Oral Presentation Society of Obstetric Medicine of Australia and New Zealand and Australasian Diabetes in Pregnancy Society Joint Scientific Meeting 2017

Association between Gestational Weight Gain and Gestational Diabetes Risk in DALI: Vitamin D and Lifestyle Intervention for the prevention of gestational diabetes (#10)

David Simmons 1 , Mireille van Poppel 2 , Roland Devlieger 2 , Andre van Assche 2 , Rosa Corcoy 2 , Juan Adelantado 2 , Fidelma Dunne 2 , Gernot Desoye 2 , Alexandra Kautzky-Willer 2 , Peter Damm 2 , Elisabeth Mathiesen 2 , Dorte Jensen 2 , Lise Lotte Andersen 2 , Anunziata Lapolla 2 , Maria Dalfra 2 , Alessandra Bertolotto 2 , Ewa Wender-Ozegowska 2 , Agnieszka Zawiejska 2 , Frank Snoek 2 , David Hill 2
  1. University of Western Sydney, Campbelltown, NSW, Australia
  2. DALI consortium, Various, EU

Background: Excess gestational weight gain (GWG) is associated with the development of gestational diabetes mellitus (GDM).  In the DALI study, significant limitation in GWG through a combined lifestyle intervention was not associated with reduced GDM development (1).  We have now compared the effect of higher and lower GWG on the insulin-glucose axis to investigate possible reasons for the limited impact of lifestyle interventions on preventing GDM.

Methods: Pregnant women at risk of GDM with a BMI≥29 (kg/m2) undertook a 75g oral glucose tolerance test (OGTT) before 20 weeks gestation. Those without GDM (n=437) at baseline received different structured lifestyle interventions (healthy eating and/or physical activity).   Comparisons were made between women above and below the median GWG at 24-28 weeks and 35-37 weeks (excluding GDM):approximately 7kg GWG difference by 24-28 weeks gestation.

Findings: Women achieving above the median GWG at 24-28/40 (≥5.65kg, vs below), had a lower baseline body mass index (BMI: 33.0±3.5 vs 34.6±4.2 kg/m2, respectively p<0.001) and were more likely to smoke (20.8% vs 9.9% p<0.01), developing a higher fasting glucose (4.64±0.03 vs 4.56±0.03 mmol/l, p<0.05) and HOMA-IS (371.5±28.9 vs 253.3±28.9, p<0.01) by 24-28 weeks gestation.  Women above the median GWG at 35-37 weeks (≥9.5kg) without GDM at 24-28 weeks, had a lower baseline 2 hour glucose (6.32±0.10 vs 6.60±0.11 mmol/l, p<0.05) but developed a higher HOMA-IR (4.30±0.19 vs 3.11±0.20, p<0.01) and HOMA-IS (460.8±28.3 vs 394.5±29.7, p<0.01) at 24-28 weeks, delivering babies who were more likely to be large for gestational age (LGA) 21.2 vs 8.6% p<0.01).  GDM rates were non-significantly higher among women with the highest GWG at 24-28 and 35-37 weeks gestation (odds ratio 1.43 (0.79-2.60), 1.26(0.67-2.42)) respectively

Interpretation: Among overweight/obese women, more GWG is associated with an increase in insulin resistance and insulin secretion.  Lifestyle interventions appear insufficient to overcome this increase in insulin resistance.

  1. 1. Simmons D, Devlieger R, van Assche A, Jans G, Galjaard S, Corcoy R, Adelantado JM, Dunne F, Desoye G, Harreiter J, Kautzky-Willer A, Damm P, Mathiesen ER, Jensen DM, Andersen L, Lapolla A, Dalfrà MG, Bertolotto A, Wender-Ozegowska E, Zawiejska A, Hill D, Snoek FJ, Jelsma JG, van Poppel MN. Effect of physical activity and/or healthy eating on GDM risk: The DALI Lifestyle Study. J Clin Endocrinol Metab 2017;102: 903-913.