Purpose: To examine the combined effect of pre-pregnancy overweight or obesity, excessive gestational weight gain, and glucose tolerance status on the incidence of adverse pregnancy outcomes among women with gestational diabetes mellitus.Methods: A observational study including 5529 gestational diabetes mellitus patients was performed. Logistic regression were used to assess the independent and multiplicative interactions of overweight or obese, excessive gestational weight gain, abnormal items of oral glucose tolerance test and adverse pregnancy outcomes. Additive interactions were calculated using an Excel sheet developed by Anderson to calculate relative excess risk.Results: Overall 1076(19.46%) study subject were overweight or obese and 1858(33.60%) women gained weight above recommended. Based on IADPSG criteria, more than one-third women with two, or three abnormal glucose values. Preconception overweight or obesity, above recommended gestational weight gain, and two or more abnormal items of oral glucose tolerance test parameters significantly increased the risk of adverse pregnancy outcomes, separately. After accounting for confounders, each two of overweight or obesity, excessive gestational weight gain, two or more abnormal items of OGTT parameters, the pairwise interactions on adverse pregnancy outcomes appear to be multiplicative. Coexistence of preconception overweight or obesity, above recommended gestational weight gain and two or more abnormal items of oral glucose tolerance test parameters increased the highest risk for adverse pregnancy outcomes. No additive interaction was found.Conclusions: Pre-pregnancy overweight or obesity, excessive gestational weight gain, two or more abnormal items of OGTT parameters contribute to adverse pregnancy outcomes independently among women with gestational diabetes mellitus. Additionally, the combined effect between these three factors and adverse pregnancy outcomes appear to be multiplicative. Interventions focus on maternal overweight or obesity and gestational weight gain should be offered to improve pregnancy outcomes.

Background: This paper investigated how second- and third-trimester gestational weight gain relates to perinatal outcomes among normal weight women with twin pregnancies in Fujian, China. Methods: A retrospective study examining the medical records of 931 normal weight twin-pregnant women was conducted in Fujian Maternity and Child Health Hospital from 2014 to 2018.The 2^nd and 3^rdtrimester weekly weight gain rates were calculated, and women were categorized as gaining below, within, or above the 2009 Institute of Medicine (IOM) recommended rates. The association between the trimester-specific weight gain rate and perinatal outcome was determined by traditional regression analysis among groups. Results: A total of 25.9%, 19.8% and 54.3% of women had rates of weight gain across the 2^nd and 3^rd trimesters less than, greater than or within the recommended rates respectively. Multivariate logistic regression analysis showed that weight gain greater than the recommended rate in the 2^nd trimester was associated with a decreased risk of preeclampsia (aOR:0.489,95%CI:0.289 ~ 0.974). Weight gain less than the recommended rate of weight gain in the 3^rd trimester was associated with increased risks of premature delivery(aOR:2.079, 95%CI:1.467 ~ 2.968), gestational diabetes mellitus (aOR: 2.048, 95%CI:1.411 ~ 2.971), intrahepatic cholestasis syndrome (aOR:3.015,95%CI: 1.058 ~ 8.587), pre-labour rupture of membrane (aOR: 1.708,95%CI: 1.169 ~ 2.493), average twin birth weight < 2500 g(aOR:1.532,95%CI: 1.125 ~ 2.084) and neonatal respiratory distress syndrome (aOR:4.934,95%CI:1.626 ~ 15.083) and was associated with decreased risks of caesarean section (aOR:0.589,95%CI:0.386 ~ 0.898) and preeclampsia (aOR:0.471, 95%CI:0.274 ~ 0.808). In addition, weight gain greater than the recommended rate of weight gain in the 3^rd trimester was associated with increased risks of premature delivery (aOR:1.589,95%CI:1.428 ~ 2.951) and gestational hypertension (aOR:2.137,95% CI:1.034 ~ 4.415) as well as preeclampsia (aOR:2.246, 95%CI:1.462 ~ 3.452). The stratified analysis of weight gain in the 3^rd trimester showed that there was no significant difference in the incidence of adverse pregnancy outcomes compared to the 2^nd trimester weight gain groups. Conclusions: While this study showed that a gestational weight gain rate above or below the recommendation in the 3^rd trimester was associated with some adverse maternal and neonatal outcomes, further prospective and multicentre studies are required to explore alternate ranges of gestational weight gain rates in twin pregnancies.

Background: To establish age-standardized charts of weight gain for term twin pregnancies in Southeast China. Methods: We designed a retrospective study on data from women pregnant with twins, a gestational age beyond 36 weeks and an average weight ≥ 2500 g. We established hierarchical linear regression models to express gestational weight gain patterns. Results: We analyzed data from 884 women pregnant with twins (151 underweight, 597 normal weight, and 136 overweight). Our final models fit the crude weight measurement data well. The means of weight gain generally decreased as the pre-pregnancy BMI increased. For each BMI category, the mean weight gains increased with the gestational age and the standard deviation increased slightly. The mean weight gains were 18.82 ± 6.73, 18.53 ± 6.74, and 16.97 ± 6.95 kg at 37 weeks in underweight, normal weight, and overweight women, respectively. Conclusion: The weight gain chart can be used to estimate maternal weight gain to be gestational age–standardized z scores by pre-pregnancy BMI and may serve as an innovative tool for perinatal care providers to guide the weight gain of women pregnant with twins.

Objective: This study identifies the optimal gestational weight gain (GWG) range for women with gestational diabetes mellitus (GDM) in singleton pregnancies and examines the relationship between GWG patterns and perinatal outcomes.Methods: We included 18,548 pregnant women diagnosed with GDM via a 75g glucose tolerance test at Fujian Maternal and Child Health Hospital from 2011 to 2022. Data on demographics, GWG, delivery details, and maternal and infant outcomes were collected. Subjects were divided into training and validation sets (7:3 ratio) and classified by pre-pregnancy BMI: underweight, normal weight, overweight, and obese. Logistic regression in the training set was conducted to determine optimal GWG for each group, and examined the relationship between adverse outcomes and the Institute of Medicine(IOM), Chinese nutrition society(CNS), and study-derived (AOR) standards in the validation set.Results: Among participants, 17.0% pregnant women gained insufficient GWG, 49.2% gained appropriate GWG, and 33.9% with excessive GWG. The optimal GWG for underweight, normal weight, overweight, and women with obesity were 12-14 kg, 8-14 kg, 6-10 kg, and 2-4 kg, respectively. Insufficient GWG in IOM and AOR standard increased composite adverse outcomes among underweight women. Normal weight: Insufficient GWG per CNS and AOR increased composite adverse outcomes; excessive GWG per all standards increased adverse outcomes. Insufficient GWG per all standards reduced the risk of small-for-gestational-age (SGA) infants, while excessive GWG increased the risk of large-for-gestational-age (LGA) infants, gestational hypertension, and cesarean section. Overweight: Excessive GWG per CNS and AOR increased composite adverse outcomes; excessive GWG per all standards increased the risk of cesarean delivery. Obese: Insufficient GWG per IOM and CNS increased composite adverse outcomes.Conclusion: GWG significantly influences adverse pregnancy outcomes. Compared to IOM guidelines, CNS recommendations and study-derived GWG ranges are more suitable for Chinese women with GDM in singleton pregnancies.

The aim of this study was to explore gestational weight gain (GWG) trajectories and their associations with adverse pregnancy outcomes. A retrospective cohort study including 11,064 women with gestational diabetes mellitus (GDM) was conducted between 2015 and 2019 in China. The latent class trajectory model was used to identify GWG trajectories, and logistic regression was performed to examine odds ratio (OR) of pregnancy outcomes. Three trajectories of GWG were identified in these 11,604 women with GDM. Trajectory 1: 64.02% of women had sustained moderate GWG throughout pregnancy; Trajectory 2: 17.75% of women showed a high initial GWG but followed by a low GWG from the third trimester until delivery; Trajectory 3: 18.23% had low initial GWG but followed by drastic GWG from the second trimester until delivery. Compared with pregnant women with Trajectory 1, women with Trajectory 2 had a higher risk of large for gestational age (adjusted odds ratio [AOR]: 1.29, 95% confidence interval [CI]: 1.12–1.48) but at a lower risk of having hypertensive disorders of pregnancy (AOR: 0.76, 95% CI: 0.57–0.96). Women in Trajectory 3 were more likely to develop small for gestational age (AOR: 2.12, 95% CI: 1.62–2.78), low birthweight (AOR: 1.49, 95% CI: 1.07–2.08), preterm birth (AOR: 1.28, 95% CI: 1.05–1.63), caesarean section (AOR: 1.26, 95% CI: 1.112–1.42) and hypertensive disorders of pregnancy (AOR: 2.24, 95% CI: 1.82–2.76). The association of GWG trajectory with adverse pregnancy outcomes differs across prepregnancy body mass index and GWG categories. Women with a slow initial GWG but followed by drastic GWG had higher risks of adverse pregnancy outcomes. Early clinical recognition of poor GWG trajectory will contribute to early intervention in high‐risk groups to minimise adverse outcomes.