Adequate gestational weight gain (GWG) is critical for maternal and child health. The Institute of Medicine (IOM) standard has long been adopted in clinical practice to guide GWG in China. Since October 2022, China has officially promulgated and adopted the Standard of Recommendation for Weight Gain during Pregnancy Period (WS/T 801-2022) (herein after referred to as SRWGPP) to guide GWG.
To compare the distribution of GWG recommended by the SRWGPP and IOM used for Chinese singleton pregnant women and associated adverse pregnancy outcomes, providing clinical evidence for further application of the SRWGPP.
The data of this study were from a prospective cohort study involving singleton pregnant women who gave birth in Beijing Obstetrics and Gynecology Hospital, Capital Medical University from May 2020 to September 2021 and participated in the Beijing Birth Cohort Study (registration number: ChiCTR220058395) . Baseline information was collected from the participants, and the incidence of pregnancy complications and outcomes was obtained from the clinical health record system. We compared the distribution of GWG of the participants based on the criteria by the SRWGPP and the IOM guidelines. Then we divided the participants into five groups: insufficient weight gain (IOM+IW) , insufficient weight gain+appropriate weight gain (IOM+IW+AW) , appropriate weight gain (IOM+AW) , appropriate weight gain+ excessive weight gain (IOM+AW+EW) , and excessive weight gain (IOM+EW) . The risk of adverse pregnancy outcomes〔large for gestational age (LGA) , small for gestational age (SGA) , macrosomia, low birth weight, and preterm birth〕 was analyzed after adjusting for confounding factors.
A total of 11 839 singleton pregnant women were included. The proportions of women with insufficient, appropriate, and excessive GWG were 36.7% (4 339/11 839) , 38.9% (4 601/11 839) , and 24.5% (2 899/11 839) , respectively, according to the IOM standard, and were 16.2% (1 913/11 839) , 45.0% (5 332/11 839) , and 38.8% (4 594/11 839) , respectively, according to the SRWGPP. The proportions of pregnant women in groups of IOM+IW, IOM+IW+AW, IOM+AW, IOM+AW+EW and IOM+EW were 16.2% (1 913/11 839) , 20.5% (2 426/11 839) , 24.6% (2 907/11 839) , 14.3% (1 694/11 839) and 24.5% (2 899/11 839) , respectively. The results from multivariate Logistic regression analysis showed that the risk of overall adverse pregnancy outcomes in IOM+AW+EW group was higher than that in IOM+AW group〔aOR=1.23, 95%CI (1.07, 1.41) , P<0.05〕. There was no difference in the risk of overall adverse pregnancy outcomes between IOM+IW+AW group and IOM+AW group〔aOR=1.02, 95%CI (0.89, 1.16) , P<0.05〕. The risk of LGA, macrosomia, cesarean section, or the overall adverse pregnancy outcomes was higher in IOM+EW group than that in IOM+AW group either in the first or second trimesters (P<0.05) .
The adoption of the SRWGPP will allow more pregnant women to meet the appropriate range for GWG, and their pregnancy outcomes will be better than those using the IOM standard. Therefore, the SRWGPP is more applicable to Chinese pregnant women for pregnancy weight management. Especially, it is critical to avoid excessive GWG in the first and second trimesters.
Gestational diabetes mellitus (GDM) is a common complication during pregnancy. However, the adherence to individualized medical nutrition therapy (IMNT) alone among GDM women is poor and the impact of group cognitive behavioral therapy (GCBT) on their pregnancy outcomes remains unclear.
To examine the impact of GCBT on the pregnancy outcomes of women with GDM, and to provide reference for improving pregnancy outcomes and developing effective gestational diabetes management programme.
A total of 878 pregnant women with GDM who delivered and received IMNT in our hospital from 2020 to 2021 were retrospectively selected as the study subjects and divided into the observation group including 141 pregnant women with GDM who received GCBT and the control group including 737 pregnant women with GDM who did not receive GCBT. The differences in pregnancy outcomes of pregnant women with GDM between the two groups before and after propensity score matching were analyzed.
There were 134 pregnant women with GDM in the observation group and 256 pregnant women with GDM in the control group after 1∶2 propensity score matching. The proportion of pregnant women with GDM who gained normal weight in the observation group (50.7%, 68/134) was higher than that in the control group (37.5%, 96/256) (P<0.05) . The gestational weeks of delivery of pregnant women with GDM in the observation group (39.0±1.1) were longer than those in the control group (38.5±1.7) (P<0.05) . Additionally, the proportions of preterm infants (3.7%) , macrosomia (1.5%) , and low birth weight infants (2.2%) were lower than those in the control group (10.5%, 5.9%, and 9.0%, respectively) (P<0.05) .
GCBT can help reduce the risk of the delivery of preterm infants, low birth weight infants, and macrosomia in pregnant women with GDM, providing a reference for the establishment of a multidisciplinary management model for GDM.
Macrosomia is not only harmful to the pregnant women and newborns, but also to the long-term metabolic health of the offspring. Maternal body mass is closely associated with pregnancy outcomes, overweight and obese pregnant women are often associated with dyslipidemia, while elevated blood lipid levels during pregnancy can affect the intrauterine environment and neonatal birth weight has not been investigated.
To analyze the association between blood lipid levels and macrosomia in pregnant women with different pre-pregnancy (BMI) .
A total of 5 287 singleton pregnant women who were registered at department of obstetrics of Beijing Obstetrics and Gynecology Hospital, Capital Medical University until delivery from January 2018 to June 2019 and met the inclusion and exclusion criteria were included in the single-center retrospective study, and divided into low-body-mass pregnant women with a non-macrosomia group (group A, n=731) and with a macrosomia group (group B, n=27) , normal-body-mass pregnant women with a non-macrosomia group (group C, n=3 539) and with a macrosomia group (group D, n=243) , overweight and obese pregnant women with a non-macrosomia group (group E, n=675) and with a macrosomia group (group F, n=72) according to maternal pre-pregnancy BMI and neonatal birth weight. Relevant clinical and laboratory data of pregnant women were collected for statistical analysis. Binary Logistic regression analysis was used to explore the association between blood lipid levels and macrosomia in pregnant women with different pre-pregnancy BMI.
The level of high-density lipoprotein cholesterol (HDL-C) in the third trimester of pregnancy in group B was lower than group A (P<0.05) . The levels of total cholesterol (TC) in the first trimester and triglyceride (TG) in the third trimester in group D were higher than group C (P<0.05) , while the levels of HDL-C in the second and third trimesters were lower than group C (P<0.05) . The TG levels in the first, second and third trimesters of pregnancy in group F were higher than group E (P<0.05) , while HDL-C levels in the second and third trimesters were lower than group E (P<0.05) . Binary Logistic regression analysis showed that HDL-C level in the third trimester〔OR=0.256, 95%CI (0.075, 0.871) 〕 was the influencing factor of macrosomia in low body mass pre-pregnancy women (P<0.05) . HDL-C levels in the second and third trimesters〔OR=0.661, 95%CI (0.450, 0.971) ; OR=0.406, 95%CI (0.271, 0.610) 〕 were the influencing factors of macrosomia in normal body mass pre-pregnancy women (P<0.05) . TG levels in the first, second and third trimesters〔OR=1.546, 95%CI (1.070, 2.234) ; OR=1.399, 95%CI (1.019, 1.758) ; OR=1.289, 95%CI (1.072, 1.550) 〕 were the influencing factors of macrosomia in overweight and obese pre-pregnancy women (P<0.05) .
For pre-pregnancy women with low and normal body mass, low HDL-C level during pregnancy is associated with an increased risk for macrosomia, while for overweight and obese pre-pregnancy women, high TG level during pregnancy is associated with an increased risk of macrosomia. For pregnant women with large fetuses or high risk of macrosomia during maternal examination, it is necessary to emphasize the detection and control of blood lipid levels.
