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Gestational Diabetes Research and Management · Journal article
Acta Obstetricia Et Gynecologica Scandinavica · August 12, 2026
Encouraging direction, but not yet definitive.
In a prospective cohort of 163 Norwegian women with pregestational BMI ≥35 kg/m², HbA1C at week 36 and weekly gestational weight gain were positively associated with birthweight z-score, biparietal diameter, and mean abdominal diameter in adjusted analyses. The study identifies modifiable factors potentially relevant to fetal growth in obesity but does not establish causality and lacks comparison to non-obese women or intervention validation.
Prospective longitudinal cohort study. 163 pregnant women with pregestational BMI ≥35 kg/m², singleton pregnancy, nulliparous 47.6%; type 1 and 2 diabetes excluded; enrolled 2016–2019.. Intervention: Observation of gestational weight gain and HbA1C measured at week 18 and week 36 in relation to fetal growth and birthweight. n = 163. Department of Gynecology and Obstetrics, Drammen Hospital, Norway.
Mean birthweight z-score was within normal range (0.117) but 18.4% were LGA and 12.9% were SGA One in three women diagnosed with GDM; approximately one in three of those needed medical treatment HbA1C measured at gestational week 36 remained positively associated with birthweight z-score, biparietal diameter, and mean abdominal diameter in adjusted multivariate analyses
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Clinicians managing obese pregnant women may consider HbA1C and gestational weight gain as modifiable factors associated with fetal growth, though the authors note current follow-up protocols do not routinely emphasize these measures. The findings are preliminary and require prospective validation before changing clinical practice.
A prospective longitudinal cohort study in a well-defined population with clear statistical analysis showing associations between HbA1C, gestational weight gain, and fetal growth markers, but limited by single-centre design, lack of comparator group, and surrogate endpoints rather than hard clinical outcomes.
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Clinicians managing obese pregnant women may consider HbA1C and gestational weight gain as modifiable factors associated with fetal growth, though the authors note current follow-up protocols do not routinely emphasize these measures. The findings are preliminary and require prospective validation before changing clinical practice.
Graded across the dimensions that decide whether you should act, each from what the source actually supports. There is no single score, and where a dimension was not assessed it says so.
Abstract Introduction Fetal growth and birthweight are influenced by various endogenous and exogenous factors during pregnancy. Pregnant women with obesity face higher rates of complications, which can impact fetal growth. This study aims to explore how gestational weight gain and metabolic factors, such as HbA1C and adipokines, are associated with fetal growth in the second and third trimesters and with birthweight in Norwegian women with a pregestational BMI ≥35 kg/m 2. Material and Methods We conducted a prospective longitudinal cohort study at the Department of Gynecology and Obstetrics at Drammen Hospital from 2016 to 2019. We included 163 pregnant women (nulliparous 47.6%) with pregestational BMI ≥35 kg/m 2 and singleton pregnancy, excluding type 1 and 2 diabetes. Gestational weight gain (GWG) was calculated as the difference between pregestational weight and the last weight before delivery. Fetal growth was monitored via ultrasonography at five time points, alongside fasting metabolic samples withdrawn around 18 and 36 weeks' gestation. Statistical analyses were conducted using linear regression in Stata Version 17.0. Results Mean birthweight was within normal ranges (mean z ‐score 0.117). However, the proportions of LGA (18.4%) and SGA (12.9%) were high. One in three women was diagnosed with GDM, of whom approximately one in three needed medical treatment. In the adjusted multivariate analyses, only HbA1C measured around gestational week 36 and the weekly weight gain remained positively associated with birthweight, biparietal diameter, and mean abdominal diameter. Conclusions In this population of pregnant women with pBMI ≥35 kg/m 2, weekly GWG calculated from weight measurement around 36 weeks' gestation was positively associated with birthweight ( z ‐score), mean abdominal diameter (MAD), and biparietal diameter (BPD). HbA1C was positively associated with birthweight ( z ‐score). Our results indicate that HbA1C and the modifiable GWG are exposures with the potential to influence fetal growth and birthweight. Nevertheless, current follow‐up protocols do not routinely emphasize these factors. Their evaluation therefore warrants further investigation.
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