Excess gestational weight gain may contribute to adverse maternal and neonatal outcomes in pregnancies complicated by type 2 diabetes mellitus (T2DM). A retrospective cohort study published in Diabetes Care evaluated whether restricted gestational weight gain or weight loss, defined as total pregnancy weight gain <5 kg, was associated with improved perinatal outcomes in pregnant individuals with T2D.

The study included 954 pregnancies from 2 academic health centers. Maternal demographics, glycemic measures, health care utilization, and diabetes therapies were compared between individuals with weight gain <5 kg and those with weight gain ≥5 kg. Logistic regression analyses adjusted for covariates were used to assess associations with perinatal outcomes.

Findings

• Weight gain <5 kg occurred in 327 pregnancies (34.3%).
• Restricted weight gain was associated with lower risk of large-for-gestational-age birth weight (adjusted odds ratio [aOR] 0.42; 95% confidence interval [CI] 0.29-0.59).
• Lower rates of neonatal intensive care unit admission (aOR 0.74; 95% CI 0.55-0.98), hypertensive disorders of pregnancy (aOR 0.56; 95% CI 0.42-0.75), and cesarean delivery (aOR 0.66; 95% CI 0.48-0.91) were also observed among pregnancies with weight gain <5 kg.
• Restricted weight gain was not associated with significantly increased risk of small-for-gestational-age birth weight (aOR 1.61; 95% CI 0.96-2.71) or preterm birth (aOR 0.92; 95% CI 0.67-1.25).

Pregnancy weight gain <5 kg was associated with lower rates of several adverse perinatal outcomes in individuals with T2DM without significant increases in small-for-gestational-age birth weight or preterm delivery. Further studies are needed to determine whether targeted interventions to limit gestational weight gain can improve maternal and neonatal outcomes.