RESUMO
AIMS/INTRODUCTION: In 2021, the guidelines on gestational weight gain (GWG) were revised and increased by 2-3 kg in Japan. This study aimed to investigate whether the revised guidelines would increase the incidence of babies with excessive birth weight in mothers with diabetes. MATERIALS AND METHODS: This retrospective study included 369 deliveries of women with diabetes whose pre-pregnancy body mass index was below 30 kg/m2 between 1982 and 2021. The primary outcome measure was large for gestational age (LGA). We compared the incidence of LGA between women who gained weight within the previous guidelines and women who gained weight within the revised guidelines. We also compared the incidence of macrosomia, preeclampsia, small for gestational age (SGA), and low birth weight. RESULTS: The incidence of LGA was not significantly different between women who gained weight within the revised guidelines and those within the previous guidelines (34.6% [95% confidence interval 25.6-44.6%] for the revised guidelines vs 28.9% [21.6-37.1%] for the previous guidelines; P = 0.246). Neither was the incidence of macrosomia or preeclampsia significantly different (8.7% [4.0-15.8%] vs 5.6% [2.5-10.8%] and 5.8% [2.1-12.1%] vs 6.3% [2.9-11.7%]; P = 0.264 and 0.824, respectively), while women who gained weight within the revised guidelines had a lower incidence of SGA (1.9% [0.2-6.8%] vs 10.6% [6.0-16.8%]; P = 0.001) and low birth weight (1.0% [0.02-5.2%] vs 7.0% [3.4-12.6%]; P = 0.023). CONCLUSIONS: The revised GWG guidelines could be beneficial in women with diabetes in terms of delivering babies with appropriate birth weight.
RESUMO
AIMS/INTRODUCTION: This study investigated the time trends of the maternal characteristics and perinatal outcomes of Japanese pregnant women with diabetes. MATERIALS AND METHODS: This retrospective study included 621 deliveries in 429 Japanese women with diabetes between 1982 and 2020. The association of the delivery date with clinical features was analyzed using the generalized estimating equations to adjust for the within-person correlation. RESULTS: The mean age of delivery and the mean diabetes duration increased over time (both P < 0.001), while the prevalence of diabetic retinopathy decreased (P = 0.006). The mean HbA1c values during pregnancy decreased significantly over time (all P < 0.001). The decreasing trends were associated with preterm delivery (P = 0.021) but not with other perinatal outcomes. The time trends were significantly different between patients with type 1 diabetes mellitus and with type 2 diabetes mellitus in large for gestational age (LGA) and stillbirth (both P for interaction <0.05). The rate of LGA decreased among patients with type 2 diabetes (P = 0.003) but not those with type 1 diabetes (P = 0.413). In contrast, the prevalence of stillbirth was decreased among those with type 1 diabetes (P < 0.001) but not those with type 2 diabetes (P = 0.768). The proportion of major congenital anomalies did not change in the overall population (P = 0.259) and among patients with type 2 diabetes (P = 0.229), but it increased among those with type 1 diabetes (P = 0.044), although the difference between those with type 1 diabetes and type 2 diabetes was not statistically significant (P for interaction = 0.166). CONCLUSIONS: Maternal glycemic control has improved over the decades, whereas the improvement of perinatal outcomes has been limited. Perinatal outcomes still need to be improved in Japanese women with diabetes.