Characteristics of Recurrent Large-for-Gestational-Age Infants in Obese Women.

Objective The objective of this study was to identify characteristics associated with recurrent large-for-gestational-age (LGA) infants in obese women and to explore the relationship between interpregnancy weight change and gestational weight gain (GWG) on risk of recurrence. Study Design We conducted a population-based historical cohort study of 1,190 obese women in Missouri who delivered LGA infants in their first pregnancy with two consecutive pregnancies resulting in singleton live births during 1998 to 2005. Adjusted odds ratios (aORs) for recurrent LGA infants were calculated with multiple logistic regression. Population-attributable risk assessed the relative importance of specific characteristics. Results A second LGA infant was delivered by 501 women (42%). Recurrence of LGA infants was associated with GWG (aOR, 1.03 [per pound]; 95% confidence interval [CI], 1.02-1.04), maternal age (aOR, 1.05 [per year]; 95% CI, 1.02-1.08), birth weight of the first LGA infant (aOR, 1.001 [per gram]; 95% CI, 1.000-1.001), being married (aOR, 1.71; 95% CI, 1.02-2.49), diabetes (aOR, 1.79; 95% CI, 1.24-2.59), and pre-pregnancy body mass index (BMI) (aOR, 1.04 [per unit BMI]; 95% CI, 1.02-1.06). Excessive GWG contributed the most to LGA infant recurrence (13%). Interpregnancy weight change was not significantly associated with LGA infant recurrence. Conclusion Lower pre-pregnancy BMI and reduced GWG may mitigate the risk of recurrent LGA infants in obese women.

The impact of interpregnancy weight change on birthweight in obese women.

OBJECTIVE: The purpose of this study was to estimate the impact of interpregnancy weight change from first to second pregnancies in obese women on the risk of large-for-gestational-age (LGA) and small-for-gestational-age (SGA) infants. STUDY DESIGN: A population-based historical cohort analysis of 10,444 obese women in Missouri who delivered their first 2 singleton live infants from 1998-2005. Interpregnancy weight change was calculated as the difference between prepregnancy body mass index (BMI) of the first and second pregnancies. LGA and SGA births were compared among 3 interpregnancy weight change groups: (1) weight loss (≥2 BMI units), (2) weight gain (≥2 BMI units), and (3) reference group (BMI maintained within 2 units). Adjusted odds ratios (aOR) were calculated for LGA and SGA births with the use of multiple logistic regression. A dose-response relationship was assessed with a linear-by-linear χ(2) test. RESULTS: Compared with the reference group, interpregnancy weight loss was associated with lower risk of an LGA infant (aOR, 0.61; 95% confidence interval, 0.52-0.73), whereas interpregnancy weight gain was associated with increased risk of an LGA infant (aOR, 1.37; 95% confidence interval, 1.21-1.54). Interpregnancy BMI change was not related to SGA infant risk, except for weight loss of >8 BMI units. A significant dose-response relationship was observed for LGA infant risk (P < .001), but not SGA infant risk (P = .840). CONCLUSION: Mild-to-moderate interpregnancy weight loss in obese women reduced the risk of subsequent birth of LGA infants without increasing the risk of SGA infants. The interpregnancy interval may be a crucial period for targeting weight loss in obese women.

Large-for-gestational-age infants of type 1 diabetic mothers: an effect of preprandial hyperglycemia?

OBJECTIVE: To determine how the frequency, timing and magnitude of hyperglycemia are associated with large-for-gestational-age (LGA) infants in pregnancies complicated by type 1 diabetes. METHODS: Charts from pregnant women with type 1 diabetes (n = 70) were reviewed. Indices of maternal glycemic control were determined for seven gestational periods (weeks 7-10, 11-15, 16-19, 20-24, 25-28, 29-32 and 33-38) and compared between women who delivered LGA infants and appropriate-for-gestational-age (AGA) infants. RESULTS: Of the 70 pregnancies, 57% of the infants were LGA (4.3 +/- 0.4 kg) and 43% were AGA (3.2 +/- 0.4 kg). Total maternal weight gain and rate of weight gain were significantly higher in mothers with LGA infants. The glycemic variables associated with an LGA infant were percentage of preprandial values above target for weeks 11-15, 25-28 and 29-32, and percentage of all values above target for weeks 33-38. For the entire pregnancy, the strongest predictors of an LGA infant were percentage of preprandial blood glucose values above target during weeks 29-32 and maternal weight gain. CONCLUSIONS: In pregnant women with type 1 diabetes, frequent episodes of preprandial hyperglycemia in the third trimester significantly impact the development of LGA infants.

A lifestyle intervention of weight-gain restriction: diet and exercise in obese women with gestational diabetes mellitus.

OBJECTIVE: This study assessed whether a weight-gain restriction regimen, with or without exercise, would impact glycemic control, pregnancy outcome, and total pregnancy weight gain in obese subjects with gestational diabetes mellitus (GDM). A total of 96 subjects with GDM met the inclusion criteria and were sequentially recruited, with 39 subjects self-enrolled in the exercise and diet (ED) group, and the remaining 57 subjects self-enrolled in the diet (D) group owing to contraindications or a lack of personal preference to exercise. All patients were provided a eucaloric or hypocaloric consistent carbohydrate meal plan and instructed in the self-monitoring of blood glucose. In addition, all ED subjects were prescribed an exercise routine equivalent to a 60% symptom-limited VO2 max. Subjects were followed at weekly or biweekly office visits. Results showed maternal weight and body mass index (35.2+/-7.2 (ED) vs. 33.5+/-9.2 (D)) at study entry as well as number of weeks into the study (7.7+/-5.7 (ED) vs. 9.4+/-4.7 (D)) were similar in both the ED and D groups. Weight gain per week was significantly lower in the ED group than in the D group (0.1+/-0.4 kg vs. 0.3+/-0.4 kg; p<0.05). Subjects (either ED or D) who gained weight had a higher percentage of macrosomic infants than those subjects who lost weight or had no weight change during pregnancy. Other pregnancy and fetal outcomes such as complications, gestational age at delivery, and rate of cesarean delivery were similar in both groups. Conclusions of this study were that caloric restriction and exercise result in limited weight gain in obese subjects with GDM, less macrosomic neonates, and no adverse pregnancy outcomes. Pregnancy is an ideal time for behaviour modification, and this intervention may also help promote long-term healthy lifestyle changes.