Early gestational weight gains within current recommendations result in increased risk of gestational diabetes mellitus among Korean women.

Background: We prospectively assessed whether maternal weight gain at 24-28 weeks of gestation (MWG24) influences the risk of developing gestational complications, such as gestational diabetes mellitus (GDM) and other adverse pregnancy outcomes, in pregnant Korean women.

Methods: Maternal weight gain from self-reported pre-pregnancy weight until 24-28 weeks of gestation was measured in 731 pregnant women, and an expected MWG24 was determined using the Institute of Medicine 2009 guidelines. Glucose tolerance, insulin resistance, insulin secretory capacity, anthropometric measurements, lipid profiles, nutrient intakes and pregnancy outcomes were evaluated at 24-28 weeks of gestation. The adjusted odds ratios (ORs) for GDM, large-for-gestational-age infants, small-for-gestational-age infants and preterm delivery were determined according to maternal weight gain by logistic regression analysis after adjusting for covariates.

Results: Compared with a normal MWG24, an inadequate MWG24 reduced the OR (0.565) for GDM, but an excessive MWG24 did not affect the OR (0.854). However, ORs for preterm delivery were significantly higher in both inadequate and excessive MWG24 groups in comparison with the normal MWG24. There were no other adverse pregnancy outcomes due to the inadequate MWG24. MWG24 was not associated with a significant increase in ORs for delivering large-for-gestational-age or small-for-gestational-age infants or delivery by caesarean section. Although energy intake was less than the estimated energy requirement in all groups, MWG24 was linearly associated with energy intake such that energy balance was positive in the excessive MWG24 group.

Conclusions: This study suggests that both target weight gain and energy intake recommendations for early pregnancy may not be optimal for Korean women and that race-specific recommendations are needed to decrease the risk of GDM without increasing adverse pregnancy outcomes.