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OCR for page 329
Weight Gain During Pregnancy: Reexaming the Guidelines
APPENDIX C
Supplementary Information on Composition and Components of Gestational Weight Gain
Tables C-1 through C-6 summarize literature and data that are referenced and/or support the discussion in Chapter 3, Composition and Components of Gestational Weight Gain: Physiology and Metabolism.
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Weight Gain During Pregnancy: Reexaming the Guidelines
STUDIES ON COMPOSITION AND COMPONENTS OF GESTATIONAL GAIN: PHYSIOLOGY AND METABOLISM
TABLE C-1A Maternal Weight Gain in Singleton Pregnancies (by trimester and total weight gain)
Study Description
Population Characteristics
Study Criteria
Weight Gain by Trimester
Total Weight Gain
1st
2nd
3rd
Author, year:
Abrams et al., 1995
Total Study N:
10,418
By ethnicity:
Hispanic
0.15 kg/wk
0.54 kg/wk
0.54 kg/wk
White
0.19 kg/wk
0.58 kg/wk
0.52 kg/wk
Black
0.21 kg/wk
0.52 kg/wk
0.49 kg/wk
Asian
0.11 kg/wk
0.56 kg/wk
0.52 kg/wk
Country:
USA
Other
0.14 kg/wk
0.56 kg/wk
0.52 kg/wk
By BMI:
Low BMI
0.15 kg/wk
0.57 kg/wk
0.49 kg/wk
Ideal BMI
0.18 kg/wk
0.58 kg/wk
0.53 kg/wk
High BMI
0.18 kg/wk
0.51 kg/wk
0.51 kg/wk
Obese
0.14 kg/wk
0.41 kg/wk
0.49 kg/wk
By fetal size:
SGA
0.13 kg/wk
0.48 kg/wk
0.48 kg/wk
AGA
0.17 kg/wk
0.56 kg/wk
0.52 kg/wk
LGA
0.22 kg/wk
0.62 kg/wk
0.57 kg/wk
Author, year:
Abrams and Selvin, 1995
Total Study N:
2,994
2.1 kg
7.7 kg
6.6 kg
16.7 kg
Group Description:
White non-obese women
Country:
USA
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Weight Gain During Pregnancy: Reexaming the Guidelines
Author, year:
Abrams et al., 1989
Total Study N:
2,163
Preterm deliveries (n = 118)
11 kg (0.33 kg/wk)
Term deliveries (n = 2,045)
14.5 kg (0.39 kg/wk)
Group Description:
Women at high risk for nutritional problems during pregnancy
Country:
USA
Author, year:
Amador et al., 2008
Total Study N:
220
Obese (n = 110)
7.4 kg
Non-obese (n = 110)
9.4 kg
Country:
Mexico
Author, year:
Bianco et al., 1998*
Total Study N:
11,926
Mean:
Morbidly obese (n = 613)
9.1 kg
Non-obese (n = 11,313)
14.2 kg
Group Description:
Women
Country:
USA
Author, year:
Carmichael et al., 1997
Total Study N:
4,218
Mean:
Mean:
Mean:
Underweight
1.92 kg
0.57 kg/wk
0.48 kg/wk
Group Description:
Women with good pregnancy outcomes
Normal weight
2.19 kg
0.58 kg/wk
0.51 kg/wk
Overweight
2.16 kg
0.51 kg/wk
0.49 kg/wk
Country:
USA
Obese
1.65 kg
0.41 kg/wk
0.47 kg/wk
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Weight Gain During Pregnancy: Reexaming the Guidelines
Study Description
Population Characteristics
Study Criteria
Weight Gain by Trimester
Total Weight Gain
1st
2nd
3rd
Author, year:
Catalano et al., 1993
Total Study N:
390
Women with GDM (n = 78)
12.6 kg
Controls (n = 312)
15.0 kg
Underweight
Country:
USA
GDM (n = 15)
0.24 kg/wk
0.35 kg/wk
0.34 kg/wk
12.2 kg
Control (n = 92)
0.28 kg/wk
0.38 kg/wk
0.39 kg/wk
15.0 kg
Average weight
GDM (n = 34)
0.29 kg/wk
0.42 kg/wk
0.39 kg/wk
14.6 kg
Control (n = 172)
0.35 kg/wk
0.40 kg/wk
0.40 kg/wk
15.2 kg
Overweight
GDM (n = 29)
0.27 kg/wk
0.32 kg/wk
0.30 kg/wk
10.5 kg
Control (n = 48)
0.28 kg/wk
0.36 kg/wk
0.37 kg/wk
14.1 kg
Author, year:
Cedergren, 2006*
Total Study N:
245,526
BMI < 20
13.5 kg
BMI 20-24.9
13.8 kg
BMI 25-29.9
13.2 kg
BMI 30-34.9
11.1 kg
BMI > 35
8.7 kg
Country:
Sweden
Author, year:
Claesson et al., 2008
Total Study N:
348
Obese (n = 155)
8.7 kg
Controls (n = 193)
11.3 kg
Adjusted:
7.5 kg
9.8 kg
Country:
Sweden
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Weight Gain During Pregnancy: Reexaming the Guidelines
Author, year:
Gunderson et al., 2001*
Total Study N:
985
Pregravid BMI:
Hispanic:
White:
Black:
Asian:
Underweight (n = 266)
12.1 kg
12.6 kg
13.5 kg
12.1 kg
Group Description:
Healthy women
Normal (n = 595)
12.9 kg
13.2 kg
13.8 kg
11.8 kg
Overweight (n = 71)
13.5 kg
14.7 kg
14.3 kg
13.4 kg
Obese (n = 53)
11.0 kg
10.6 kg
10.9 kg
11.9 kg
Country:
USA
Race/ethnicity:
Hispanic (n = 130)
White (n = 532)
Black (n = 100)
Asian (n = 223)
Author, year:
Hediger et al., 1989
Total Study N:
1,790
Total (n = 1,790)
7.29 kg
7.46 kg
14.75 kg
Adequate gain (n = 955)
9.12 kg
9.26 kg
18.38 kg
Early inadequate (n = 304)
1.89 kg
8.89 kg
10.78 kg
Group Description:
Adolescents
Late inadequate (n = 387)
8.94 kg
3.27 kg
12.21kg
Country:
USA (Camden, NJ)
Both inadequate (n = 144)
2.18 kg
3.69 kg
5.87 kg
(early gain, 0-24 wks)
(late gain, 24 wks-delivery)
(0-delivery)
Author, year:
Hickey et al., 1995
Total Study N:
1,015
Black women, pregravid BMI:
Group Description:
Non-obese low-income black and white women
Low BMI (n = 255)
2.61 kg
0.49 kg/wk
0.46 kg/wk
Normal BMI (n = 422)
2.54 kg
0.46 kg/wk
0.45 kg/wk
Country:
USA
White women, pregravid BMI:
Low BMI (n = 143)
2.93 kg
0.52 kg/wk
0.42 kg/wk
Normal BMI (n = 195)
1.81 kg
0.52 kg/wk
0.45 kg/wk
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Weight Gain During Pregnancy: Reexaming the Guidelines
Study Description
Population Characteristics
Study Criteria
Weight Gain by Trimester
Total Weight Gain
1st
2nd
3rd
Author, year:
Johnston et al., 1992
Total Study N:
272
Adolescents (n = 123)
15.4 kg
Adults (n = 149)
14.4 kg
(39.6 wks gestation)
Group Description:
Middle class, upper class
Country:
USA
Author, year:
Kinnunen et al., 2007
Total Study N:
132
Intervention (n = 48)
14.6 kg
Control (n = 56)
14.3 kg
Group Description:
Primiparas
Country:
Finland
Author, year:
Kramer et al., 1992
Total Study N:
9,742
Mean prepregnancy BMI:
14.5 kg
22.1 kg/m2
(0.37 kg/wk)
Group Description:
Mostly Canadian-born, Caucasians
Time of delivery:
≥ 37 weeks
14.6 kg
< 37 weeks
12.5 kg
< 34 weeks
9.9 kg
< 32 weeks
9.1 kg
Author, year:
Lawton et al., 1988
Total Study N:
334
Delivered SGA infant (n = 30)
0.99 kg
12.6 kg
Delivered AGA infant (n = 128)
1.95 kg (gain between 28-32 weeks)
12.8 kg
Group Description: Predominantly white women
Country:
UK
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Weight Gain During Pregnancy: Reexaming the Guidelines
Author, year:
Loris et al., 1985
Total Study N:
145
Pregravid weight/height:
75%-90% ideal weight (n = 25)
16 kg
Group Description:
Teens, aged 13-19 years Delivered at term
91%-110% ideal weight (n = 68)
18 kg
Country:
USA
111%-166% ideal weight (n = 28)
17 kg
Author, year:
Muscati et al., 1996*
Total Study N:
371
Normal weight (90-120% of standard pregravid wt/ht)
0-20 wks:
21-30 wks:
31-term:
Group Description:
Healthy, white, nonsmoking women
PPWR < median
3.8 kg
5.3 kg
4.1 kg
13.2 kg
PPWR ≥ median
7.1 kg
6.8 kg
6.2 kg
20.2 kg
Country:
Canada
Underweight (< 90% of standard pregravid wt/ht)
PPWR < median
3.8 kg
5.4 kg
4.1 kg
13.3 kg
PPWR ≥ median
7.1 kg
6.4 kg
6.1 kg
19.6 kg
Overweight (> 120% of standard pregravid wt/ht)
PPWR < median
1.4 kg
4.5 kg
3.7 kg
9.6 kg
PPWR ≥ median
7.6 kg
6.2 kg
5.3 kg
19.1 kg
Author, year:
Oken et al., 2007*
Total Study N:
1,044
Prepregnancy BMI:
< 19.8 (n = 124)
15.7 kg
19.8-26.0 (n = 622)
16.4 kg
26.1-29.0 (n = 134)
15.3 kg
> 29.0 (n = 164)
13.1 kg
Country:
USA
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Weight Gain During Pregnancy: Reexaming the Guidelines
Study Description
Population Characteristics
Study Criteria
Weight Gain by Trimester
Total Weight Gain
1st
2nd
3rd
Author, year:
Rees et al., 1992
Total Study N:
459
Birth weight:
< 3,000 g (n = 88)
0.50 kg/wk
13.8 kg
Group Description:
Adolescents
3,000-4,000 g (n = 274)
0.58 kg/wk
16.6 kg
Country:
USA
Author, year:
Rosso, 1985
Total Study N:
262
Prepregnancy weight:
Group Description:
Mostly black (51%) and Hispanic (41%) women
Underweight, < 89% standard weight (n = 62)
12 kg
Country:
USA
Normal, 90-110% standard weight (n = 137)
10 kg
Overweight, > 111% standard weight (n = 63)
7 kg
Author, year:
Schieve et al., 1999*
Total Study N:
266,172
Mean:
Mean:
Low BMI (n = 45,142)
0.39 kg/wk
15.2 kg
Group Description:
Low income women
Average BMI (n = 135,390)
0.38 kg/wk
15.0 kg
High BMI (n = 33,697)
0.35 kg/wk
13.8 kg
Obese (n = 51,943)
0.29 kg/wk
11.6 kg
Country:
USA
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Weight Gain During Pregnancy: Reexaming the Guidelines
Author, year:
Scholl et al., 1988
Total Study N:
696
Prepregnant relative weight (% ideal):
Group Description:
Adolescents; Delivered at 37 weeks or more gestation
Underweight, < 90% (n = 183)
14.5 kg
Country:
USA
Ideal, 90-119% (n = 397)
14.6 kg
Overweight, ≥ 120% (n = 116)
14.7 kg
Author, year:
Scholl et al., 1995*
Total Study N:
274
Low gain
10.2 kg
< 34 kg/wk (n = 59)
Group Description:
Low SES 12-29 years
Moderate gain (n = 138)
13.3 kg
Country:
USA
Excessive gain
20.0 kg
> 0.68 kg/wk (n = 77)
Author, year:
Segel and McAnarney, 1994
Total Study N:
55
Rapid gain (n = 30)
> 0.40 kg/wk
Average gain (n = 15)
0.23-0.40 kg/wk
Group Description:
Teens, Black
Slow gain (n = 10)
< 0.23 kg/wk
Country:
USA
Author, year:
Siega-Riz et al., 1994*
Total Study N:
8,736
BMI < 19.8
1.60 kg
0.57 kg/wk
0.52 kg/wk
BMI 19.8-26
1.03 kg
0.56 kg/wk
0.54 kg/wk
BMI 26-29
0.74 kg
0.49 kg/wk
0.51 kg/wk
BMI > 30
0.78 kg
0.43 kg/wk
0.52 kg/wk
Country:
USA
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Weight Gain During Pregnancy: Reexaming the Guidelines
Study Description
Population Characteristics
Study Criteria
Weight Gain by Trimester
Total Weight Gain
1st
2nd
3rd
Author, year:
Siega-Riz et al., 1996
Total Study N:
9,651
Preterm deliveries (n = 517)
1.4 kg
0.51 kg/wk
0.50 kg/wk
Term deliveries (n = 7,072)
1.2 kg
0.53 kg/wk
0.53 kg/wk
Group Description:
80% Hispanic
Country:
USA
Author, year:
Stevens-Simon and McAnarney, 1992*
Total Study N:
141
Weight Gain:
Slow, < 0.28 kg/wk (n = 23)
0.16 kg/wk
6.50 kg
Group Description:
Teens, Black
Average, 0.28-0.45 kg/wk (n = 87)
0.32 kg/wk
13.3 kg
Rapid, > 0.45 kg/wk (n = 31)
0.56 kg/wk
22.7 kg
Country:
USA
Author, year:
Soltani and Fraser, 2000*
Total Study N:
77
Normal weight (n = 29)
11.0 kg
Overweight (n = 23)
11.9 kg
Obese (n = 25)
9.7 kg
Country:
UK
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Weight Gain During Pregnancy: Reexaming the Guidelines
Author, year:
Takimoto, 2006*
Total Study N:
46,659
9.9 kg
Group Description:
Low risk deliveries
Country:
Japan
Author, year:
Tsukamoto et al., 2007
Total Study N:
3,071
BMI < 18 (n = 493)
10.5 kg
BMI 18-24 (n = 2,301)
9.8 kg
BMI > 24.0 (n = 277)
6.6 kg
Country:
Japan
Author, year:
Villamor et al., 1998
Total Study N:
432
Maternal Height
Predicted weight gain (mean):
140-155 cm
0.39 kg/wk
156-160 cm
0.48 kg/wk
161-165 cm
0.44 kg/wk
166-170 cm
0.47 kg/wk
Country:
Isreal
171-180 cm
0.69 kg/wk
NOTES: First trimester, 0-13 weeks; Second trimester, 13-26 weeks; Third trimester, 27-40 weeks. PPWR = Postpartum weight retention.
*Indicates that study is included in the systematic literature review conducted by Viswanathan et al., 2008.
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Weight Gain During Pregnancy: Reexaming the Guidelines
Author (Year)
Population/Study Characteristics
Study Criteria
Body Composition Measurements (FFM, FM, TBW)
Author, year:
Kopp-Hoolihan et al., 1999
Total Study N:
9
Body weight
Group Description:
Healthy, non-smokers planning a pregnancy
TBW
TBW/FFM
TBBM
FFM
Country:
USA
FM
Mean wt gain
Mean fat gain % wt as FM
Author, year:
Lederman et al., 1997*
Total Study N:
196
BMI/Gain Categories
Body water gain:
Group Description:
Hispanic, White and Black women
BMI < 19.8
Total (n = 21)
6.1 L
< rec (n = 6)
6.4 L
Country:
USA
Aged 18-35 years
[BC by 4-compartment method]
rec (n = 7)
5.9 L
> rec (n = 8)
6.1 L
BMI 19.8-26
Total (n = 118)
7.0 L
< rec (n = 31)
6.2 L
rec (n = 46)
6.9 L
> rec (n = 41)
7.6 L
BMI > 26-29
Total (n = 29)
7.8 L
< rec (n = 7)
6.9 L
rec (n = 9)
5.7 L
> rec (n = 13)
9.7 L
BMI > 29
Total (n = 28)
7.3 L
< rec (n = 7)
7.8 L
rec (n = 6)
6.0 L
> rec (n = 15)
7.6 L
Author, year:
Lof and Forsum, 2004
Total Study N:
17
Pregnant women
Body weight
Group Description:
Adults
TBW
FFM
FM
[BC by deuterium dilution underwater weighing]
Country:
Sweden
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Weight Gain During Pregnancy: Reexaming the Guidelines
Pregravid Weight/Body Comp
Weight Gain/Body Composition by Trimester
Total Weight Gain
Postpartum Weight/Body Composition
1st
2nd
3rd
8-10 wks
24-26 wks
34-36 wks
4-6 wks
64.7 kg
64.9 kg
72.1 kg
75.9 kg
68.0 kg
33.5 kg
33.9 kg
36.5 kg
39.1 kg
33.8 kg
0.72
0.73
0.74
0.74
0.72
2525 g
—
—
—
2463 g
46.3 kg
46.7 kg
49.7 kg
52.8 kg
46.7 kg
20.2 kg
20.3 kg
24.4 kg
24.3 kg
22.0 kg
—
0.19 kg
7.23 kg
3.76 kg
11.2 kg
—
—
0.10 kg
4.10 kg
−0.10 kg
4.20 kg
—
—
53.00
57.00
−3.00
—
—
Fat gain:
63.4 kg
4.8 kg
12.60 kg
0.6 kg
7.90 kg
6.0 kg
12.60 kg
6.9 kg
16.10 kg
3.9 kg
12.2 kg
1.3 kg
8.60 kg
3.8 kg
12.1 kg
6.0 kg
15.2 kg
2.8 kg
11.0 kg
0.3 kg
8.50 kg
2.8 kg
9.10 kg
4.2 kg
13.6 kg
0.2 kg
8.70 kg
−5.2kg
3.20 kg
−0.6kg
6.9 kg
3.1 kg
12.0 kg
Week 14
Week 32
2 wk pp:
66.6 kg
68.4 kg
77.3 kg
16.7 kg
71.5 kg
31.5 kg
32.5 kg
38.1 kg
33.6 kg
43.9 kg
44.9 kg
51.0 kg
45.7 kg
22.7 kg
23.5 kg
26.3 kg
25.8 kg
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Weight Gain During Pregnancy: Reexaming the Guidelines
Author (Year)
Population/Study Characteristics
Study Criteria
Body Composition Measurements (FFM, FM, TBW)
Author, year:
Okereke et al., 2004
Total Study N:
15
WT
NGT (n = 8)
Group Description:
Obese women
GDM (n = 7)
FFM
NGT
GDM
Country:
USA
FM
NGT
GDM
Author, year:
Stevens-Simon et al., 1997
Total Study N:
108
Teens < 16 yrs
WT
Group Description:
Teens, Black [All weights are net wt Total body potassium]
LBM
FM
Teens 16-18 yrs
WT
Country:
USA
LBM
FM
NOTE: First trimester, 0-13 weeks; Second trimester, 13-26 weeks; Third trimester, 27-40 weeks. GDM = gestational diabetes mellitus; FFM = fat-free mass; FM = fat mass; TBW = total body weigh; NGT = normal glucose tolerance; WT = weight.
*Indicates that study is included in the systematic literature review conducted by Viswanathan et al., 2008.
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Weight Gain During Pregnancy: Reexaming the Guidelines
Pregravid Weight/Body Comp
Weight Gain/Body Composition by Trimester
Total Weight Gain
Postpartum Weight/Body Composition
1st
2nd
3rd
12-14 wks
34-36 wks
71.4 kg
73.2 kg
84.1 kg
78.2 kg
79.6 kg
89.5 kg
49.4 kg
50.1 kg
55.2 kg
51.7 kg
52.1 kg
56.8 kg
22.0 kg
23.1 kg
28.9 kg
26.5 kg
27.5 kg
32.7 kg
15-16 wks
34-35 wks
59.7 kg
61.6 kg
68.3 kg
46.6 kg
50.8 kg
15.0 kg
17.50 kg
61.7 kg
63.9 kg
69.6 kg
47.8 kg
51.2 kg
16.1 kg
18.3 kg
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Weight Gain During Pregnancy: Reexaming the Guidelines
TABLE C-5 Mean Weights and Percentiles for Placentas (singletons, twins, and triplets)
Gestational age (weeks)
90th Percentile
Mean Placental Weight
10th Percentile
Cases (n)
Singletons
Twins
Triplets
Singletons
Twins
Triplets
Singletons
Twins
Triplets
Singletons
Twins
Triplets
19
—
263
—
—
212
—
—
161
—
—
2
—
20
—
270
285
—
218
253
—
166
226
—
3
3
21
172
286
320
143
231
284
114
176
257
3
2
2
22
191
310
345
157
251
319
122
191
289
6
5
2
23
211
343
400
172
276
361
133
210
331
7
2
3
24
233
382
445
189
307
406
145
232
371
9
3
5
25
256
426
498
208
341
456
159
257
408
19
5
6
26
280
475
558
227
380
509
175
284
444
14
4
6
27
305
528
630
248
421
564
192
314
480
9
8
4
28
331
584
697
270
464
621
210
345
516
16
7
5
29
357
641
772
293
509
679
229
377
553
11
12
6
30
384
700
849
316
554
738
249
409
591
12
17
10
31
411
758
925
340
600
797
269
441
631
14
13
15
32
438
815
1,000
364
644
855
290
472
674
24
29
7
33
464
870
1,072
387
687
911
311
503
719
30
27
14
34
491
923
1,139
411
727
965
331
531
768
32
53
43
35
516
971
1,200
434
764
1,017
352
558
821
44
52
33
36
542
1,014
1,253
457
798
1,065
372
582
878
36
66
19
37
566
1,051
1,297
478
827
1,108
391
602
940
32
58
8
38
589
1,082
1,330
499
850
1,147
409
619
1,007
62
54
5
39
611
1,105
—
519
868
—
426
631
—
103
38
—
40
632
1,118
—
537
879
—
442
639
—
193
47
—
41
651
1,123
—
553
882
—
456
642
—
8 7
1 2
—
SOURCES: Pediatric Pathology & Laboratory Medicine by Pinar H., C. J. Sung, C. E. Oyer and D. B. Singer. Copyright 1996 by Informa Clinical Medicine—Journals. Reproduced with permission of Informa Clinical Medicine—Journals via Copyright Clearance Center; Reprinted from Pinar H., M. Stephens, D. B. Singer, T. K. Boyd, S. M. Pflueger, D. L. Gang, D. J. Roberts and C. J. Sung. 2002. Triplet placentas: reference values for weights. Pediatric and Developmental Pathology 5(5): 495-498 with kind permission from Springer Science and Business Media.
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TABLE C-6 DNA, Glycogen, and Lipid Content in Placentas from Normal and Diabetic Human Pregnancies
Pregnancy
Placental Weight (g)
Placental DNA
Placental Glycogen
Placental Lipid Triglycerides
(mg/g)
(g/total placenta)
(mg/g)
(mg/mg DNA)
(g/total placenta)
(μmol/g)
(μmol/mg DNA)
(mmol/total placenta)
Normal (n = 50)
550 ± 28
2.54 ± 0.13
1.40 ± 0.07
8.4 ± 0.5
3.3 ± 0.3
4.67 ± 0.29
2.51 ± 0.16
0.98 ± 0.15
1.38 ± 0.10
Gestational diabetes (n = 23)
664 ± 60
2.58 ± 0.24
1.71a ± 0.12
9.9 ± 0.8
3.8 ± 0.4
6.57a ± 0.60
3.32a ± 0.31
1.29 ± 0.20
2.20a ± 0.25
Insulin-treated diabetes (n = 12)
615 ± 110
3.04 ± 0.32
1.87a ± 0.20
14.9b ± 1.9
4.9a ± 0.3
9.16b ± 0.88
4.56b ± 0.70
1.50 ± 0.16
2.80b ± 0.41
NOTE: Values in the table are means ± SE for number of patients indicated in parentheses.
a Significant difference from value for normal pregnancy (p < 0.05).
b Significant difference from value for normal pregnancy (p < 0.01).
SOURCE: Modified from Diamant et al., 1982. This information was published in the American Journal of Obstetrics and Gynecology, Vol 144, Diamant Y. Z., B. E. Metzger, N. Freinkel and E. Shafrir, Placental lipid and glycogen content in human and experimental diabetes mellitus, Pages 5-11, Copyright Elsevier (1982).
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