Gestational weight gain in insulin-resistant pregnancies

Objective:to examine the institute of medicine (iom) guidelines for gestational weight gain (gwg) in insulin-resistant pregnancy.study design:secondary analysis of a prospective cohort of 435 women with type 2 or gestational diabetes from 2006 to 2010. the exposure was categorized as gwg less than, within or greater than the iom recommendations for body mass index. the maternal outcome was a composite of preeclampsia, eclampsia, third- to fourth-degree laceration, readmission or wound infection. the neonatal outcome was a composite of preterm delivery, level 3 nursery admission, oxygen requirement >6 h, shoulder dystocia, 5-min apgar⩽3, umbilical cord arterial ph<7.1 or base excess <−12. secondary outcomes were cesarean delivery (cd), macrosomia and small for gestational age (sga).result:incidence of the maternal outcome did not differ with gwg (p=0.15). women gaining more than recommended had an increased risk of cd (relative risk (rr) 1.31, 95% confidence interval (ci) 1.01 to 1.69) and the neonatal outcome (rr 1.40, 95% ci 1.01 to 1.95) compared with women gaining within the iom recommendations. women gaining less than recommended had an increased risk of sga (rr 3.29, 95% ci 1.09 to 9.91) without a decrease in the risk of the maternal outcome (rr 0.93, 95% ci 0.49 to 1.78) or cd (rr 0.74, 95% ci 0.40 to 1.37) compared with women gaining within the iom recommendations.conclusion:women with insulin resistance should be advised to gain within the current iom guidelines.