Gestational Weight Gain in Insulin Resistant Pregnancies

OBJECTIVE: To examine the Institute of Medicine (IOM) guidelines for gestational weight gain (GWG) in insulin-resistant pregnancy. STUDY DESIGN: Secondary analysis of a prospective cohort of 435 women with type 2 or gestational diabetes from 2006–2010. The exposure was categorized as GWG less than, within, or greater than the IOM recommendations for body mass index. The maternal outcome was a composite of preeclampsia, eclampsia, 3(rd)–4(th) degree laceration, readmission, or wound infection. The neonatal outcome was a composite of preterm delivery, level 3 nursery admission, oxygen requirement >6 hours, shoulder dystocia, 5-minute Apgar≤3, umbilical cord arterial pH<7.1, or base excess <−12. Secondary outcomes were cesarean delivery (CD), macrosomia, and small for gestational age (SGA). RESULTS: Incidence of the maternal outcome did not differ with GWG (p=0.15). Women gaining more than recommended had an increased risk of CD (relative risk (RR) 1.31, 95% confidence interval (CI) 1.01–1.69) and the neonatal outcome (RR 1.40, 95% CI 1.01–1.95) compared to women gaining within the IOM recommendations. Women gaining less than recommended had an increased risk of SGA (RR 3.29, 95% CI 1.09–9.91) without a decrease in the risk of the maternal outcome (RR 0.93, 95% CI 0.49–1.78) or CD (RR 0.74-0.40-1.37) compared to women gaining within the IOM recommendations. CONCLUSIONS: Women with insulin resistance should be advised to gain within the current IOM guidelines.