| Objective:Gestational diabetes mellitus(GDM)is a special type of diabetes,which can cause adverse outcome for both mothers and fetuses.This study was aimed to evaluate the morbidity level of GDM of pregnant women in Kunshan,Jiangsu Province,to explore the influence of blood glucose at the second trimester on pregnancy outcomes,especially the weight of the newborn,to provide theoretical basis for reducing adverse pregnancy outcomes.Methods:Pregnant women and their newborn registered between January 2015 and December 2017 in Kunshan area were investigated.Demographic characteristics for pregnant women at<14 weeks,complications during pregnancy,delivery mode,neonatal weight,and Apgar score and pregnancy outcome were collected,blood glucose values at the first and second trimester were detected.The diagnosis of GDM is based on the 75 gram oral glucose tolerance test(OGTT)at the middle stage of pregnancy(24-28 weeks).According to the standard of the average birth weight of Chinese newborns in 2015,small for gestational age(SGA)is defined as a birthweight below the 10th percentile(P10)of average birth weight of the same gestational age and the same gender,a birthweight above the 90th percentile(P90)is defined as large for gestational age(LGA),and a birthweight between P10 and P90 is appropriate for gestational age(AGA).The data was integrated into the Excel data management system,and was cleaned up and analyzed by SAS software.The effect of gestational diabetes on neonatal adverse outcomes was analyzed by logistic regression.Results:1.A total of 6446 pregnant women with completed blood glucose were included in this study,and gestational diabetes was screened according to the OGTT test in the middle stage of pregnancy.As a result,1,067 pregnant women were diagnosed with GDM,and the incidence of GDM was 16.55%.2.The average level of blood glucose in pregnant women with GDM was higher than that of the normal group,and the newborn weight of pregnant women with GDM was higher than that of the normal group.Proportion of LGA in neonates delivered by women with GDM was higher than those with normal blood glucose(13.68%vs.9.85%,P<0.001),while the proportion of AGA and SGA in the newborns of women with GDM was lower than those with normal blood glucose(AGA 83.32%vs.85.46%,SGA 3.00%vs.4.68%).3.According to quartiles of FPG,OGTT-1h and OGTT-2h blood sugar value in the second trimester of pregnancy,participants were divided into 4 groups.The results showed that with the increase of blood glucose quantile levels,the birth weight of newborns increased.Moreover,with the increase of blood glucose quantile levels of FPG,OGTT-1h and OGTT-2h,the proportion of LGA in neonates increased,while proportions of AGA and SGA showed a decreasing trend.4.Multivariate logistic regression analysis showed that the risk of SGA in women with GDM was 0.81(multiple(95%CI:0.61-1.06))times as that in women with normal glucose tolerance,however,the risk of LGA in women with GDM was 1.31 times as that in women normal glucose tolerance.The risk of SGA in pregnant women with a low BMI(<18.5kg/m2)was 2.17 times higher than that in those with normal BMI.Pregnant women with gestational hypertension had 2.23 times of risk to deliver a LGA,compared to those with normal blood pressure.Pregnant women with a family history of diabetes are more likely to develop LGA than women without a family history of diabetes,with OR of 1.90.The risk of LGA in parturients is 1.34 times as that in primiparas.The risk of LGA in overweight pregnant women is 1.87 times as that in women with normal BMI.Obese women before conception had 2.71 times of risk to give birth to an LGA than women with a normal BMI.5.After adjusting for factors such as age,educational level,BMI,and disease history of pregnant women,the risk of SGA in pregnant women with blood glucose value greater than P75 was lower than those in the group with less than P25,and OR was 0.73(95%CI:0.56-0.95).However,the risks of LGA in pregnant women with FBG value of P25～P50,P50～P75 and greater than P75 were 1.35(95%CI:1.04-1.75)times,1.39(95%CI:1.08-1.80)times and 1.74(95%CI:1.36-2.22)times as those in the group with FBG value less than P25.Compared with pregnant women with OGTT 1h blood glucose ≤P25,the risk of LGA was 1.38(95%CI:1.08-1.77)and 1.52(95%CI:1.19-1.94)for those with OGTT 1h blood glucose between P25 and P50,and more thanP75,respectively.The risks of LGA in pregnant women whose OGTT-2h blood sugar values between P50 and P75,and greater than P75 were higher than that in those with OGTT-2h blood sugar values less than P25,with OR of 1.34(95%CI:1.06-1.72)and 1.38(95%CI:1.08-1.76).6.The incidence of low Apgar in GDM group was higher than that in the group with normal glucose tolerance(2.44%vs.1.26%,P=0.0035).Univariate logistic analysis showed that neonates of mothers with GDM had 1.95 times of risk to have low Apgar score contrasted with those with normal glucose tolerance.Those aged 31-35 had 0.31 times to deliver fetuses with low Apgar score as those aged ≤25.The risk of low Apgar score in neonates delivered by pluripara women was 0.40 times as that of primipara women.While fetuses of women with pregnancy-induced hypertension had 4.24 times of risk to have low Apgar score,compared to those of women without gestational hypertension.After adjustment for factors such as age,educational level,parity,and gestational hypertension,the risk of low Apgar score in GDM patients was 2.01(95%CI:1.26-3.21)times as that in normal blood glucose group.7.Stratified by the BMI of pregnant women,the predictive value of blood glucose in the second trimester and GDM on LGA was analyzed.It was found that FPG value had a predictive effect on LGA in pregnant women with BMI<18.5kg/m2 at≤14 weeks,and the area under ROC curve was 0.63.When 18.5 kg/m2<BMI of pregnant women<23.9 kg/m2,FPG,OGTT-1h and OGTT-2h blood glucose values had predictive effects on LGA,and the areas under ROC curve were all 0.55.In pregnant women with BMI between 24.0 and 28.0 kg/m2,OGTT-1h(continuity)blood glucose had a predictive effect on LGA,and the area under ROC curve was 0.55.When BMI of pregnant women was more than 28.0,except OGTT-2h,the other three indexes had predictive effects on LGA.FPG had the strongest predictive effect,and the area under ROC curve was 0.71,the optimal cut-off value of FPG predicting LGA was 4.815mmol/L in obesity group,and the maximum Yoden index was 0.33.Conclusions:1.This study showed that the incidence of GDM in the region was 16.55%,which was consistent with the results of previous studies.2.Gestational diabetes increases the risk of neonatal LGA occurrence,and with the increase of blood glucose level in the second trimester,the weight of neonates has a increase trend.3.Newborns of pregnant women with gestational diabetes are more likely to have a low Apgar score.4.The monitoring results of blood sugar have a certain predictive effect on the weight situation of newborns,especially for pregnant women with obesity ≤14 weeks,it is necessary to control the pre-pregnancy weight,carry out early screening,monitor and control the blood sugar level,and avoid adverse outcomes. |
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