Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Pediatric Original Article
  • Published:

Weight gain, total fat gain and regional fat gain during pregnancy and the association with gestational diabetes: a population-based cohort study

Abstract

Objective:

In a multi-ethnic population-based study, we investigate the change in indicators of adiposity (being weight gain and gain of total fat, truncal fat and mean skinfold thickness) from early pregnancy to 28 weeks of gestation overall and across ethnic groups, and explore the association between the change in indicators of adiposity and gestational diabetes (GDM).

Design:

Weight, skinfold thickness and bioelectrical impedance analysis were performed twice in 728 pregnant women in gestational week 15 (visit 1) and week 28 (visit 2). GDM was defined by the modified International Association of Diabetes in Pregnancy Study Group (IADPSG) criteria (1-hour glucose not available).

Results:

An increase in all indicators of adiposity gave increased odds ratios (OR) for GDM. After adjusting for pre-pregnant body mass index, a 0.14 kg per week (one standard deviation (s.d.)) increase in truncal fat gave an OR of 1.31 (95% CI 1.10–1.56), while a 0.21 kg per week (one s.d.) weight gain gave an OR of 1.23 (95% CI 1.04–1.46) for GDM. The ORs for the indicators of adiposity remained after additional adjustments for insulin resistance in early pregnancy. When combining the effects of an ethnic origin, 0.14 kg per week (one s.d.) truncal fat gain and 4.7 kg m−2 (one s.d.) increased pre-pregnant BMI the OR for South Asians was 5.9 (3.5–10.0) versus 2.1 (1.6–2.8) for Europeans.

Conclusion:

Weight gain and gain of total fat mass, mean skinfold thickness and especially truncal fat were all positively associated with GDM. South Asians, in particular, should be encouraged to avoid an excessive weight gain during pregnancy to reduce risk of GDM.

This is a preview of subscription content, access via your institution

Access options

Buy this article

Prices may be subject to local taxes which are calculated during checkout

Figure 1

Similar content being viewed by others

References

  1. O'Sullivan JB, Gellis SS, Dandrow RV, Tenney BO . The potential diabetic and her treatment in pregnancy. Obstet Gynecol 1966; 27: 683–689.

    CAS  PubMed  Google Scholar 

  2. Kim C, Newton KM, Knopp RH . Gestational diabetes and the incidence of Type 2 diabetes. A systematic review. Diabetes Care 2002; 25: 1862–1868.

    Article  Google Scholar 

  3. Benhalima K, Hanssens M, Devlieger R, Verhaeghe J, Mathieu C . Analysis of pregnancy outcomes using the new IADPSG recommendation compared with the Carpenter and Coustan Criteria in an area with a low prevalence of gestational diabetes. Int J Endocrinol 2013; 2013: 248121.

    Article  Google Scholar 

  4. Wendland EM, Torloni MR, Falavigna M, Trujillo J, Dode MA, Campos MA et al. Gestational diabetes and pregnancy outcomes-a systematic review of the World Health Organization (WHO) and the International Association of Diabetes in Pregnancy Study Groups (IADPSG) diagnostic criteria. BMC Pregnancy Childbirth 2012; 12: 23.

    Article  Google Scholar 

  5. Dabelea D . The predisposition to obesity and diabetes in offspring of diabetic mothers. Diabetes Care 2007; 30 (Supplement 2): S169–S174.

    Article  Google Scholar 

  6. WHO. Global Health Observatory; Obesity 2013, http://www.who.int/gho/ncd/risk_factors/obesity_text/en/index.html.

  7. Norman JE, Reynolds RM . The consequences of obesity and excess weight gain in pregnancy. Proc Nutr Soc 2011; 70: 450–456.

    Article  CAS  Google Scholar 

  8. Torloni MR, Betrán AP, Horta BL, Nakamura MU, Atallah AN, Moron AF et al. Prepregnancy BMI and the risk of gestational diabetes: a systematic review of the literature with meta-analysis. Obes Rev 2009; 10: 194–203.

    Article  CAS  Google Scholar 

  9. Institute of Medicine. Weight Gain During Pregnancy: Reexamining the Guidelines. National Academy of Sciences: Washington, DC, 2009.

  10. Baci Y, Ustuner I, Keskin HL, Ersoy R, Avsar AF . Effect of maternal obesity and weight gain on gestational diabetes mellitus. Gynecol Endocrinol 2013; 29: 133–136.

    Article  Google Scholar 

  11. Poston L . Gestational weight gain: influences on the long-term health of the child. Curr Opin Clin Nutr Metab Care 2012; 15: 252–257.

    Article  Google Scholar 

  12. Siega-Riz AM, Viswanathan M, Moos M-K, Deierlein A, Mumford S, Knaack J et al. A systematic review of outcomes of maternal weight gain according to the Institute of Medicine recommendations: birthweight, fetal growth, and postpartum weight retention. Am J Obstet Gynecol 2009; 201: 339.e1–339.e14.

    Article  Google Scholar 

  13. Freemantle N, Holmes J, Hockey A, Kumar S . How strong is the association between abdominal obesity and the incidence of type 2 diabetes? Int J Clin Pract 2008; 62: 1391–1396.

    Article  CAS  Google Scholar 

  14. Jenum AK, Diep LM, Holmboe-Ottesen G, Holme IM, Kumar BN, Birkeland KI . Diabetes susceptibility in ethnic minority groups from Turkey, Vietnam, Sri Lanka and Pakistan compared with Norwegians—the association with adiposity is strongest for ethnic minority women. BMC Public Health 2012; 12: 150.

    Article  Google Scholar 

  15. Jenum AK, Morkrid K, Sletner L, Vangen S, Torper JL, Nakstad B et al. Impact of ethnicity on gestational diabetes identified with the WHO and the modified International Association of Diabetes and Pregnancy Study Groups criteria: a population-based cohort study. Eur J Endocrinol 2012; 166: 317–324.

    Article  CAS  Google Scholar 

  16. Jenum AK, Sletner L, Voldner N, Vangen S, Morkrid K, Andersen LF et al. The STORK Groruddalen research programme: a population-based cohort study of gestational diabetes, physical activity and obesity in pregnancy in a multiethnic population. Rationale, methods, study population and participation rates. Scand J Public Health 2010; 38: 60–70.

    Article  Google Scholar 

  17. Volgyi E, Tylavsky FA, Lyytikainen A, Suominen H, Alen M, Cheng S . Assessing body composition with DXA and bioimpedance: effects of obesity, physical activity, and age. Obesity (Silver Spring) 2008; 16: 700–705.

    Article  Google Scholar 

  18. McCarthy EA, Strauss BJ, Walker SP, Permezel M . Determination of maternal body composition in pregnancy and its relevance to perinatal outcomes. Obstet Gynecol Surv 2004; 59: 731–742 (quiz 745–6).

    Article  Google Scholar 

  19. Ulijaszek SJ, Kerr DA . Anthropometric measurement error and the assessment of nutritional status. Br J Nutr 1999; 82: 165–177.

    Article  CAS  Google Scholar 

  20. Sletner L, Nakstad B, Yajnik CS, Mørkrid K, Vangen S, Vårdal MH et al. Ethnic differences in neonatal body composition in a multi-ethnic population and the impact of parental factors: a population-based cohort study. PLoS One 2013; 8: e73058.

    Article  CAS  Google Scholar 

  21. Mørkrid K, Jenum AK, Sletner L, Vårdal MH, Waage CW, Nakstad B et al. Failure to increase insulin secretory capacity during pregnancy-induced insulin resistance is associated with ethnicity and gestational diabetes. Eur J Endocrinol 2012; 167: 579–588.

    Article  Google Scholar 

  22. Petry CJ . Gestational diabetes: risk factors and recent advances in its genetics and treatment. Br J Nutr 2010; 104: 775–787.

    Article  CAS  Google Scholar 

  23. Martin AM, Berger H, Nisenbaum R, Lausman AY, MacGarvie S, Crerar C et al. Abdominal visceral adiposity in the first trimester predicts glucose intolerance in later pregnancy. Diabetes Care 2009; 32: 1308–1310.

    Article  Google Scholar 

  24. Suresh A, Liu A, Poulton A, Quinton A, Amer Z, Mongelli M et al. Comparison of maternal abdominal subcutaneous fat thickness and body mass index as markers for pregnancy outcomes: a stratified cohort study. Aust N Z J Obstet Gynaecol 2012; 52: 420–426.

    Article  Google Scholar 

  25. Brisson D, Perron P, Guay SP, Gaudet D, Bouchard L . The ‘hypertriglyceridemic waist’ phenotype and glucose intolerance in pregnancy. CMAJ 2010; 182: E722–E725.

    Article  Google Scholar 

  26. Bhopal RS . A four-stage model explaining the higher risk of Type 2 diabetes mellitus in South Asians compared with European populations. Diabet Med 2013; 30: 35–42.

    Article  CAS  Google Scholar 

  27. Sniderman AD, Bhopal R, Prabhakaran D, Sarrafzadegan N, Tchernof A . Why might South Asians be so susceptible to central obesity and its atherogenic consequences? The adipose tissue overflow hypothesis. Int J Epidemiol 2007; 36: 220–225.

    Article  Google Scholar 

  28. Ronnberg AK, Nilsson K . Interventions during pregnancy to reduce excessive gestational weight gain: a systematic review assessing current clinical evidence using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) system. BJOG 2010; 117: 1327–1334.

    Article  CAS  Google Scholar 

  29. Thangaratinam S, Rogozinska E, Jolly K, Glinkowski S, Roseboom T, Tomlinson JW et al. Effects of interventions in pregnancy on maternal weight and obstetric outcomes: meta-analysis of randomised evidence. Br Med J 2012; 344: e2088.

    Article  CAS  Google Scholar 

  30. Oteng-Ntim E, Varma R, Croker H, Poston L, Doyle P . Lifestyle interventions for overweight and obese pregnant women to improve pregnancy outcome: systematic review and meta-analysis. BMC Med 2012; 10: 47.

    Article  Google Scholar 

  31. Gould Rothberg BE, Magriples U, Kershaw TS, Rising SS, Ickovics JR . Gestational weight gain and subsequent postpartum weight loss among young, low-income, ethnic minority women. Am J Obstet Gynecol 2011; 204: 52 e1–11.

    Article  Google Scholar 

  32. Deurenberg P, Deurenberg-Yap M, Guricci S . Asians are different from Caucasians and from each other in their body mass index/body fat per cent relationship. Obes Rev 2002; 3: 141–146.

    Article  CAS  Google Scholar 

  33. Committee A-PS, Bassett J, Organization WH, Obesity IAftSo, Institute ID, Force IOT. The Asia-Pacific Perspective: Redefining Obesity and Its Treatment. Health Communications: Australia, 2000.

    Google Scholar 

  34. Boffetta P, McLerran D, Chen Y, Inoue M, Sinha R, He J et al. Body mass index and diabetes in Asia: a cross-sectional pooled analysis of 900 000 individuals in the Asia cohort consortium. PLoS One 2011; 6: e19930.

    Article  CAS  Google Scholar 

Download references

Acknowledgements

The STORK Groruddalen study was funded by the Norwegian Research Council, the South-Eastern Norway Regional Health Authority, the Norwegian Directorate of Health and collaborative partners in the city of Oslo, Stovner, Grorud and Bjerke administrative districts.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to C Sommer.

Ethics declarations

Competing interests

The authors declare no conflict of interest.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Sommer, C., Mørkrid, K., Jenum, A. et al. Weight gain, total fat gain and regional fat gain during pregnancy and the association with gestational diabetes: a population-based cohort study. Int J Obes 38, 76–81 (2014). https://doi.org/10.1038/ijo.2013.185

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/ijo.2013.185

Keywords

This article is cited by

Search

Quick links