University of Oulu

Mustaniemi S, Nikkinen H, Bloigu A, Pouta A, Kaaja R, Eriksson JG, Laivuori H, Gissler M, Kajantie E and Vääräsmäki M (2021) Normal Gestational Weight Gain Protects From Large-for-Gestational-Age Birth Among Women With Obesity and Gestational Diabetes. Front. Public Health 9:550860. doi: 10.3389/fpubh.2021.550860

Normal gestational weight gain protects from large-for-gestational-age birth among women with obesity and gestational diabetes

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Author: Mustaniemi, Sanna1,2; Nikkinen, Hilkka1,2; Bloigu, Aini1;
Organizations: 1PEDEGO Research Unit, Medical Research Center Oulu, Oulu University Hospital, University of Oulu, Oulu, Finland
2Department of Public Health and Welfare, Population Health Unit, Finnish Institute for Health and Welfare, Oulu, Finland
3Department of Government Services, Finnish Institute for Health and Welfare, Helsinki, Finland
4Turku University Hospital, Turku University, Turku, Finland
5Department of General Practice and Primary Health Care, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
6Folkhälsan Research Center, Helsinki, Finland
7Department of Obstetrics and Gynecology, Human Potential Translational Research Programme, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
8Department of Obstetrics and Gynecology, Faculty of Medicine and Health Technology, Tampere University Hospital, Tampere University, Tampere, Finland
9Medical and Clinical Genetics, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
10Institute for Molecular Medicine Finland, Helsinki Institute of Life Science, University of Helsinki, Helsinki, Finland
11Information Services Department, Finnish Institute for Health and Welfare, Helsinki, Finland
12Department of Neurobiology, Care Sciences and Society, Karolinska Institute, Stockholm, Sweden
13Children’s Hospital, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
14Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway
Format: article
Version: published version
Access: open
Online Access: PDF Full Text (PDF, 0.6 MB)
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Language: English
Published: Frontiers Media, 2021
Publish Date: 2021-08-20


Background: Pre-pregnancy obesity, excess gestational weight gain (GWG), and gestational diabetes (GDM) increase fetal growth. Our aim was to assess whether normal GWG is associated with lower risk for a large-for-gestational-age (LGA; over the 90th percentile of birth weight for sex and gestational age) infant and lower birth weight standard deviation (SD) score in the presence of GDM and maternal obesity.

Methods: This multicenter case-control study is part of the Finnish Gestational Diabetes (FinnGeDi) Study and includes singleton pregnancies of 1,055 women with GDM and 1,032 non-diabetic controls. Women were divided into 12 subgroups according to their GDM status, pre-pregnancy body mass index (BMI; kg/m²), and GWG. Non-diabetic women with normal BMI and normal GWG (according to Institute of Medicine recommendations) served as a reference group.

Results: The prevalence of LGA birth was 12.2% among women with GDM and 6.2% among non-diabetic women (p < 0.001). Among all women, normal GWG was associated with lower odds of LGA [odds ratio (OR) 0.57, 95% CI: 0.41–0.78]. Among women with both obesity and GDM, the odds for giving birth to a LGA infant was 2.25-fold (95% CI: 1.04–4.85) among those with normal GWG and 7.63-fold (95% CI: 4.25–13.7) among those with excess GWG compared with the reference group. Compared with excess GWG, normal GWG was associated with 0.71 SD (95% CI: 0.47–0.97) lower birth weight SD score among women with GDM and obesity. Newborns of normal weight women with GDM and normal GWG had 0.28 SD (95% CI: 0.05–0.51) lower birth weight SD scores compared with their counterparts with excess GWG. In addition, in the group of normal weight non-diabetic women, normal GWG was associated with 0.46 SD (95% CI: 0.30–0.61) lower birth weight SD scores compared with excess GWG.

Conclusion: GDM, obesity, and excess GWG are associated with higher risk for LGA infants. Interventions aiming at normal GWG have the potential to lower LGA rate and birth weight SD scores even when GDM and obesity are present.

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Series: Frontiers in public health
ISSN: 2296-2565
ISSN-E: 2296-2565
ISSN-L: 2296-2565
Volume: 9
Article number: 550860
DOI: 10.3389/fpubh.2021.550860
Type of Publication: A1 Journal article – refereed
Field of Science: 3123 Gynaecology and paediatrics
Funding: This study was supported by the Academy of Finland (grant numbers 127437, 128929, 129306, 130326, 134791, and 274794), the Foundation for Pediatric Research, the Diabetes Research Foundation, the Juho Vainio Foundation, the Novo Nordisk Foundation, the Signe and Ane Gyllenberg Foundation, the Sigrid Jusélius Foundation, the Yrjö Jahnsson Foundation, and Medical Research Center Oulu.
Copyright information: © 2021 Mustaniemi, Nikkinen, Bloigu, Pouta, Kaaja, Eriksson, Laivuori, Gissler, Kajantie and Vääräsmäki. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.