GDM治疗后，初次使用GDM体重增加过多（妊娠体重增加[EGWG]）和继续进行EGWG（cEGWG）会增加不良结局的风险，尽管已进行了优化血糖的治疗。研究设计和方法分析了在单个机构中从GDM孕妇中前瞻性收集的数据。GDM是根据《妊娠协会1998年指南》（1992-2015年）中的《澳大利亚糖尿病》诊断的。EGWG表示通过GDM提示，已超出医学研究所推荐的整个妊娠目标范围的上限。评估了EGWG和产前75克口服葡萄糖耐量测试（oGTT）值与不良结局之间的关系。检查了cEGWG，胰岛素需求量和大胎龄（LGA）婴儿之间的关系。结果在3281名孕妇中，有776名（23.6％）患有EGWG。校正后，EGWG的女性在oGTT上的平均空腹血糖（FPG）较高（5.2 mmol / L [95％CI 5.1-5.3]与5.0 mmol / L [95％CI 4.9-5.0]； P <0.01）。混杂因素，并且更常接受胰岛素治疗（47.0％比33.6％； P <0.0001），调整后的优势比（aOR）为1.4（95％CI 1.1-1.7； P <0.01）。每增加2千克cEGWG，aOR值比使用胰岛素疗法高1.3倍（95％CI 1.1-1.5； P <0.001），最终每日胰岛素剂量增加8个单位（95％CI 5.4-11.0； P <0.0001）和1。LGA婴儿的分娩率提高了4倍（95％CI 1.2-1.7； P <0.0001）。结论GDM中缺乏EGWG和cEGWG的限制对基于oGTT的FPG，有LGA婴儿的风险和胰岛素需求具有缓解作用。