Third-Trimester Energy-Restriction or Weight Loss and Maternal and Child Body Composition One Year Postnatally After a Pregnancy With Gestational Diabetes: Results From the DiGest Follow-up Study

OBJECTIVE: Energy restriction and weight loss are evidence-based, safe, and well-tolerated methods for lowering glycemia in type 2 diabetes. We assessed if imposed energy restriction or natural weight loss in the third trimester in women with gestational diabetes was associated with maternal and offspring weight postnatally. RESEARCH DESIGN AND METHODS: Women with gestational diabetes and BMI ≥25 kg/m2 were randomized to a standard- (2,000 kcal/day) or reduced-energy (1,200 kcal/day) diet from ∼29 to -36 weeks' gestation, with follow-up to 12 months postnatally. We performed both trial and cohort analyses, using adjusted linear and logistic regression and a Super-Imposition by Translation and Rotation model. RESULTS: Allocation to energy restriction did not alter antenatal or postnatal growth, with infants in both randomized groups having normal weight for age throughout the first year of life. In cohort analysis, women who lost weight in pregnancy (average loss of 3 kg) had lower adjusted weight at 3 but not 12 months. Infants exposed to pregnancy weight loss had lower risk of large-for-gestational age at birth and lower fat mass at 3 months, and no higher prevalence of low infant weight (<5% had weight for age < -2 SD). Infants exposed to weight loss in pregnancy showed no evidence of growth faltering or excessive catch-up or catch-down growth. CONCLUSIONS: Among women with gestational diabetes and high BMI, energy restriction or weight loss in pregnancy were associated with no adverse effects on offspring weight or growth in the first year. Future work will assess associations with child obesity at 3 years.