Excessive Gestational Weight Gain and Pregnancy Outcomes in Gestational and Pre-gestational Diabetes

The 2009, Institute of Medicine Guidelines provides specific ranges for appropriate gestational weight gain as per pre-pregnancy body mass index (BMI) category. These recommendations are largely based on studies of women with normal glucose tolerance that associates excessive gestational weight gain with adverse obstetric outcomes. Since their publication, a number of studies have examined the guidelines in relation to women with diabetes in pregnancy. Based on the results, it is reasonable to conclude that these guidelines are also applicable to women with both gestational and pre-gestational diabetes. Unfortunately, over 50% of women with diabetes gain excessive weight during pregnancy and interventions to modify gestational weight gain have had minimal effect on pregnancy outcomes. This chapter will explore these issues in further detail.