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Comment & Response
July 8, 2019

Implications of Gestational Weight Gain in Studies of Gestational Diabetes—Reply

Author Affiliations
  • 1Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
  • 2Center for Molecular Medicine, Karolinska University Hospital, Stockholm, Sweden
  • 3National Institute for Health and Welfare, Helsinki, Finland
  • 4Division of Family Medicine, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
  • 5Research Centre for Child Psychiatry, University of Turku, Turku, Finland
JAMA Pediatr. Published online July 8, 2019. doi:10.1001/jamapediatrics.2019.2192

In Reply The Letter to the Editor by Pitocco et al states that the study by Kong et al1 on associations between maternal diabetes disorders and offspring being large for gestation age (LGA) and/or preterm birth would have been improved by the consideration of maternal self-reported prepregnancy weight. Indeed, in our study,1 we stratified the association analyses by self-reported prepregnancy body mass index (BMI) and found that the BMI influenced the association for maternal type 2 diabetes and gestational diabetes to the offspring LGA. Pitocco et al also commented that it would have been appropriate to also consider gestation weight gain (GWG) in our article.1 We fully agree with that statement. Excessive gestational weight gain (GWG) is not only associated with maternal complications, including gestational diabetes (GDM), gestational hypertension, preeclampsia, cesarean delivery, labor induction, but also with fetal adverse outcomes, such as macrosomia, prematurity, stillbirth, and congenital abnormalities.2,3 Further, inadequate weight gain during pregnancy will lead to preterm delivery and low birth weight.4 Unfortunately, GWG was not available to our study.1 Therefore, we mentioned the lack of GWG as a limitation.1 Thus, further research is warranted to estimate the associations between GWG, stratified by maternal prepregnancy BMI and diabetes, and increased LGA risks, which might support counseling for pregnant women to control GWG.

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