Factors Other than Gestational Weight Gain Linked to Metabolic Complications of Pregnancy

Factors other than how much weight a woman gains during pregnancy may contribute to metabolic complications such as gestational diabetes (GDM), according to a paper recently published in Journal of the Endocrine Society.

Researchers led by Fernanda L. Alvarado, MD, of the Mother Infant Research Institute at Tufts Medical Center in Boston, Mass., point out that efforts to reduce complications like GDM by having women decrease excessive weight gain during pregnancy have seen limited success. “Increased [gestational weight gain (GWG)] early during pregnancy has been associated with the development of GDM, but the role of excess GWG in the development of GDM is still unclear,” the authors write.

The authors go on to write that the relationship between GWG and changes in maternal insulin resistance are not well described, and few studies have baseline measures before pregnancy. “Hence, the purpose of this secondary analysis was to examine the relationship between the longitudinal changes in weight/body composition and insulin sensitivity/response and to estimate its impact in women with normal glucose tolerance (NGT) and those who developed GDM,” they write.

The researchers analyzed data from 29 NGT and 17 GDM women, evaluating them for longitudinal changes in insulin sensitivity/response using the hyperinsulinemic-euglycemic clamp and an IV-glucose tolerance test. They found that no significant difference in clinical characteristics between women with NGT and those developing GDM. But prior to pregnancy, the women who developed GDM had lower insulin sensitivity levels compared to NGT women. “Changes in body weight contributed to only 9% of the Δ in insulin sensitivity both in women developing GDM and NGT women,” the authors write.

The authors conclude that they found no clinically significant correlation between changes in components of glucose metabolism and weight or body composition from preconception to late pregnancy. “We hypothesize that this low contribution is the main reason why lifestyle interventions during pregnancy targeting maternal weight have not impacted the progression of insulin resistance during pregnancy,” they write.