Is birth weight modified during pregnancy? Using sibling differences to understand the impact of blood glucose, obesity, and maternal weight gain in gestational diabetes

Objective The purpose of this study was to examine the extent to which blood glucose, obesity, and maternal weight gain explains differences in birth weight using offspring sibling pairs in gestational diabetes mellitus (GDM). Study design A retrospective analysis of 90 women with at least 2 GDM pregnancies was conducted. A fixed effects model was used to examine differences between siblings of the same mother (within-women), and results were contrasted with a multivariable regression model that compared different mothers (between-women). Results Higher maternal weight gain was significantly associated with increased birth weight within mothers, but not between different women. Conversely, overweight status (body mass index [BMI] ≥25) was significant between-mothers, but not within an individual motherʹs pregnancies. One-hour postprandial glucose was significant between-mothers, with a weaker association within-mothers. There was no association between fasting glucose and birth weight in either analysis. Conclusion Controlling pregnancy weight gain may reduce offspring birth weight in individual women with GDM, while the association between high birth weight and elevated prepregnancy BMI may represent a predisposition to both characteristics.