| Gestational diabetes mellitus(GDM)is one of the most common complications during pregnancy.Currently,there is a lack of large-sample epidemiological studies on GDM in China,and the data are mostly from a single hospital or multiple hospitals,lacking regional representativeness Therefore,we conducted a retrospective cohort study using data from the Medical Birth Registry of Xiamen(MBRX)and other related Xiamen medical databases,including the hospital diagnosis and treatment data,public health related data,chronic disease management data,etc.The objective was to investigate the prevalence of GDM in pregnant women in Xiamen,China and to assess the associated risk factors.Results showed that from March 1,2011 to March 30,2018,a total of 78,572 eligible pregnant women were enrolled in this study,among which 13,738(17.6%)were diagnosed with GDM.After adjusting for age and pre-pregnancy body mass index(BMI),the prevalence of GDM showed a relatively stable trend during the observation period,which was 17.5%in 2012 and it was 17.7%in 2017.Increasing maternal age was associated with GDM.The results of this study showed that women older than 40 years displayed a 7-times higher risk of being diagnosed with GDM than woman younger than 25 years(OR:7.485,95%CI,6.510-8.606).There was a positive correlation between body weight and GDM.Obese woman displayed a 2.789-time higher risk of being diagnosed with GDM than woman of normal weight(OR:2.789,95%CI:2.521-3.086).Multivariate analysis showed that pregnant women age,pre-pregnancy BMI,family diabetes history(aOR:1.581,90%CI:1.280-1.952),weight gain during early pregnancy(aOR:1.088,90%CI:1.053-1.125),and systolic blood pressure(aOR:1.015,90%CI:1.010-1.020)were independent risk factors associated with GDM.Previous studies showed that the potential relationship between age at menarche and risk of GDM is inconclusive.This study we also attempted to preliminarily explore the correlation between age of menarche and risk of GDM and elevated blood glucose during pregnancy in pregnant women in Xiamen.In the database,a total of 70,041 women aged 18 to 53 who met the inclusion criteria were selected and stratified according to the age of 8-12,13,14,15 and 16-19 years of menarche.The results showed that after adjustment for family history of diabetes,earlier age at menarche(8-12,and 13 years old)was associated with an increased risk of GDM compared with the mean age of menarche(14 years old)(OR:1.08,95%CI:1.02-1.15;OR:1.07,95%CI:1.03-1.14).However,after adjustment for pre-pregnancy BMI,blood pressure,education level,age at delivery,and hepatitis B surface antigen(OR:0.93;OR:1.02),the association weakened(OR:0.93;OR:1.02),and was no longer statistically significant.Multivariate regression analysis was further performed using age of menarche as a continuous variable,and the risk of GDM decreased by 2%for each 1-year increase in age of menarche(OR:0.98,95%CI 0.96-0.99).However,after adjusting for blood pressure and BMI,the correlation was no longer statistically significant.Multi variable-adjusted spline regression models showed a linear dose-response association between age at menarche and GDM(P for nonlinearity,0.203;P for linearity,0.006).In linear regression analysis,earlier age at menarche(8-12,and 13 years old)was significantly associated with elevated blood glucose 1 and 2 hours after a glucose load but not with the fasting plasma glucose.Some studies had found that Hepatitis B virus is also a risk factor for GDM and China is the main area of hepatitis B virus infection.Therefore,in this study we also use multivariate logistic regression analysis to assess the association between hepatitis B surface antigen(HBsAg)infection status and GDM as well as pregnancy outcomes in Xiamen population.This study included 3789 HBsAg positive women and 29,648 HBsAg negative women.The results showed that the probabilities of GDM(aOR,1.13;95%CI,1.03-1.23)and cesarean section(aOR,1.12;95%CI,1.03-1.21)occurred in HBsAg positive pregnant women were higher.Previous studies paid little attention to the association between blood glucose levels of pregnant women with oral glucose tolerance test(OGTT)and obesity in their offspring.In this study,6,090 maternal and child pairs were followed for an average of 5.2 years to investigate the association between maternal OGTT blood glucose levels during pregnancy and offspring weight development.Multi-factor linear regression was used to analyze the correlation between offspring BMI Z score and maternal OGTT fasting blood glucose,1-hour blood glucose and 2-hour blood glucose during pregnancy.It was found that offspring BMI Z score was still correlated with 1-hour blood glucose after adjusting for maternal age,pre-pregnancy BMI,offspring birth weight and insulin treatment.Stratifying blood glucose as a discrete variable,multivariate analysis showed that the correlation between offspring BMI Z-score and overweight/obesity incidence and maternal 1-hour gestational blood glucose levels remained significant after adjustment.Further stratifying blood glucose levels as discrete variables,multivariate analysis showed significant positive correlations between offspring BMI Z score and overweight/obesity incidence and maternal 1-hour gestational blood glucose levels after adjustment.Sex-specific exploratory analysis showed that the correlation was roughly the same for boys and girls.This study is the first to show that blood glucose 1h after maternal glucose load during pregnancy is an independent risk factor for weight gain at age 5.Based on the data of a large sample of study population,we evaluated the sensitivity and specificity of fasting glucose as a diagnostic criterion for GDM,and attempted to optimize the currently accepted procedure for GDM diagnosis by OGTT.This study found that if FPG 5.1 mmol/L as the upper limit of the critical value,4794 cases(6.10%)of pregnant women could be directly diagnosed with GDM in this study.If with FPG 4.5 mmol/L as the threshold lower limit,35932(45.73%)of pregnant women could be excluded from the diagnosis of GDM in this study,but about 27.3%of pregnant women would be missed.If 75-g OGTT was performed in pregnant women with FPG values between 4.5-5.1 mmol/L,about 50.37%pregnant women can avoid the performance of formal 75-g OGTT.An attempt can be made to use FPG 4.5 mmol/L as the cut-off value for further confirmation of GDM diagnosis with OGTT,which has a high sensitivity and then further improves the diagnosis rate by stratification of maternal age and BMI of pre-pregnancy.In conclusion,the prevalence rate of GDM in pregnant women in Xiamen is 17.6%,and shows a relatively stable trend during the observation period.Age and maternal overweight/obesity are major risk factors for GDM.However,weight and other insulin resistance-related factors may weaken the effect of menarche on GDM.Early menarche was significantly associated with increased blood glucose after glucose loading during pregnancy,but the correlation was small.HBsAg infection status slightly increases the risk of GDM and cesarean delivery in pregnant women.This study found new evidence of a positive correlation between maternal 1-hour blood glucose during pregnancy and offspring BMI Z-score as well as the occurrence of overweight/obesity.In addition,this study also explored the sensitivity and specificity of GDM diagnostic process based on fasting glucose,and explored the optimization of the diagnostic process for GDM.It is recommended to perform OGTT only for pregnant women with FPG between 4.5mmol/L and 5.1mmol/L for the diagnosis of GDM,which has high sensitivity.Comprehensive evaluation of the age of pregnant women and pre-pregnancy BMI stratification can further improve the diagnosis rate. |
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