ADIPS Poster Presentation Australasian Diabetes in Pregnancy Society and Society of Obstetric Medicine Australia and New Zealand Joint Scientific Meeting 2025

Gestational weight gain trajectories and adverse outcomes: a comparison between type 1 and type 2 diabetes (#130)

Ngan Nguyen 1 2 , Wah Cheung 1 2 , Jina Rhou 1 2 , Angela Xun-Nan Chen 2 , Suja Padmanabhan 1 2
  1. Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
  2. Department of Diabetes and Endocrinology, Westmead Hospital, Westmead , NSW, Australia

Background: Pregnancies complicated by pregestational diabetes have increased rates of adverse outcomes. Gestational weight gain (GWG) is an independent determinant of outcomes, however, trajectories across trimesters have not been elucidated. Furthermore, the applicability of Institute of Medicine (IOM) GWG recommendations in this group is unclear.

Objective: To model GWG trajectories, examine their associations with adverse outcomes, and determine the applicability of IOM recommendations in pregestational diabetes.

Methods: This retrospective cohort study included 119 and 383 women with Type 1 and Type 2 diabetes, respectively, managed at Westmead Hospital (2010-2025). Latent class mixed models identified GWG trajectories, and regression analyses were performed to examine associated outcomes. Agreement between trajectory and IOM classifications was assessed with Cohen’s kappa.

Results: Three trajectories (low, moderate, rapid gain) were identified in each diabetes type. The median total GWG in trajectory classes for Type 1 diabetes were 6.7, 15.0 and 25.6 kg, and for Type 2 diabetes were 7.0, 15.4 and 25.3 kg.  In Type 2 diabetes, moderate (aOR 2.47, 95% CI 1.21-5.31, p = 0.016) and rapid (aOR 2.85, 95% CI 1.06-7.52, p = 0.035) GWG trajectories were associated with macrosomia, and higher birthweight and centiles compared to low GWG. There were no trajectory-outcome associations in Type 1 diabetes. Trajectory classes showed only fair agreement with IOM categories (κ = 0.34-0.39, p < 0.001). 

Conclusion: GWG trajectories were associated with adverse outcomes in Type 2 diabetes and stratified women into risk groups different to IOM guidelines, supporting their potential role in antenatal diabetes care.

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