Correlation between Excessive Early Gestational Weight Gain and Risk of Gestational Diabetes Mellitus

Vidhya Selvam, Vani K^*, Kousica M and Yuvarani R

^*Correspondence: Dr. Vani K, Department of Obstetrics and Gynaecology, Sree Balaji Medical College and Hospital, Tamil Nadu, Chennai, India, Email:

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Introduction

Weight gain, one among the hallmarks of pregnancy, has been extensively studied because it relates to the wellbeing of the fetus and mother. Optimal weight gain in pregnancy has been the topic of considerable discussion, and attitudes regarding what’s appropriate have changed with time, even in recent history [1]. GWG is a unique and complex biological phenomenon that supports the functions of growth and development of the foetus. Gestational weight gain is influenced not only by changes in maternal physiology and metabolism, but also by placental metabolism [2]. Approximately 7% of all pregnancies are complicated by GDM, resulting in more than 200,000 cases annually. More recent reports from our country however detected higher frequencies up to 7.7% [3]. The glucose intolerance of GDM is usually mild but perinatal mortality associated with this complication is 4 to 5 times increased compared to the general pregnant population.

Materials and Methods

Study design: Prospective observational study.

Sample size: Consistent with qualitative analysis (n=4 pq/l²)=two hundred patients.

Inclusion criteria

• Singleton pregnancy

• regular antenatal visits

• No associated co morbidity

Exclusion Criteria

• Multiple pregnancy

• Anaemia complicating pregnancy

• Chronic hypertension

• Pregestational diabetes mellitus

• Thyroid problems complicating pregnancy

• Molar pregnancy

Procedure

During the first antenatal visit and 14 weeks, height and weight are measured.

The BMI is calculated based on quetlet index (weight in kg/height in meters squared).

A detailed history, general examination, and obstetric examination were performed.

Blood samples (6-8 ml) to be taken at reserving visit

• Hb

• HbA1C

Blood samples to be tested between 12-14 weeks, 24-28 weeks, and 32-36 weeks

• Oral glucose challenge test

Statistical tools used: In an excel spread sheet, data were recorded and analysed using the SPSS statistical program. The usage of this software program, 't' values and 'p' values had been calculated with frequencies, percentages, manner, and well known deviations. A 'p' cost less than 0.05 will denote extensive courting (Table 1).

Table 1: Proportion of cases with GDM Overall.

Result

In this study, there were two hundred study participants included and among them 35% and 65% of participants were found to be with and without Gestational Diabetes Mellitus (GDM), respectively (Table 2).

Table 2: Association between age and GDM.

On assessing the association between the age and GDM, there was a statistically significant association reported (p=0.000). The age distribution data of the 200 women are summarized in Table 2. The age distribution had a high proportion between 26-30 years. The mean age of the study participants among GDM and non GDM caseswas found to be 28.0 ± 2.9 years and 28.6 ± 2.4 years, respectively and the difference was found to be statistically significant (Tables 3 and 4).

Table 3: Association between parity and GDM.

Table 4: Association between occupation and maternal weight gain.

In this study 37% of the participants were employed and among them 14% had gained abnormal weight (≥ 1.5 kgs) and 19.5% had gained weight within normal limits. Also among those who were not employed there were 23% and 43.5% of participants who had gained excessive weight and weight within normal limits, respectively. On assessing the association between occupational status and weight gain, it was found to be statistically insignificant (p=0.3192) (Tables 5,6).

Table 5: Association between family history of DM and GDM.

Table 6: Association between weight gain in early pregnancy and GDM Overall.

Excessive weight gain in early pregnancy (≥ 1.5 kgs) was reported among 74 (37%) of participants. Among them 25% of participants developed GDM. The association between weight gain in early pregnancy and GDM was found to be statistically significant (p=0.000) (Table 7).

Table 7: Detection of GDM at 24 weeks of gestation among those with abnormal weight gain during first trimester.

On assessing the risk of GDM at 24 weeks of gestation among those with abnormal early trimester weight gain, their OGCT values were within normal limits at first trimester 48.38% participants who had abnormal weight gain (≥ 1.5 kgs) developed GDM. Similarly 15.87%, who had normal weight gain, developed GDM. The association between the weight gain and GDM screening at second trimester was found to be statistically significant (p=0.000) (Table 8).

Table 8: Detection of GDM at 34 weeks of gestation among that abnormal weight gain during first trimester.

On assessing the risk of GDM at 34 weeks of gestation among those who gained excessive early trimester weight, there were 12.5% of them who gained excessive weight developed GDM. The association between the weight gain and GDM screening at third trimester was found to be statistically insignificant (p=0.06) (Table 9).

Table 9: Association between induction of labour and GDM.

Out of 42 women in whom induction of labour, was done with prostaglandin E2 gel, 38 (44.28%) had been women with GDM (Table 10).

Table 10: Association between maternal weight gain at early trimester and mode of delivery.

Out of 74 women who had won excessive weight gain (≥ 1.5 kgs), 56.7% had operational delivery which confirmed sizable correlation ‘p’<.0001 (Table 11).

Table 11: Association between maternal weight gain at early trimester and APGAR score.

Our examine showed no large affiliation on the subject of APGAR score (Table 12).

Table 12: Association between maternal weight gain at early trimester and neonatal complications.

In this study, among the cases with excessive maternal weight gain and normal weight gain, 25.68% and 21.42% of cases had no neonatal complications, respectively. Among the cases who had gained excessive weight, there were 8.1%, 21.6%, 16.21%, 9.46% and 18.91% of cases had LGA, SGA, hypoglycaemia, birth asphyxia and hyperbilirubinemia, respectively.

Similarly among the cases who had gained weight within normal limits, there were 17.46%, 18.25%, 12.69%, 15.87% and 14.28% of cases had LGA, SGA, hypoglycaemia, birth asphyxia and hyperbilirubinemia, respectively.

On assessing the association between the neonatal complications and GDM, there was no statistical significance found (p=0.3055)

Discussion

In our study, we found that excessive early gestational weight gain in early pregnancy was associated with increased risk of GDM. Similarly, there were 15.5% and 49% belonged to age group of 26-30 years were found to be with and without GDM, respectively and 7.5% and 8.5% of participants in the age group more than 30 years were found to be with and without GDM, respectively. In our study, maternal age and weight gain association was statistically significant. But in Previous studies, they resulted that there is no relationship between maternal age and the pattern of weight gain. On assessing the association between occupational status and maternal weight gain, it was found to be statistically insignificant (p=0.3192). The association between family history and GDM was found to be statistically significant (p=0.004).

In our observe we realised that the correlation of GWG and threat of GDM became strongly attributable to accelerated weight gain in the first trimester. Immoderate weight benefit turned into pronounced amongst seventy four participants from our look at populace, 12 (16.2%) of cases evolved GDM while sixty two (83.8%) of members did now not develop GDM with a with p value of .0001, displaying sturdy association between excessive early gestational weight benefit and risk of GDM [4]. In previous study, 802 women with diabetes in pregnancy participated, and Excessive GWG was reported among 59% of women with significant p value of <.001 [5].

During the assessment of GDM at 24 weeks of gestation by OGCT, among those who had gained abnormal weight (≥ 1.5 kgs) 48.38% of participants developed GDM. In the assessment of GDM at 34 weeks of gestation among those who gained excessive early trimester weight, their OGCT values were within normal limits at first and second trimester respectively. There were 12.5% of them who gained excessive weight developed GDM. The association between the weight gain and GDM screening at third trimester was found to be statistically significant. (p=0.06). Induction of labour was done in 42 women, 54.28% and 3.07% were women with GDM and non GDM, respectively. On assessing the association between induction of labour and GDM, statistically significant (p=0.000).

In this study 74 participants had excessive weight gain (≥ 1.5 kgs), 14.5%, 20% and 2.5% of cases delivered through spontaneous vaginal delivery, LSCS and assisted techniques, respectively whereas those who gained weight within normal limits(<1.5 kgs), there were 50%, 7.5% and 5.5% of cases delivered through spontaneous vaginal delivery, LSCS and assisted techniques, respectively. In order to reduce operative deliveries we need to instil the importance of weight gain during pregnancy. The association between the mode of delivery and weight gain was statistically significant (p<.000). Previous studies resulted that, overweight and obese women with GDM, third trimester weight loss is associated with some improved maternal and neonatal outcomes, both total and primary caesarean sections with a significant p value of <.01 [6].

Conclusion

Inappropriate gestational weight gain is considered as a modifiable risk factor of early pregnancy. Lifestyle adjustments like easy exercises (walking) and nutritional adjustments can prevent GDM and its related complications. This cost effective early intervention can result in healthy generations. From our study, we observe that excessive early pregnancy weight gain specifically inside the first trimester correlates with developing the hassle of GDM.

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