| Objective: To establish optimal gestational weight gain(GWG)for Chinese pregnant women and compare with the GWG recommended by Institute of Medicine(IOM),and examine the relationship between the rates of gestational weight gain(RGWG)during early and mid-pregnancy and the risk of gestational diabetes mellitus(GDM).Methods: Pregnant women at 8-16 weeks of gestation were recruited to the Tongji Maternal and Child Health Cohort(TMCHC)in Hubei Maternal and Child Health Hospital,the Central Hospital of Wuhan,or Jiangan Maternal and Child Health Hospital during January 2013 to May 2016.Questionnaire was used to obtain the information on the maternal sociodemographic,lifestyle during pre and early pregnancy,medical and family history of disease at the first antenatal care.Bodyweight and blood pressure were measured regularly in every following antenatal examinations.At 24-28 weeks of gestatioanal,oral glucose tolerance test(OGTT)was conducted to screen GDM and the maternal information of lifestyle during mid-pregnancy was obtained.The perinatal outcomes of mothers and neonatal were collected at delivery.The risk of SGA and LGA were estimated based on pre-gravid body mass index(BMI)among healthy subjects with singleton and term pregnancy.The GWG of the lowest risks for SGA or LGA was regarded as optimal GWG for pregnant women,defined as TMCHC recommendation for GWG.Logistic regression was used to analysis the association between GWG and adverse pregnancy outcomes and the relationship between RGWG during early and mid-pregnancy and the risk of GDM.Result:(1)5174 sbjects were healthy and gave birth to term infants among 7023 pregnant women.The mean GWG was 16.3±4.6kg.6.5% newborns were SGA,and the occurrence of LGA were 8.2%.The GWG with lower risk of SGA or LGA based on pre-gravid body mass index(BMI)is 10.0-17.0kg for underweight,and 8.0-15.0kg for normal weight,respectively,which are defined as TMCHC recommendation.(2)Among pre-gravid normal weight women,women exceeding the TMCHC guidelines for GWG experienced higher risk of LGA(OR,2.77;95%CI,2.16-3.57),macrosomia(OR,3.08;95%CI,2.29-4.15),cesarean section(OR,1.52;95%CI,1.34-1.72)and PIH(OR,1.89;95%CI,1.27-2.79)than those within the TMCHC recommendations;while as those below the TMCHC guidelines for GWG had increased risk of SGA(OR,2.32;95%CI,1.34-4.03),low birth weight(OR,2.94;95%CI,1.01-8.51)and preterm(OR,1.89;95%CI,1.02-3.53).The corresponding OR(95%CI)of the group with excessive GWG according to IOM recommendations were 2.22(1.76-2.79)for LGA,2.13(1.65-2.77)for macrosomia,1.48(1.30-1.68)for cesarean,and 1.76(1.20-2.59)for PIH,respectively,and the OR(95%CI)of the group with inadequate GWG was 1.52(1.07-1.17)for preterm.(3)Among pre-gravid underweight women,compared with women who met the TMCHC guidelines for GWG,women with excessive GWG had increased risk of LGA(OR,6.28;95%CI,3.00-13.13)and macrosomia(OR,7.03;95%CI,2.29-16.15),and those with inadequate GWG experienced higher risk of SGA(OR,2.90;95%CI,1.33-6.32).According to the IOM guidelines for GWG,excessive GWG was associated with increased risk of LGA(OR,4.02;95%CI,2.09-7.73)and macrosomia(OR,5.09;95%CI,2.38-10.89).(4)The gestational weight gain was inversely associated with the risk of GDM,but the RGWG prior to glucose screening test and RGWG in the first trimester were positively associated with the risk of GDM.The RGWG in the second trimester was significantly associated with GDM only among women with RGWG in early pregnancy more than 0.086kg/w(OR 2.04,95%CI 1.16-3.59 for 0.658kg/w or more vs.0.418kg/w or less).Conclusions: The optimal GWG recommended by TMCHC were 8.0-15.0kg for normal weight and 10.0-17.0kg for underweight women,respectively.Excesive GWG increases the risk of LGA,macrosomia,cesarean section and PIH;and inadequate GWG increases the risk of SGA,low birth weight and preterm.Optimal GWG based on TMCHC recommendations are more effective in preventing adverse pregnancy outcomes in Chinese than the IOM recommendations and should be used in weight management of Chinese pregnant women.Elevated GWG during early and mid-pregnancy were associated with increase the risk of GDM,and the monitoring and management of gestational weight gain need more attention and shoud be started form the early stages of pregnancy. |
