Original articleResidual risk associations between initial hyperglycemia and adverse pregnancy outcomes in a large cohort including 6709 women with gestational diabetes
Introduction
A decade ago, the International Association of Diabetes and Pregnancy Study Groups (IADPSG) established the now widely adopted diagnostic criteria for gestational diabetes mellitus (GDM), i.e., fasting plasma glucose (PG) ≥ 5.1 mmol/L (92 mg/dL), 1-hr PG ≥ 10.0 mmol/L (180 mg/dL), or 2-hr PG ≥ 8.5 mmol/L (153 mg/dL), measured at a 2-hr 75-g oral glucose tolerance test (OGTT) between 24 and 28 gestational weeks [1], [2], [3], [4], [5]. The PG thresholds included in the IADPSG criteria were derived from the risk associations between hyperglycemia and selected adverse pregnancy outcomes (excess newborn birth weight, cord C-peptide, neonatal hypoglycemia, and percent body fat). These associations were initially quantified in the Hyperglycemia and Adverse Pregnancy Outcome (HAPO) study [6]. It is notable that all these associations were indicated to be linear, meaning that no natural PG thresholds exist and that women who do not meet the IADPSG criteria might also be at increased risks of adverse outcomes.
Two randomized clinical trials preceding the IADPSG criteria demonstrated a significant decline in the incidence of adverse pregnancy outcomes following glycemic control among women with GDM, which was diagnosed using other criteria [7, 8]. This benefit has been confirmed by more recent clinical trials [9, 10]. However, as only few of these trials used the IADPSG criteria to enroll their study participants, whether the same benefit can be expected from the IADPSG criteria remains undetermined.
Considering these uncertainties, we hypothesized residual risk associations existing between PG levels during 75-g OGTT and adverse pregnancy outcomes in the presence of glycemic control intervention for women fulfilling the IADPSG criteria. In order to confirm the existence and magnitudes of these residual risk associations, we undertook an observational study focusing on excess newborn birth weight, primary cesarean section, and preterm delivery.
Section snippets
Study population
This study was designed to include all women with singleton pregnancy whose routine 75-g OGTT screening at 24 – 28 gestational weeks, glycemic control in case of GDM, and childbirth all took place at Guangzhou Women's and Children's Medical Center between 2016 and 2020 (n = 49,961). The final study population was determined after excluding women with any of the following characteristics: 1) < 18 years of age (n = 8); 2) pre-existing diabetes mellitus or overt diabetes (i.e., fasting PG ≥
Results
In this study of 41,067 women, those who developed GDM and thus received glycemic control intervention accounted for 16.3% (n = 6709). Baseline maternal and neonatal characteristics, overall and by maternal GDM status, are described in Table 1. Maternal age, prepregnancy BMI, parity, and mean arterial pressure showed apparently positive associations with maternal GDM. Unsurprisingly, maternal PG levels at 75-g OGTT were higher in GDM women than in non-GDM women. As for neonatal characteristics,
Discussion
In this cohort of pregnant Chinese women, despite glycemia-controlling intervention among women with GDM, both fasting and post-load PG levels continued to demonstrate statistically significant associations with increased risks of excess newborn birth weight and pre-term delivery. The strength of the association between fasting PG level and excess newborn birth weight in this study was similar to that reported by the HAPO study, where hyperglycemia was untreated, in contras to considerably
Funding
This study was financially supported by a joint project between Guangzhou Metropolitan Science Bureau and Guangzhou Women and Children's Medical Center (grant reference number: 202102010245).
Disclosure of interest
The authors declare that they have no competing interests.
Appendix supplementary material
Supplementary materials (Tables S1 and S2) associated with this article can be found at http://www.scincedirect.com at doi . . .
Acknowledgments
The authors would like to thank Mrs. Juan Li for her administrative support.
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2022, Diabetes and MetabolismCitation Excerpt :Whether there is a residual risk of LGA after GDM treatment is questionable. The results of Li et al. suggested that care for women with GDM diagnosed from elevated FPG levels was insufficient to counteract the association between high FPG levels and LGA infant, whereas the excess risk was controlled when GDM was diagnosed from elevated 1h-PG or 2h-PG values [5]. Our results may differ from Li et al.’s study for several reasons.
Effects of puerarin on maternal gestational diabetes mellitus rats and fetal growth
2024, Chinese Pharmacological Bulletin
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