| Background:Elevated blood glucose during pregnancy could induce some serious adverse effects on both mothers and offspring,which is related to increased weight in newborns and elevated blood pressure in pregnant women.Pregnant women with injured glucose tolerance would develop gestational diabetes mellitus(GDM),which can increase the risk of type 2 diabetes mellitus(T2DM)in them and their offspring;plus,the risk of obesity would also elevate after their offspring grow up.Therefore,early detection of high risk groups with abnormal blood glucose during pregnancy plays a key role on early prevention and treatment of GDM and adverse pregnancy outcomes.The glucose challenge test(GCT)is the most commonly used method for screening GDM.Some reports suggested that blood routine indexes were related with pregnancy blood glucose.Blood routine examination is one of the common physical tests for pregnant women;thus,it is beneficial to carry out in community health service centers because it is simple,feasible and economic.Nevertheless,the relationship between blood routine indexes and blood sugar during pregnancy,the risk of macrosomia remains unclear.Therefore,we attempted to explore the correlation between blood routine indexes with risks of GCT hyperglycemia and macrosomia.Associated the related routine blood indexes and other factors may better to find adverse pregnancy group,so as to lower prevalence of GDM and the occurrence of adverse pregnancy outcomes.Objects:(1)The relationship between blood routine indexes in early pregnancy and GCT blood glucose level;(2)The relationship between blood routine indexes in early pregnancy and macrosomia,and the interaction between blood routine and blood glucose on the occurrence of macrosomia.Methods:The data in this study was from"a large maternal and child health care queue system in Tianjin women and children health center".A total of 8,850registered pregnant women in an urban district(Heping)and a suburb district(Tanggu)from January 1,2009 to December 31,2010 were collected from community health service centers.Finally,4,430 subjects were selected according to the strict inclusion and exclusion criteria.During the follow-up to the second trimester(24 to 28 weeks),GCT was performed to detect the glucose level.A total of 875 subjects with GCT≥7.8mmol/L were chosen into the case group(hyperglycemia group).While,the other subjects with GCT<7.8 mmol/L entered into the control group(normal glucose group).After following up,all subjects were divided into the case group with the neonatal weight≥4000 g(macrosomia group)and the control group with the neonatal weight<4000 g(non-macrosomia group).Methods included:(1)Descriptive analysis was conducted to compare the distribution of different blood glucose levels in the second trimester of pregnancy and birth weights.(2)In a non-matching nested case-control study,restricted cubic spline(RCS)was used to estimate the threshold point for the occurrence of second-trimester hyperglycemia,and the relevant indexes of blood routine were classified according to the most three-point count.Binary logistic regression model was used to analyze the correlation between blood routine indexes in early pregnancy and blood glucose level in the second trimester.(3)The receiver operator characteristic curve(ROC)model was used to calculate the area under the curve(AUC)to reflect the prediction of blood routine related indexes for second-trimester hyperglycemia.(4)The correlation between blood routine indexes and macrosomia was analyzed by using binary logistic regression model through the unmatched nested case-control study.(5)The subjects were divided into four groups based on the combination of blood glucose and blood routine indexes,and the additive interaction model was adopted to verify whether the blood routine related indexes in early pregnancy and the hyperglycemia in middle pregnancy had interactive effects on the occurrence of macrosomia.SPSS 22.0 and SAS 9.3softwares were used for statistical analysis.Results:(1)Age,education level>12 years,high body mass index(BMI)and weight gain in GCT were risk factors for hyperglycemia in the second trimester.(2)The relationship between hemoglobin(Hb)level and white blood count(WBC)with hyperglycemia were approximately non-linear,and there were threshold points.The risks of hyperglycemia in Hb>145g/L and WBC>9.5×10~9/L group were 3.509 times(95%CI:2.615～4.710)compared to Hb≤145g/L group,2.212 times(95%CI:1.839～2.661)compared to WBC≤9.5×10~9/L group,respectively.The step-to-step regression analysis showed that both Hb>145g/L and WBC>9.5×10~9/L had significant predictive effects on hyperglycemia,with OR values of 3.301(95%CI:2.425～4.440)and 2.151(95%CI:1.789～2.5889)separately.(3)Hb level and WBC counts increased the predictive effect of traditional risk factors on hyperglycemia with the AUC rising from 0.739(95%CI:0.722～0.751)to 0.763(95%CI:0.756～0.781)(P<0.05).(4)BMI,GCT positive and weight gain in GCT were risk factors for macrosomia.The subjects were divided into 4 groups according to Hb combined with GCT results.Compared with Hb≤132 g/L&GCT<7.8 mmol/L group,the risks of macrosomia in Hb≤132g/L&GCT≥7.8 mmol/L group,Hb>132g/L&GCT<7.8mmol/L and Hb>132 g/L&GCT≥7.8 mmol/L group were 1.497 times(95%CI:1.100～2.039),1.302 times(95%CI:1.020～1.661)and 2.029 times(95%CI:1.508～2.732).Additionally,relative excess risk of interaction(RERI)was 0.230(95%CI:0.056～0.404);thus,there was an additive interaction between Hb level in the first trimester and GCT blood glucose level in the second trimester on the pregnant women with macrosomia delivery.Conclusions:(1)Risk factors in the first trimester for high blood glucose in the second trimester were age,high BMI,high education level and more weight gain during GCT.(2)Blood routine indexes including Hb level and WBC counts in early pregnancy were independent risk factors for hyperglycemia in the second trimester.And the significant threshold points for blood glucose were 145g/L and 9.5×10~9/L,respectively.Hb level and WBC counts had certain predictive effects on hyperglycemia in the second trimester,and increasing the prediction of traditional risk factors for hyperglycemia.(3)The risk factors for macrosomia were higher BMI in the first trimester and higher blood glucose level,weight gain in the second trimester.(4)Hb level in blood routine was an independent risk factor for macrosomia.There was an additive interaction between the Hb and blood glucose on macrosomia,which means that high level of Hb would aggravate the effects of hyperglycemia on macrosomia.The occurrence of high Hb level in pregnant women may be related to high BMI in early trimester. |
PDF Full Text Request