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Am J Perinatol
DOI: 10.1055/a-2568-6317
Original Article

The Association of Adverse Perinatal Outcomes in Pregnancies with Gestational Diabetes and Excessive Gestational Weight Gain According to Obesity Status

Henry Lesser 
1   Department of Obstetrics and Gynecology, Geisinger Medical Center, Danville, Pennsylvania
,
Vani Movva
2   Department of Obstetrics and Gynecology, Essentia Health Maternal-Fetal Medicine, Duluth, Minnesota
,
Amanda Young
3   Biostatistics Core, Department of Population Health Sciences, Geisinger Medical Center, Danville, Pennsylvania
,
Celia Gray
4   Department of Population Health Sciences, Phenomic Analytics and Clinical Data Core Geisinger, Danville, Pennsylvania
,
A Dhanya Mackeen
1   Department of Obstetrics and Gynecology, Geisinger Medical Center, Danville, Pennsylvania
› Author Affiliations Funding None.
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Abstract

Objective

Obesity, gestational diabetes mellitus (GDM), and excessive gestational weight gain (EGWG) are associated with adverse outcomes. It is unclear which carries the greatest risk. In this study, the relationship of obesity, GDM, and EGWG independently and concomitantly was analyzed to determine if one is a greater risk factor than the other.

Study Design

A retrospective cohort study of singleton gestations at Geisinger from October 2007 to March 2023 was performed. Exclusion criteria were pregravid body mass index (BMI) <18 kg/m2, gestational age (GA) <34 weeks, pregestational diabetes or chronic hypertension, prior cesarean delivery (CD) or contraindication to vaginal delivery. Patients were grouped by BMI class, and the order of groups within each BMI for the test for trend were no GDM/no EGWG, GDM/no EGWG, no GDM/EGWG, and GDM/EGWG. The rates of hypertensive disorders of pregnancy (HDP), severe HDP, CD, large for gestational age (LGA), shoulder dystocia, and neonatal intensive care unit (NICU) admission at ≥35 weeks were evaluated. A test for trend and odds ratios with 95% CIs were reported. p-values were reported across the GDM/EGWG groups per BMI category.

Results

A total of 42,627 pregnancies were included. At each BMI category, HDP, severe HDP, CD, LGA, and shoulder dystocia generally increased from patients with no GDM/no EGWG to those with GDM/no EGWG to those with no GDM/EGWG to those with GDM/EGWG. NICU admission at ≥35 weeks did not follow this progression.

Conclusion

EGWG poses a greater risk than GDM regardless of pregravid BMI for HDP, severe HDP, CD, LGA, and shoulder dystocia. Attention should be given to determine the optimal strategy to manage pregnancies experiencing EGWG.

Key Points

  • Isolated EGWG in pregnancy is associated with a greater risk of targeted maternal adverse outcomes.

  • The combination of EGWG, GDM, and obesity poses the greatest risk during pregnancy.

  • Attention should be given to determining the optimal role for antenatal surveillance for patients with EGWG.

Keywords

excessive gestational weight gain - adverse perinatal outcomes - gestational diabetes - obesity

Authors' Contributions

H.L.: Substantial contributions, including verified data and analytical methods, discussed results, helped supervise and compose manuscript.

V.M.: Substantial contributions, including verified data and analytical methods, discussed results, helped supervise and compose manuscript.

C.G.: Substantial contributions, including developing the theory for analytical analysis and performing data abstraction.

A.Y.: Substantial contributions, including developing the theory for analytical and statistical analysis. Structure and organize data for figures and tables.

A.D.M.: Substantial contributions, including conceiving and developing the presented idea. Supervised all components of the research presented.




Publication History

Received: 06 March 2025

Accepted: 27 March 2025

Accepted Manuscript online:
31 March 2025

Article published online:
30 April 2025

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