Excessive weight gain and gestational diabetes melitus (GDM), hypertensive states, and Cesarean deliveries among Wyoming women
Date
2016
Authors
Chance, Alicia, author
Bachand, Annette, advisor
Reif, John, committee member
Melby, Chris, committee member
Magzamen, Sheryl, committee member
Journal Title
Journal ISSN
Volume Title
Abstract
Background The proportion of women gaining more weight during pregnancy has become an increasing public health issue. Recent data show that nationally, about half of pregnant women gain more weight than the current Institute of Medicine guidelines. Further, over gaining during pregnancy can lead to a number of adverse outcomes for both the mother as well as the fetus. In this study our aim was to determine if, and to what extent, excessive gestational weight gain increased the risk of gestational diabetes mellitus, hypertensive conditions and incidence of Cesarean deliveries among Wyoming women. Methods Birth certificates from all Wyoming residence were collected between January 2006 and August 2010. More than 36,000 records were obtained. Logistic regression models were used, to evaluate the associations between excessive weight gain and gestational diabetes, hypertensive conditions and cesarean deliveries. Confounders and effect modifiers were also assessed. Results Among the entire population we found that 49% gained more weight than recommended. Further, 2% had gestational diabetes, 4.9% had a hypertensive condition and 25% had a cesarean delivery. We found that women who were classified as having excessive weight gain were not significantly more likely to have an increased risk of gestational diabetes. Women with excessive weight gain were 2 times more likely to have a hypertensive state (OR: 2.148; 95% CI: 1.85-2.49) and were 30% more likely to have a Cesarean delivery (OR: 1.29; 95% CI: 1.22-1.37). None of our 16 potential confounders, identified a priori, were identified to significantly affect this relationship. Several interaction variables were significantly associated. When the endpoint of interest was hypertension there were two interactions that were associated. Among women who had excessive weight gain, women who had adequate plus prenatal care, compared to women with adequate were 50% more likely to have a hypertensive condition. Among women who had excessive weight gain, women who were American Indian, compared to white were half as likely to have a hypertensive condition. When the endpoint of interest was Cesarean deliveries there were three interactions that were associated. Among women who had excessive weight gain, women who had three or more children, compared to women who had none were 20% less likely to have a Cesarean delivery. Among women who had excessive weight gain, women who were had less than a high school level of education, compared to women with a college level of education were 20% less likely to have a Cesarean delivery. Lastly, among women who had excessive weight gain, women who were classified as a race of other, compared to white women were 25% more likely to have a Cesarean delivery. Conclusion The results from this study show that excessive weight gain is associated with twice the risk of having a hypertensive condition and 30% increased risk in having a Cesarean delivery. These results add to the accumulating body of evidence to help explain the risk of excessive weight gain and how optimal gain depends on maternal characteristics.