Poster Presentation International Association of the Diabetes and Pregnancy Study Groups 2022 - Hosted by ADIPS

Excessive gestational weight gain in women with gestational diabetes is associated with less available Medical Nutritional Therapy: results from a tertiary maternity centre in Western Australia (#111)

Cathy Latino 1 , Emily J Gianatti 2
  1. Department of Dietetics, Fiona Stanley Hospital, Murdoch, WA, Australia
  2. Department of Endocrinology, Fiona Stanley Hospital, Murdoch, WA, Australia

Background:

  • Excessive gestational weight gain (GWG) is a risk factor for adverse maternal and neonatal outcomes.
  • Medical Nutrition Therapy (MNT) which meets the Academy of Nutrition and Dietetics (AND) evidence based guidelines for GDM is known to assist women achieve blood glucose and GWG targets, reduce requirement for insulin, attain a nutritionally adequate dietary intake, and optimise maternal and neonatal outcomes, including rates of Neonatal Intensive Care (NICU) admission.
  • The level of MNT available to women with diet controlled GDM at our site does not meet AND guidelines with resources exhausted managing high numbers of women requiring insulin.

Aim:

  • To identify differences in attainment of GWG targets between women who manage their GDM with diet or insulin.

Method:

  • Digital medical records of consecutive GDM women commencing insulin and remaining on dietary treatment were audited.
  • Data collected included pre-pregnancy weight and Body Mass Index (BMI), weight at each antenatal visit, mode of delivery, birthweight and admission to NICU.
  • Institute of Medicine (IOM) GWG targets were calculated based on pre-pregnancy BMI categories. GWG was assessed as either achieving the target, exceeding or not achieving.
  • Results are presented as percentages due to categorical data with small sample size.

Results:

  • The final sample size was 59, 29 in the insulin treated group (GDM-Insulin) and 30 in the diet treated group (GDM-Diet).
  • Women in GDM-Diet group had on average 1.9 MNT appointments as compared to GDM-Insulin women who had on average 3.3 appointments.
  • A larger percentage of GDM-Diet women started their pregnancy in the healthy weight range (43 % versus 27.5 % of GDM-Insulin group).
  • Of the women who required insulin therapy, 45 % were obese prior to pregnancy, versus 17% of GDM-Diet group.
  • The percentage of women who exceeded GWG targets was 50 % in the GDM-Diet group compared to 28 % of the GDM-Insulin group, consistent with a moderate association (Cramer’s V effect size = 0.25).
  • Admission to NICU [n = 7 (23 %)] was higher for the GDM-Diet group compared to GDM-Insulin [n = 2 (7 %)].
  • Small for Gestational Age was higher in the GDM-Diet group [n = 3 (10 %) vs 0].

Conclusion:

Lower levels of Medical Nutrition Therapy are associated with greater risk of excessive gestational weight gain and poorer outcomes at our site.  Increased education of women regarding appropriate gestational weight gain, increasing monitoring of gestational weight gain and increasing dietetic FTE are priorities for our service.