Comparison of three gestational weight gain guidelines for adverse pregnancy outcomes in Chinese women with gestational diabetes: A cohort study.

Abstract

Background: This study aimed to assess the associations between post-diagnostic gestational weight gain (GWG) and adverse pregnancy outcomes among women with gestational diabetes mellitus (GDM) and to systematically compare the predictive performance of three mainstream GWG guidelines (IOM-2009, CNS-2021, NHCC-2023), so as to provide real-world evidence for precise GWG management in clinical GDM care.

Methods: This retrospective population-based study was conducted utilizing the standardized prenatal surveillance system in Tianjin, China. Women with GDM were stratified into insufficient, appropriate, and excessive GWG groups according to the IOM-2009, CNS-2021, and NHCC-2023 criteria. Independent associations of abnormal GWG with adverse perinatal outcomes were analyzed using independent t-tests, chi-squared tests, and multivariable logistic regression models in SPSS 26.0.

Results: A total of 69,859 pregnant women were enrolled in the present study, including 7,198 women diagnosed with GDM. The NHCC-2023 guideline identified the highest proportion of excessive GWG (56.6%), compared with CNS-2021 (52.7%) and IOM-2009 (53.3%). Notably, only NHCC-2023 revealed a significant bidirectional association between GWG and PE risk: insufficient GWG (OR = 1.512, 95% CI: 1.057-2.162) and excessive GWG (OR = 2.449, 95% CI: 1.844-3.253) were both independently correlated with higher PE susceptibility. Excessive postdiagnostic GWG was associated with elevated risks of cesarean section and large for gestational age (LGA) infants across all three guideline frameworks, while associations for preterm birth and small-for-gestational-age (SGA) varied by guideline criteria.

Conclusions: The GDM-specific NHCC-2023 guideline supports precise, population-tailored GWG management for Chinese women with GDM and holds promising clinical applicability for Asian GDM populations.