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. 2025 Mar 18;23(1):165.
doi: 10.1186/s12916-025-03992-5.

Reconsideration of lowering gestational weight gain guidelines in pregnant women diagnosed with gestational diabetes: evidence from a Belgian study

Katrien Benhalima #  1   2 , Caro Minschart #  3 , Ina Geerts  4 , Lieveke Ameye  5   6 , Bart Van Der Schueren  3   4 , Roland Devlieger  5   7   8 , Annick Bogaerts  9   10   11 , Chantal Mathieu  3   4
Affiliations

Reconsideration of lowering gestational weight gain guidelines in pregnant women diagnosed with gestational diabetes: evidence from a Belgian study

Katrien Benhalima et al. BMC Med. .

Abstract

Background: The suitability of the United States National Academy of Medicine guidelines for gestational weight gain in women with gestational diabetes remains uncertain, raising global concerns. This study aimed to evaluate the association of gestational weight gain with pregnancy and birth outcomes and to determine optimal ranges for gestational weight gain per pre-pregnancy body mass index category in women with gestational diabetes.

Methods: An epidemiological analysis between 2009-2018 analyzed a large Belgian cohort of singleton pregnancies with gestational diabetes and gestational age 38-40 weeks. Multivariate logistic regression assessed associations between gestational weight gain and relevant pregnancy and birth outcomes, with and without adjustment for confounding variables, including maternal age, origin, education, mode of conception, parity, gestational age at delivery, social deprivation, and year of delivery. Potential optimal weight gain ranges were calculated by minimizing the combined risk of small- and large-for-gestational-age infants (SGA, LGA).

Results: A total of 13,060 women with gestational diabetes were included. Compared to recommended weight gain, gestational weight gain above guidelines occurred in 26.9% and was associated with an increased risk of gestational hypertension (aOR 1.41, 95% CI 1.20-1.66, p < 0.001), emergency caesarean section (aOR 1.45, 95% CI 1.25-1.69, p < 0.001), LGA infants (aOR 1.84, 95% CI 1.63-2.08, p < 0.001), and macrosomia (aOR 1.78, 95% CI 1.55-2.04, p < 0.001). Weight gain less than recommended (40.2%) was associated with a decreased risk of gestational hypertension (aOR 0.81, 95% CI 0.69-0.96, p = 0.015), LGA infants (aOR 0.58, 95% CI 0.50-0.66, p < 0.001), and macrosomia (aOR 0.57, 95% CI 0.49-0.65, p < 0.001), but at the expense of an increased risk of SGA infants (aOR 1.68, 95% CI 1.45-1.96, p < 0.001) and low birth weight (aOR 2.28, 95% CI 1.57-3.32, p < 0.001). Based on current analysis, the optimal ranges for gestational weight gain would be 9 to 14 kg for women with a normal weight, 1 to 9 kg for women with overweight, and -7 to 1 kg for women with obesity.

Conclusions: This Belgian study suggests that optimal gestational weight gain for singleton at-term pregnancies complicated by gestational diabetes should be lower than current recommendations, highlighting the need to reevaluate gestational weight gain guidelines in this context.

Keywords: Gestational diabetes mellitus; Gestational weight gain; National Academy of Medicine guidelines; Pregnancy; Recommendations.

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Conflict of interest statement

Declarations. Ethics approval and consent to participate: As this study was based on database research of data collected as part of routine care for quality control, no ethics approval was needed. Consent for publication: Not applicable. Competing interests: KB reports research funding and receipt of study devices from Medtronic for the investigator-initiated CRISTAL study, receipt of study devices from Dexcom, received study medication of Novo Nordisk for the investigator-initiated SERENA study, received consulting fees from Astrazeneca and Lilly, and served on the speaker bureau for Novo Nordisk, AstraZeneca and Mundipharma. RD reports receiving consulting fees from Metagenics, Procter & Gamble Company and Janssen Pharmaceutics and served on the speaker bureau for Metagenics, Procter & Gamble Company and Janssen Pharmaceutics. AB reports research support for analyzing epidemiological data (2023-2024) from Novo Nordisk. CM2 serves or has served on the advisory panel for Novo Nordisk, Sanofi, Eli Lilly and Company, Novartis, Boehringer Ingelheim, Roche, Medtronic, Imcyse, Insulet, Biomea Fusion and Vertex. Financial compensation for these activities has been received by KU Leuven; KU Leuven has received research support for CM2 from Medtronic, Imcyse, Novo Nordisk, Sanofi and ActoBio Therapeutics; CM2 serves or has served on the speakers bureau for Novo Nordisk, Sanofi, Eli Lilly and Company, Medtronic and Boehringer Ingelheim. Financial compensation for these activities has been received by KU Leuven. CM2 is president of EASD. All external support of EASD is to be found on www.easd.org. All disclosures are unrelated to the present work.

Figures

Fig. 1
Fig. 1
Predicted probabilities of selected adverse outcomes in relation to GWG for the different BMI categories. (A Normal; B Overweight; C Obese). Abbreviations: BMI: body mass index; GWG: gestational weight gain, CS: caesarean section, SGA: small-for-gestational-age, LGA: large-for-gestational-age, LBW: low birth weight. The predicted probabilities were calculated for a multiparous White woman of 30 years, with a secondary education degree and no social deprivation, with spontaneous conception, gestational age of 39 weeks at delivery in 2018
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