Women who gain excessive weight during pregnancy, especially in the first trimester, may increase their risk of developing diabetes later in pregnancy.
A three-year study by the Kaiser Permanente Division of Research of 1,145 pregnant women from an ethnically diverse population found that women who gained more weight than is recommended by the Institute of Medicine had a 50 percent increased risk of developing gestational diabetes mellitus (GDM). The association between pregnancy weight gain and gestational diabetes was more pronounced among overweight and non-white women. The study included 345 pregnant women with gestational diabetes and 800 pregnant women without gestational diabetes.
Gestational diabetes is defined as glucose intolerance that typically occurs during the second or third trimester of pregnancy. It causes complications in as many as seven percent of pregnancies in the United States. It can lead to early delivery, C-sections and type 2 diabetes, and can increase the child's risk of developing diabetes and obesity later in life.
The study followed women members of Kaiser Permanente Northern California region and examined their overall rate of pregnancy weight gain up to the time of screening for gestational diabetes (typically between 24-28 weeks), as well as the trimester-specific rates of weight gain compared to the Institute of Medicine's 2009 guidelines for recommended pregnancy weight gain.
After adjusting for age at delivery, race/ethnicity, previous births, and pre-pregnancy body mass index, the risk of gestational diabetes increased with increasing rates of pregnancy weight gain. Women who exceeded the IOM guidelines for weight gain had a 50 percent increase in the risk of gestational diabetes compared to women who gained within or below the IOM recommendations.
The researchers hypothesized that rapid weight gain early in pregnancy may result in an early increase in insulin resistance that leads to the "exhaustion" of the beta-cells in the pancreas that make and release insulin, which controls the level of glucose in the blood. This could reduce beta-cells' capacity to secrete adequate levels of insulin to compensate for the insulin resistance induced by the progression of pregnancy and therefore lead to the development of gestational diabetes.
Lead author Monique Hedderson, Ph.D., at the Kaiser Permanente Division of Research, was quoted as saying, "Health care providers should talk to their patients early in their pregnancy about the appropriate gestational weight gain, especially during the first trimester, and help women monitor their weight gain. Our research shows that weight gain in early pregnancy is a modifiable risk factor for gestational diabetes. Randomized studies are needed to determine the feasibility of this early intervention and the best methods to help women meet the IOM recommendations."
SOURCE: Obstetrics and Gynecology, February 22, 2010
No comments:
Post a Comment