Objective: To study the potential correlation between pregnancy weight gain (WG) and the incidence of gestational diabetes mellitus (GDM). Methods: Clinical records of women with singleton pregnancies who had a first visit at Fujian Maternity and Child Health Hospital before 14 weeks and delivered after 28 weeks were retrospectively analyzed. Based on the first trimester WG, the participants were grouped as inadequate (iWG-F), adequate (aWG-F), and excessive (eWG-F) WG groups. The outcomes of interest included GDM, gestational hypertension, preeclampsia, small for gestational age (SGA), LGA, low birth weight (LBW), preterm birth, macrosomia, primarily cesarean section (CS), and admission to the neonatal intensive care unit (NICU). Statistical analyses included logistic regression, interaction, and mediation analyses. Results: A total of 16,824 pregnancies were analyzed. GDM incidences of the iWG-F, aWG-F, and eWG-F groups were 24.53%, 26.62%, and 29.46%, respectively, with a statistically significant difference ( p < 0.001). Multivariable logistic regression showed that inadequate WG correlated with reduced risk of GDM when adjusted for pre-pregnancy body mass index (PPBMI) of below 18.5 kg/m ² [adjusted odds ratio (aOR) = 0.68], and 18.5–23.9 kg/m ² (aOR = 0.88). The association of inadequate WG and reduced risk of GDM persisted when adjusted for age <30.5 years (aOR = 0.81), fasting glucose ≥4.9 mmol/L (aOR = 0.74), triglycerides <1.4 mmol/L (aOR = 0.84), and HDL <1.63 mmol/L (aOR = 0.85). WG in the second trimester was associated with GDM ( β = −0.003, p = 0.036) and partially mediated the effect of eWG-F (−3.7% of the total effect). WG before OGTT showed no association with GDM. Conclusion: First trimester WG is significantly associated with the occurrence of GDM. In contrast, there is only a minimal association between second-trimester and pre-OGTT WG and the risk of GDM. Inadequate first-trimester weight gain reduces GDM risk, especially in younger women, women with normal or low PPBMI, elevated fasting glucose, and low HDL or triglycerides, without increasing abnormal neonatal birth weight. Early pregnancy represents a critical window for GDM prevention. Minimal weight gain during this period may be a feasible and acceptable approach to reducing GDM risk.

Background: Evidence-based medicine has shown that successful vaginal birth after cesarean (VBAC) is associated with fewer complications than an elective repeat cesarean. Although spontaneous vaginal births and reductions in cesarean delivery (CD) rates have been advocated, the risk factors for VBAC complications remain unclear and failed trials of labor (TOL) can lead to adverse pregnancy outcomes.Methods: To construct an antepartum predictive scoring model for VBAC. Retrospective analysis of charts from 1062 women who underwent TOL at no less than 28 gestational weeks with vertex singletons and no more than one prior CD.Results: We constructed our scoring model based on the following variables: maternal age, previous vaginal delivery, interdelivery interval (time between prior cesarean and the following delivery), presence of prior cesarean TOL, dystocia as prior CD indication, intertuberous diameter, maternal predelivery body mass index, gestational age at delivery, estimated fetal weight, and hypertensive disorders. Previous vaginal delivery was the most influential variable. The nomogram showed an area under the curve of 77.7% (95% confidence interval, 73.8–81.5%; sensitivity, 78%; specificity, 70%; cut-off, 13 points). The Kappa value to judge the consistency of the results between the predictive model and the actual results was 0.71(95% confidence interval 0.65–0.77) indicating strong consistency. We used the cut-off to divide the VBAC women into two groups according to the success of the TOL. The maternal and neonatal outcomes such as labor time, number of deliveries by midwives, postpartum hemorrhage, uterine rupture, neonatal asphyxia, puerperal infection were significantly different between the two groups.Conclusions: Our predictive scoring model incorporates easily ascertainable variables and can be used to personalize antepartum counselling for successful TOLs after cesareans.

The growing prevalence of assisted reproductive technology (ART) is leading to a continuous rise in twin pregnancies. This study assessed the influence of ART on neonatal outcomes of twin pregnancies. Clinical records of twin deliveries at Fujian Maternity and Child Health Hospital between 2019 and 2021 were retrospectively selected and grouped based on the method of conception: ART-conceived and naturally conceived. Neonatal outcomes of interest included low birth weight (LBW), intrauterine growth restriction (IUGR), prematurity, low Appearance, Pulse, Grimace, Activity and Respiration scores, and neonatal intensive care unit admission. Univariate and multivariable logistic regression analyses were conducted to adjust for potential confounders. The results were expressed as odds ratio (OR) with 95% confidence interval (CI). A total of 1270 pairs of twins were included in the analysis. ART-conceived twins had significantly lower odds of being born with LBW (adjusted OR 0.57, 95% CI: 0.43, 0.75), prematurity (adjusted OR 0.71, 95% CI: 0.55, 0.91), and IUGR (adjusted OR 0.21, 95% CI: 0.10, 0.39) compared to naturally conceived twins. Rates of other outcomes were comparable in both groups. Twins born through ART had reduced odds of LBW, prematurity, and IUGR, with no impact on other neonatal outcomes. These findings suggest that ART may have a protective effect on twin fetal growth, although the risks associated with multiple gestations remain. Further studies should explore the mechanisms and long-term effects of these outcomes.

Objective: This retrospective cohort study aimed to investigate the effects of parity on gestational weight gain (GWG) and its association with maternal and neonatal outcomes in women with gestational diabetes mellitus (GDM). Methods: This retrospective cohort study data from 2,909 pregnant women with GDM who delivered between 2021 and 2023 at Fujian Maternity and Child Health hospital, were analyzed. Participants were categorized into nulliparous (no previous births), primiparous (one previous birth), and multiparous (two or more previous births) groups. Women aged 18–45 years with singleton pregnancies were included, while those with multiple pregnancies, pre-existing diabetes, hypertension, thyroid disorders, or incomplete BMI data were excluded. Data extracted from hospital records included demographic information, BMI, GWG at various gestational stages, and pregnancy outcomes. Statistical analysis involved logistic regression models, adjusting for confounders such as maternal age, BMI, and gestational age at delivery. P-values < 0.05 were considered significant. Results: Primiparous and multiparous women exhibited significantly higher GWG than nulliparous women (p < 0.01). Primiparous women had reduced risks of pregnancy-induced hypertension (adjusted OR, 0.64; 95% CI, 0.45–0.92) and premature rupture of membranes (adjusted OR, 0.58; 95% CI, 0.48–0.70). Both primiparous and multiparous women had lower risks of delivering large-for-gestational-age newborns or those with neonatal jaundice. Conclusion: Parity significantly influences GWG and maternal/neonatal outcomes in GDM pregnancies, highlighting the need for parity-specific guidelines. doi: https://doi.org/10.12669/pjms.41.1.11412 How to cite this: Lin L, Chen R, Lin H, Yao T, Chen Z, Zheng L. Influence of parity on weight gain during pregnancy in women with Gestational Diabetes: A retrospective cohort study. Pak J Med Sci. 2025;41(1):29-36. doi: https://doi.org/10.12669/pjms.41.1.11412 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.