Association between prepregnancy body mass index or gestational weight gain and adverse pregnancy outcomes among Chinese women with gestational diabetes mellitus: a systematic review and meta-analysis.

The association between prepregnancy body mass index (BMI) or gestational weight gain (GWG) and adverse pregnancy outcomes among Chinese women with gestational diabetes mellitus (GDM) is unknown. This study aims to evaluate such association by synthesising the evidence. Systematic review and meta-analysis. PubMed, Web of Science, Scopus, EMBASE, China Biology Medicine disc, China National Knowledge Infrastructure, Wangfang, and China Science and Technology Journal Database searched from inception to 11 August 2023. Prospective cohort studies, retrospective cohort studies and case-control studies estimating the relationship of abnormal prepregnancy BMI (including underweight, overweight or obesity) or inappropriate GWG (including excess GWG or insufficient GWG) with adverse pregnancy outcomes of interest were included. Outcomes included macrosomia, caesarean section, preterm birth, gestational hypertension, large for gestational age (LGA) and small for gestational age (SGA). Two reviewers independently selected studies, extracted the data and assessed the risk of bias. OR estimate and its 95% CI were pooled using Stata software fixed-effect model. Subgroup analysis, meta-regression and sensitivity analysis were performed to ensure credibility of the results. Twenty-three studies (eighteen retrospective cohort studies, three prospective cohort studies and two case control studies) involving 57 013 Chinese women with GDM were identified. Meta-analysis results showed that compared with GDM women with normal weight, GDM women with underweight were at a higher risk of SGA (OR=1.79 (1.54 to 2.07), five studies involving 31 967 women); women with overweight had higher risks of macrosomia (OR=1.65 (1.49 to 1.82), eleven studies involving 41 683 women), caesarean section (OR=1.48 (1.38 to 1.59), ten studies involving 34 935 women), preterm birth (OR=1.27 (1.13 to 1.43), eight studies involving 38 295 women) and LGA (OR=1.73 (1.54 to 1.95), seven studies involving 31 342 women) and women with obesity had higher risks of macrosomia (OR=2.37 (2.04 to 2.76), eleven studies involving 41 683 women), caesarean section (OR=2.07 (1.84 to 2.32), nine studies involving 34 829 women), preterm birth (OR=1.31 (1.09 to 1.57), eight studies involving 38 295 women) and LGA (OR=2.63 (2.15 to 3.21), six studies involving 31 236 women). Regard to GWG, compared with Chinese GDM women with sufficient GWG, GDM women with excessive GWG had higher risks of macrosomia (OR=1.74 (1.58 to 1.92), twelve studies involving 40 966 women), caesarean section (OR=1.44 (1.36 to 1.53), nine studies involving 36 205 women) and LGA (OR=2.12 (1.96 to 2.29), twelve studies involving 42 342 women); women with insufficient GWG conversely had higher risks of preterm birth (OR=1.59 (1.45 to 1.74), nine studies involving 37 461 women) and SGA (OR=1.38 (1.27 to 1.51), ten studies involving 41 080 women). For Chinese women with GDM, abnormal prepregnancy BMI or inappropriate GWG were related to higher risks of many adverse pregnancy outcomes. Therefore, medical staff should pay more attention to the weight management of GDM women during pregnancy.

Zhu Y ，Zheng Q ，Pan Y ，Jiang X ，Li J ，Liu R ，Huang L ... -  《BMJ Open》

Association of Gestational Weight Gain With Adverse Maternal and Infant Outcomes.

LifeCycle Project-Maternal Obesity and Childhood Outcomes Study Group ，Voerman E ，Santos S ，Inskip H ，Amiano P ，Barros H ，Charles MA ，Chatzi L ，Chrousos GP ，Corpeleijn E ，Crozier S ，Doyon M ，Eggesbø M ，Fantini MP ，Farchi S ，Forastiere F ，Georgiu V ，Gori D ，Hanke W ，Hertz-Picciotto I ，Heude B ，Hivert MF ，Hryhorczuk D ，Iñiguez C ，Karvonen AM ，Küpers LK ，Lagström H ，Lawlor DA ，Lehmann I ，Magnus P ，Majewska R ，Mäkelä J ，Manios Y ，Mommers M ，Morgen CS ，Moschonis G ，Nohr EA ，Nybo Andersen AM ，Oken E ，Pac A ，Papadopoulou E ，Pekkanen J ，Pizzi C ，Polanska K ，Porta D ，Richiardi L ，Rifas-Shiman SL ，Roeleveld N ，Ronfani L ，Santos AC ，Standl M ，Stigum H ，Stoltenberg C ，Thiering E ，Thijs C ，Torrent M ，Trnovec T ，van Gelder MMHJ ，van Rossem L ，von Berg A ，Vrijheid M ，Wijga A ，Zvinchuk O ，Sørensen TIA ，Godfrey K ，Jaddoe VWV ，Gaillard R ... -  《-》

Prediction of the ideal gestational weight gain for reducing the risk of macrosomia/large for gestational age in women with gestational diabetes mellitus in northern Taiwan.

Appropriate weight gain reduces the risk of fetal macrosomia and large for gestational age (LGA) in women with gestational diabetes mellitus (GDM), especially in the second and third trimester. This study aims to identify the optimal weight g-ain for such women across several pre-pregnancy body mass index (BMI) categories to lower the risk of macrosomia and LGA. This retrospective cohort study enrolled women with GDM in north Taiwan who delivered between January 2012 and July 2022. BMI cut-offs were based on Chinese-specific guidelines and used to classify the participants as underweight (<18.5 kg/m2), normal weight (18.5-24.0 kg/m2), overweight (24.0-28.0 kg/m2), or obese (>28 kg/m2). Receiver operator curve analysis was used to determine the optimum GWG cut-off ranges to predict macrosomia / LGA, and uni- and multivariate analyses were used to analyze risk factors. In addition, a multivariable model predicting macrosomia and LGA in infants was developed. A total of 963 participants was included in our analysis. Optimal mean weekly rates of GWG in the second and third trimesters were 0.43 kg/week and 0.61 kg/week, respectively, in the underweight and normal weight group, and 0.33 kg/week and 0.32 kg/week, respectively, in the overweight and obesity group. The 2009 IOM guidelines, offering weight gain recommendations for pregnant women, appear to be applicable to Asian women diagnosed with GDM. This indicates that it is essential for such women to maintain an adequate total GWG throughout pregnancy. Physicians should address GWG using the IOM guidelines and trigger intervention when it is required to reduce macrosomia and LGA occurrence.

Chen TL ，Wu CH ，Gau ML ，Cheng SF ... -  《-》

Association between gestational diabetes mellitus diagnostic criteria and adverse pregnancy outcomes-a systematic review and meta-analysis of adjusted effect sizes from studies using current diagnostic criteria.

To quantify the association between Gestational Diabetes Mellitus (GDM) and adverse pregnancy outcomes and primarily compare the associations between diagnostic criteria following the International Association of Diabetes and Pregnancy Study Groups (IADPSG) recommendations and non-IADPSG criteria, which use higher blood glucose cut-offs. Systematic review and meta-analysis of observational studies using contemporary GDM diagnostic criteria. PubMed, Scopus, Google Scholar, Cochrane Database of Systematic Reviews and the Cumulative Index to Nursing and Allied Health Literature (CINAHL) were searched for articles published between 2010 and 2023. The search was carried out on 15 May 2023. Studies were included if they were observational studies that reported adjusted effect sizes for GDM-related adverse outcomes and compared outcomes between women with and without GDM, used contemporary diagnostic criteria and were conducted after 2010. Two reviewers independently extracted data and assessed study quality using the MethodologicAl STandards for Epidemiological Research (MASTER) scale. Bias-adjusted inverse variance heterogeneity meta-analysis models were used to synthesise adjusted effect sizes. The same meta-analytic models were used to synthesise the overall OR and their 95% CIs for comparisons of the criteria which followed the IADPSG recommendations to other criteria, mostly with higher blood glucose cut-offs (non-IADPSG). We included 30 studies involving 642 355 participants. GDM was associated with higher odds of maternal outcomes, namely; caesarean section (adjusted OR (aOR) 1.24, 95% CI 1.01 to 1.51) and pregnancy-induced hypertension (aOR 1.55, 95% CI 1.03 to 2.34). GDM was associated with higher odds of neonatal outcomes, specifically; macrosomia (aOR 1.38, 95% CI 1.13 to 1.69), large for gestational age (aOR 1.42, 95% CI 1.23 to 1.63), preterm birth (aOR 1.41, 95% CI 1.21 to 1.64), neonatal intensive care unit admission (aOR 1.42, 95% CI 1.12 to 1.78), neonatal hypoglycaemia (aOR 3.08, 95% CI 1.80 to 5.26) and jaundice (aOR 1.47, 95% CI 1.12 to 1.91). Further analyses showed no major differences in adverse pregnancy outcomes between IADPSG and non-IADPSG criteria. GDM is consistently associated with adverse pregnancy, maternal and foetal outcomes, regardless of the diagnostic criteria used. These findings suggest no significant difference in risk between lower and higher blood glucose cut-offs used in GDM diagnosis.

Mahmoud E ，Elsayed AM ，Elsayed B ，Elsalakawi Y ，Gopinath A ，Chivese T ... -  《BMJ Open》

Impact of Gestational Diabetes Mellitus on Neonatal Birth Outcomes.

Liu Y ，Wang M ，Zhou J 《BRITISH JOURNAL OF HOSPITAL MEDICINE》