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Weight Gain During Early-Pregnancy Can Lead to Impaired Glucose Tolerance

Posted: Wednesday, September 02, 2009

Greater gestational weight gain before second-trimester glycemic screening may increase a pregnant woman's risk for impaired glucose tolerance, according to two papers.

Dr. Sharon J. Herring, of Temple University School of Medicine used data from 1,960 pregnant women to examine the relationship between gestational diet, physical activity, and maternal weight gain and hyperglycemia.

Subjects' mean pre-pregnancy body mass index was 25.1, and their mean weight gain before glycemic screening was 10.2 kg. On screening, 1,615 women (82%) had normal glucose tolerance, 174 (9%) had glucose challenge test levels >140 mg/dL but normal oral glucose tolerance tests, 61 (3%) had impaired glucose tolerance, and 110 (6%) had gestational diabetes.

Women who gained more weight before glycemic screening had a higher risk of impaired glucose tolerance in pregnancy (adjusted OR, 2.14), the authors said. Women in the highest quartile of weight gain (12.9 to 29.1 kg) had an adjusted odds ratio for impaired glucose tolerance of 2.54 compared to women in the lowest quartile of gestational weight gain (up to 7.9 kg).

No increased risk for impaired glucose tolerance was seen in women who had high weight gains in the first trimester but low gains in the second (adjusted OR, 1.40), or vice versa (adjusted OR, 1.20).

Dr. Herring stated that, "Interventions are needed to test whether avoiding high amounts of weight gain in early to mid-pregnancy leads to decreased rates of impaired glucose tolerance in pregnancy and thus to improved pregnancy outcomes.

"I am in the process of developing an intervention to encourage appropriate pregnancy weight gain and healthy behaviors among urban, low-income mothers in Philadelphia," Dr. Herring added. "The next step is to test whether mothers randomized to participate in such an intervention have improved short- and long-term maternal and fetal outcomes, compared to those mothers randomized to usual care."

In another report, researchers from Harvard Medical School and Harvard School of Public Health in Boston, stated that a healthful diet and greater physical activity are associated with reduced risk for excessive gestational weight gain.

Dr. Alison M. Stuebe and colleagues prospectively studied associations of diet and physical activity with weight gain in 1,388 pregnant women. At the start of pregnancy, 379 (27%) were overweight (BMI > 26). Over the course of pregnancy, 703 (51%) had excessive gestational weight gain.

On multivariate analysis, predictors of weight gain were intake of total energy (odds ratio, 1.11 per 500 kcal/day), dairy (OR, 1.08 per serving/day), and fried food (OR, 3.68 per serving/day).

"Vegetarian diet in the first trimester was inversely associated with excessive gain (OR, 0.45)," the researchers report, as was vigorous physical activity in the second trimester (OR, 0.76 per 30 min/day). There was a trend toward a decreased risk for excessive weight gain with walking (OR, 0.92 per 30 min/ day) and total activity (OR, 0.95 per 30 min/day)."

Source: Diabetes In Control: Am J Obstet Gynecol July 2009;201:58.e1-8, 61.e1-7.

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