ABSTRACT
This chapter discusses optimal weight gain during pregnancy in women with diabetes. Most data on optimal weight gain concern the general pregnant population, with specific data on maternal diabetes generally lacking. Weight gain should especially be restricted in obese women, since excessive weight gain hampers an already impaired outcome. Fetal macrosomia in women with diabetes depends on many factors, such as genetics and epigenetics, prepregnancy body mass index, glucose control during pregnancy, and gestational weight gain. Good glucose control in early pregnancy is associated with an increase in macrosomia, probably due to a better placentation, whereas a good control late in pregnancy decreases the risk. In women with preexisting diabetes or gestational diabetes mellitus, the incidence of fetal macrosomia is high, and macrosomia is one of the key factors important for childhood and later obesity and metabolic syndrome. Weight gain in pregnancy should regularly be assessed, and in the case of weight gain, appropriate dietary advices should be given.
