| Part ? Early Third Trimester Maternal Response to Glucose Challenge and Pregnancy Outcome in Chinese Women-Relationship between Upper Distribution Level with Recommended Diagnostic CriteriaBackground and Objective:The diagnostic criteria of gestational diabetes mellitus?GDM?have yet to reach a consensus,despite the numerous studies reported recently.The results of the Hyperglycemia and Adverse Pregnancy Outcomes?HAPO?study showed a continuous and linear association between sub-threshold maternal glucose levels with obstetric and neonatal outcomes.Accordingly,the International Association of Diabetes and Pregnancy Study Groups?IADPSG?proposed a new set of diagnostic criterion for GDM based on the HAPO study,which adopted a fasting plasma glucose level that is much lower than previous criteria.Some studies reported treating mild GDM would be cost-effective because of the decreased rates of adverse pregnancy outcomes.However,Langer et al noted that the new criterion increased the prevalence of GDM associated 2-3 fold higher detection rate.The earlier WHO diagnostic criterion for GDM published in 1985 and 1999,in our center,we have used the 1999 WHO criterion for GDM since 2001,and we treat all impaired glucose tolerance?IGT?as part of GDM as recommended.There is no published data on the distributions of the results of the 75g OGTT performed in a uniform manner in China.This study was therefore conducted to examine the distribution of glucose values in the 75g OGTT among our patients with results below the WHO threshold for overt diabetes mellitus?DM?,and how would cutoff levels defined statistically relate to both the WHO IGT and IADPSG criteria as well as with pregnancy outcome.Methods:The distribution of the OGTT 2-h values of 13,501 pregnant women,which were below the World Health Organization?WHO?threshold for overt diabetes mellitus?DM?,and managed in one hospital in China,was reviewed and related with maternal characteristics and pregnancy outcomes.Results:1.For the entire group,the 90th and 95th percentile values of the OGTT 2-h glucose level respectively were close to the diagnostic cutoff values of the WHO and International Association of Diabetes and Pregnancy Study Groups?IADPSG?criteria.For adverse maternal outcomes,glucose level above the 90th percentile value was associated with increased hypertensive disorders,while no difference was seen with cutoff using the 95th percentile value.2.For perinatal outcomes,the 90th percentile was associated with increased neonatal intensive care unit admission and hypoglycemia,while the 95th percentile showed in addition association with phototherapy for jaundice and 5th minute Apgar score<7.While no differences in incidence of adverse pregnancy outcome was found between using the different cutoffs,the>95th percentile cutoff value would have missed out 33.3%-56.7%of the cases of adverse outcomes that would otherwise have been attributed to GDM.Conclusions:Further studies are warranted to clarify which diagnostic criterion is most appropriate to identify adverse pregnancy outcomes attributed to GDM,and which could be mitigated with treatment specific for GDM.Part ? Maternal Hyperglycemia and Adverse Pregnancy Outcomes in Kunming Chinese WomenBackground and Objective:Along with the continuously study-Developmental Origins of Health and Disease?DOHaD?research,it has long been recognized that overt diabetes diagnosed during pregnancy is associated with significant levels of perinatal morbidity.The results of the Hyperglycemia and Adverse Pregnancy Outcomes?HAPO?study showed a continuous and linear association between sub-threshold maternal glucose levels with obstetric and neonatal outcomes.But there is no published data on the distributions of the results of the 75g OGTT performed in China.Moreover,at present there are not much published data on the associated risk relating to maternal glucoses levels with adverse pregnancy outcomes.This study was therefore conducted to examine the distribution of glucose values in the 75g OGTT among our patients,and clarify the risk of adverse pregnancy outcomes associated with various degrees of maternal glucose.Methods:We conducted a retrospective cohort study on 16,001 singleton pregnant women who did their antenatal visit and delivered in our hospital from January 2005 to December 2013.Results:1.There were 16,001 pregnant women who did their antenatal visit and delivered in our hospital and were Included in the final study cohort during January 2004 to December 2013.The mean age of birth was 28.45 years,the 0-h and 2-h plasma glucose were4.0±0.6mmol/L and 6.3±1.3mmol/L mmol/L respectively,who had OGTT done at 28.6 weeks.2.The rates of LGA and macrosomia were significantly increasing in the fasting plasma glucose level;Compared to the highest Oh glucose level,the risk of LGA and macrosomia in group 7?the highest Oh glucose level?increase significantly?LGA:OR 2.73,95%CI 1.41-5.28;macrosomia:OR 7.47,95%CI 3.34-16.68?.For the 2-hour plasma glucose level,there were continuous associations between the glucose level in group 1-3 and LGA/macrosomia.the risk of LGA and macrosomia in group 2 and group3 increase significantly?group 2:LGA:OR 1.28,95%CI 1.05-1.56;macrosomia:OR 1.11,95%CI 0.78-1.59;group 3:LGA:OR 1.67,95%CI 1.34-2.07;macrosomia:OR 1.49,95%CI 1.02-2.19?.it was similar between group 4-7 to group3.Increased with the glucose level,the incidences of cesarean section increased,small for gestational age?SGA?decreased.3.We calculated adjusted odds ratios for adverse pregnancy outcomes associated with an increase glucose level of 1 mmol/L,for LGA,the odds ratios were 1.44?95%CI 1.28 to 1.62?at fasting plasma glucose level and 1.09?95%CI 1.03 to 1.15?at OGTT2h glucose level,for macrosomia,1.82?95%CI 1.48 to 2.22?and 1.13?95%CI 1.03 to 1.25?respectively.there were no similar association between maternal glucose and CS.With an increase glucose level of 1 mmol/L,the odds ratios decrease 21%and 12%respectively.Conclusions:Our results indicate continuous associations of maternal glucoses levels with adverse pregnancy outcomes.However,although treatment cannot eliminate all adverse influence,but treatment of GDM did reduce the frequences of LGA and macrosomia to the normal range of our hospital.Part ? Effect of treatments on pregnancy outcome in impaired glucose tolerance in Kunming Chinese WomenBackground and Objective:Gestational diabetes mellitus?GDM?is a glucose metabolism disorder detected during pregnancy.It is closely associated with perinatal outcome and with the risk of developing type 2 diabetes in the future life of both fetus and the mother.The overall prevalence of diabetes was estimated to be 8.3%according to International Diabetes Federation?IDF?,and prevalence of diabetes is rapidly evolving in the Chinese adult population.There were 21 million new patients with gestational diabetes mellitus around the globe in 2013,account of 17%of all live births.The International Association of Diabetes and Pregnancy Study Groups?IADPSG?and American Diabetes Association?ADA?have adopted the new criteria for GDM diagnosis.Medical records of 13 hospitals in China indicate prevalence of GDM increased to 17.5%.The rapid increase of incidence rates of GDM challenge us to do more system and standard care to lower the risk of perinatal complications.In 2008,the Hyperglycaemia and Adverse Pregnancy Outcomes?HAPO?study revealed strong,pre-dominantly linear associations between maternal hyperglycemia less severe?OGTT Oh<5.8mmol/L,OGTT 2h<11.1mmol/L?and adverse pregnancy outcomes.Lorene found a dose-response relationship between women with evidence of insulin resistance but without evidence of GDM and macrosomia.Suggests that even if the maternal glucose level increased less severe,intensive care should be given to prevent adverse pregnancy outcomes.The treatment for GDM includes medical nutrition therapy?MNT?,self-glucose monitoring,if the glycemic goals are not accomplished with these measurements,medical therapy should be initiated.Antenatal Insulin treatment?AIT?remains the gold standard medication for GDM treatment.Many high quality research confirmed that women in whom GDM is diagnosed should be treated with nutrition therapy and,when necessaryc medication for both fetal and maternal benefit.Both the ACHOIS?ACHOIS—a large randomized controlled trial of the treatment of mild GDM?and MFMU?MFMU-a large randomized controlled trial of the treatment of mild GDM?,which were randomly assigned research,demonstrated that treatment of impaired glucose tolerance?IGT,according to WHO criteria:OGTT 0h?6.1,<7.0mmol/L,OGTT 2h?7.8mmol/L,<11.1 mmol/L?reduces poor pregnancy outcomes.But all the study groups which they assigned to were treatment group and usual prenatal group,but we don't know if there are any differences between MNT or AIT,and we has not se en similar research reports in China.So we conducted a retrospective cohort study on the pregnant women who diagnosed for IGT in Kunming,Evaluation of different treatment measures effects on perinatal outcomes in IGT pregnant women.Factors that can predict insulin need are also identified.Methods:We conducted a retrospective cohort study on 13,501 singleton pregnant women who did their antenatal visit and delivered in our hospital from January 2005 to December 2012.We have adopted the 1999 WHO?world health organization?diagnostic criterion for GDM,women with GDM received the same special care.The study population were assigned to 3 groups according to different treatment measures,include medical nutrition therapy?MNT?,MNT+ antenatal insulin treatment?AIT?,and normal glucose tolerance?NGT?,then estimate the pregnancy outcomes.Results:1.The overall incidence of IGT was 12.3%?3,098/25,123?.For the final study cohort,the OGTT 0-h and 2-h plasma glucose were 3.96±0.55 mmol/L and 6.32±1.21 mmol/L respectively.1,471cases were diagnosed IGT,14.2%?209/1,471?of those were given antenatal insulin therapy.2.Comparison of pre-gestational and gestational factors between patients with NGT,MNT and MNT+AIT:IGT?include MNT and MNT+AIT?were found to be more older at diagnosis?NGT:29,08±3.57;MNT:30.59±3.72;MNT+AIT:30.31±4.07;p<0.001?,they also had higher pre-gestational BMI?NGT:20.35±2.53;MNT:21.15±2.65:MNT+AIT:20.74±3.08;p<0.001?,family history of diabetes was more prevalent?NGT:9.5%vs.MNT:10.6%vs.MNT+AIT:15.8%;p=0.007?,but the significant difference disappeared before delivery?NGT:29.08±3.57;MNT:30.59±3.72;MNT+AIT:30.31±4.07;p=0.086?;3.Observed the maternal outcomes:Compared with NGT,the rate and risk of Caesarean section increased in MNT group?40.2%vs.36.8%;OR 1.146,95%CI 1.018-1.290,p=0.024?,but were similar with MNT+AIT group?34.4%vs.36.8%;p=0.509?.The rate and risk of pregnancy induced hypertensive diseases was significantly increased in MNT+AIT group?6.0%vs.2.6%;OR 2.371,95%CI 1.276-4.406,p=0.005?,MNT group comes second?3.7%vs.2.6%;OR 1.466,95%CI 1.076-1.997,p=0.015?.4.Observed the neonatal outcomes:The birth weight of MNT+AIT group was lowest?NGT:3228.76±413.17;MNT:3200.30±437.94;MNT+AIT:3167.84±437.45;p=0.002?.There were significant increase with MNT as compared with NGT,including the rate and risk of neonatal admission to intensive care unit?16.8%vs.12.0%;OR 1.502,95%CI 1.284-1.757,p=0.000?,the rate of Jaundice requiring phototherapy?10.0%%vs.8.0%,p=0.006?and the rate and risk of hypoglycemia?3.2%vs.1.5%;OR 2.148,95%CI 1.511-3.053,p=0.000?.But the rate of neonatal admission to intensive care unit?11.5%vs.12.0%;p=0.838?,Jaundice requiring phototherapy?7.1%vs.8.0%,p=0.656?and hypoglycemia?1.6%vs.1.5%;p=0.844?were similar between MNT+AIT and NGT.The rate and risk of small for gestational age?SGA?was significantly increased in MNT +AIT group?14.8%vs.8.7%;OR 1.824,95%CI 1.207-2.759,p=0.004?,but it was similar between MNT group and NGT group?8.1%vs.8.7%;p=0.430?.Other outcomes:large for gestational age?LGA??NGT vs.MNT:9.9%vs.9.3%,p=0.347;NGT vs.MNT+AIT:9.9%vs.9.8%,p=0.962?,Macrosomia?NGT vs.MNT:3.1%vs.2.8%,p=0.274;NGT vs.MNT+AIT:3.1%vs.3.8%,p=0.571?,preterm delivery?NGT vs.MNT:4.1%vs.5.2%,P=0.050;NGT vs.MNT+AIT:4.1%vs.3.3%,p=0.561?,premature rupture of membrane?PROM??NGT vs.MNT:13.0%vs.14.3%,p=0.134;NGT vs.MNT+AIT:13.0%vs.10.9%,p=0.408?,Apgar Score<7 @5min?NGT vs.MNT:0.3%vs.0.7%,p=0.066;NGT vs.MNT+AIT:0.3%vs.0.5%,p=0.490?,and perinatal mortality?NGT vs.MNT:0.1%vs.0.2%,p=0.631;NGT vs.MNT+AIT:0.2%vs.0.5%,p=0.158?were statistically indifferent.5.Multivariate analysis demonstrated that OGTT 2h glucose level were significant predictor for insulin requirement in IGT?Logistic regression:OR 1.482,95%CI 1.182-1.858,p=0.001;ROC area:0.922,95%CI 0.901-0.943,p=0.000?).Conclusions:Our study provide that even if the maternal glucose level increased less severe,intensive care should be given to prevent adverse pregnancy outcomes.Part IV Ethnic differences in development of gestational diabetes mellitus in Kunming Chinese WomenBackground and Objective:Previous studies have examined gestational diabetes mellitus?GDM?by race/ethnicity and nativity,it has been shown that the distribution of glucose levels during pregnancy varies by ethnicity.Mocarski's study suggests ethnic variation exists in the impact of GDM,women with GDM have an increased risk of several important adverse perinatal outcomes across all ethnic groups compared to those without GDM.The clearest example can be seen among Asian women who have the highest prevalence of GDM in this sample,with a risk 5.5 times that of Non-Hispanic White women.Kim examined the risk of GDM among foreign-born and U.S.-born mothers by race/ethnicity,they found that racial/ethnic is independently associated with GDM,and this relationship was independent of BMI,age,parity,and height.Studies have found that diabetes mellitus is different between the ethnic groups in China.Yunnan province is located in the southwest border of China,there are many ethnic minorities in Yunnan province.Consider the lack of knowledge available regarding the risk of GDM between different ethnic groups who live in the same environment,the present study was carried out to evaluate the association between the ethnic origin and the occurrence of GDM.Methods:In a prospective study,a 75g oral glucose tolerance test?OGTT?was performed in 18,195 singleton pregnant women living in Kunming who received antenatal care in three hospitals from January 2004 to December 2013.Han nationality and some minority nationalities as Hui,Bai and Yi were analyzed.The GDM was diagnosed according to 1999 WHO criteria.Results:1.There were 32,937 pregnant women who did their antenatal visit and delivered in three hospital in Kunming during January 2004 to December 2013,the final study cohort was 18,195,and 2,256 cases who were in the WHO category of GDM,the total incidence of GDM in the study period was 12.4%.2.Compared with the incidence of GDM in Han nationality,Hui had a significantly higher incidence than Han?17.5%vs.12.5%,P=0.026?,whereas Yi had a significantly lower incidence than Han?6.4%vs.12.5%,p=0.003?.There was borderline significant difference in incidence of GDM between Bai and Han nationalities 15.8%vs.12.5%,p=0.061).3.Multivariate logistic regression showed that maternal age?OR= 1.12,95%CI 1.10?1.14?,BMI before pregnancy?OR=1.12,95%CI 1.06?1.17?,BMI at OGTT?OR=1.45,95%CI 1.36?1.54?,the first-degree relatives family history of diabetes?OR=1.96,95%CI 1.45?2.64?,Bai nationality?OR=1.63,95%CI 1.11?2.41?were the independent risk factors for GDM.Conclusions:The incidence of GDM is different between different ethnic groups in the same living background,suggesting that ethnic background could be considered as a risk factor in screening for GDM.Part ? The Effects of Maternal Age on Maternal and Neonatal Outcomes in Kunming Chinese WomenBackground and Objective:In today's society,many women are delaying childbearing into their later reproductive years for various reasons;these include late marriage,higher education and career pursuit,longer life expectancy,more effective contraceptive techniques,and modern infertility treatment.The past three decades have seen significant increases in maternal age at childbirth in many high-income countries.Some studies have found that pregnant women aged 35 years or older carry an increased risk for perinatal mortality,low birth weight infants and preterm delivery.However,other studies challenge these findings.Prior studies have mainly investigated European and American populations.It is not clear whether women in China also delay childbearing and are at increased risk for adverse pregnancy outcomes.These conflicting findings may in part reflect the fact that many of the datasets reported in the literature contain data on births from 25-30 years ago.Such data will not reflect recent demographic changes in the antenatal population which may also influence outcome.Third,most previous studies evaluated birth certificate information,it failed to control for important confounders,such as prepregnancy body mass index,educational level,prior obstetric history and coexisting pregnancy complications,which were often incomplete and subject to misclassification and informational errors.The objectives of this study were therefore to investigate whether there is an increasing trend in the mean maternal age and to study the association between maternal age and adverse perinatal outcomes within a large homogeneous population.Methods:We performed a population-based cohort study using data on all singleton births who received antenatal care and were delivered in our hospital from January 1,2005 to December 31,2013.We compared pregnancy outcomes in women aged<25,30?34.9,35?39.9 and ?40 years with aged 25?29.9 years,Logistic regressions were applied to estimated the independent effect of maternal age on perinatal outcomes.Results:1.Between 2005 and 2013,28,302 singleton gestations were delivered in our institute,86.1%?24372/28302?were primiparous,13.9%?3930/28302?were multiparous,the mean age of birth increased from 28.45 years in 2005 to 29.57 years in 2013.2.Higher rates of gestational diabetes mellitus?GDM??primiparous:group 1:8.8%,group 2:11.9%,group 3:17.8%,group 4:26.8%,group 5:35.4%,p=0.000;multiparous:group 1:9.3%,group 2:13.3%,group 3:19.3%,group 4:26.8%,group 5:43.2%,p=0.000?,preeclampsia?primiparous:group 1:2.9%,group 2:1.9%,group 3:2.6%,group 4:4.5%,group 5:11.1%,p=0.000;multiparous:group 1:1.2%,group 2:4.0%,group 3:4.3%,group 4:8.9%,group 5:14.4%,p=0,000?,cesarean delivery?primiparous:group 1:24.4%,group 2:32.2%,group 3:42.4%,group 4:60.2%,group 5:64.2%,p=0.000;multiparous:group 1:32.4%,group 2:38.0%,group 3:46.7%,group 4:51.9%,group 5:54.4%,p=0.000?,frequency of NICU admission?primiparous:group 1:15.5%,group 2:13.2%,group 3:15.3%,group 4:17.6%,group 5:21.6%,p=0.000;multiparous:group 1:18.5%,group 2:14.8%,group 3:15.5%,group 4:19.9%,group 5:28.7%,p=0.000?and preterm birth?primiparous:group 1:13.4%,group 2:7.4%0 group 3:7.4%,group 4:11.1%,group 5:21.0%,p=0.000;multiparous:group 1:21.2%,group 2:13.2%,group 3:15.0%,group 4:17.4%,group 5:20.5%,p=0.000?were noted as maternal age increased;3.After adjusting for the confounding effects of maternal characteristics and classification according to maternal parity,compared with the reference group?group 2:25?Age<30 years?,increasing maternal age was associated with increased risk of perinatal outcomes:?1?primiparous:the risk of GDM inreased from group 3?group 3:OR 1.56,95%CI 1.18-2.05,p=0.002;group 4:OR 2.36,95%CI 1.77-3.15,p=0.000;group 5:OR 7.98,95%CI 3.32-7.47,p=0.000?;the risk of preeclampsia inreased from group 4?group 4:OR 2.60,95%CI 1.70-3.97,p=0.000;group 5:OR 4.21,95%CI 2.42-7.31,p=0.000?;the risk of cesarean delivery inreased from group 3?group 3:OR 1.26,95%CI 1.06-1.50,p=0.009;group 4:OR 1.49,95%CI 1.23-1.80,p=0.000;group 5:OR 1.51,95%CI 1.09-2.09,p=0.013?;the risk of NICU admission inreased?group 4:OR 1.35,95%CI 1.07-1.70,p=0.013;group 5:OR 2.11,95%CI 1.48-3.03,p=0.000?and the risk of preterm birth inreased?group 4:OR 1.35,95%CI 1.06-1.72,p=0.016;group 5:OR 1.52,95%CI 1.02-2.25,p=0.040?.?2?multiparous:?1?primiparous:the risk of GDM inreased from group 3?group 3:OR 1.59,95%CI 1.46-1.75,p=0.000;group 4:OR 2.68,95%CI 2.32-3.09,p=0.000;group 5:OR 4.05,95%CI 2.74-5.98,p=0.000?;the risk of preeclampsia inreased?group 3:OR 1.30,95%CI 1.06-1.59,p=0.011;group 4:OR 2.07,95%CI 1.55-2.77,p=0.000;group 5:OR 5.19,95%CI 3.00-8.95,p=0.000?;the risk of cesarean delivery inreased?group 3:OR 1.50,95%CI 1.41-1.60,p=0.000;group 4:OR 3.12,95%CI 2.78-3.49,p=0.000;group 5:OR 4.22,95%CI 2.94-6.04,p=0.000?;the risk of NICU admission?group 3:OR 1.17,95%CI 1.08-1.27,p=0.000;group 4:OR 1.34,95%CI 1.17-1.55,p=0.000;group 5:OR 1.68,95%CI 1.15-2.45,p=0.008?and the risk of preterm birth?group 4:OR 1.57,95%CI 1.32-1.86,.p=0.000;group 5:OR 3.33,95%CI 2.27-4.89,p=0.000?inreased.Conclusion:There has been an increasing trend of the mean maternal age and the proportion of women delivering infants at the age of 35 years or older,maternal age of 30 years and beyond is associated with a range of adverse perinatal outcomes.Part ? Relationship between inter-pregnancy interval and pregnancy outcomes in Kunming Chinese WomenBackground and Objective:Both short and long interpregnancy interval?IPI?have been associated with poor pregnancy outcomes.Short IPI has been associated with a plethora of maternal and obstetric complications including preeclampsia,hypertensive disorders,premature rupture of membranes,third-trimester bleeding,placental abruption,placenta previa,low birth weight,small for gestational age,preterm delivery and fetal or neonatal death.However,less consistent is showing that long intervals are also associated with these risks,whether extreme intervals themselves carry a risk or are simply markers that a woman is already at risk is uncertain.Most researches about IPI were conducted in the USA and Africa,Ritchie found there were significantly higher rates of short interpregnancy intervals among Pacific Islanders and Asian subgroups,they advised more work should focus on rates of adverse maternal and neonatal outcomes associated with short interpregnancy intervals in these populations.In China,"a couple only one child" has been a basic national policy since 1978,most local governments rule the IPI for 4 years according to social population economics theory,and there is no published data on the relationship between IPI and adverse pregnancy outcomes.This study aimed to evaluate relationship between interpregnancy interval and pregnancy outcomes,provide suitable advice for the patients who need pre-conception counseling and education,and provide important implications for the health care system.Methods:We conducted a retrospective cohort study on 2,119 singleton infants born to multiparous mothers who did their antenatal visit and delivered in our hospital from January 2005 to December 2013.Results:1.The rate of multiparous women significantly increased from 10.2%in 2005 to 19.7%in 2013;The median interpregnancy interval was 68.3±1.1 month?MO?;2.Women in the interpregnancy interval of more than 72 months had higher rate of gestational diabetes mellitus(72-119MO:23.6%;?120MO:29.4%?p=0.000?,and higher rate of preeclampsia?48-71MO:4.5%;72-119MO:4.5%;?120MO:6.9%?p=0.001??for IPI>48 months;3.After adjusted for confounding factors and compared with 24-47 months,mother with IPI of more than 72 months had higher odds ratios for GDM?72-119MO:OR 1.35?1.01-1.75?;?120MO:OR 1.85?1.54-2.17??,and IPI ?48MO were associated with increased odds ratios for preeclampsia development?48-71MO:OR 1.66?1.38-1.97?;72-119MO:OR1.27?1.01-1.58?;?120MO:OR 1.63?1.32-1.95??.No significant differences between IPI and the risk of LGA,SGA and preterm delivery were found.Conclusion:Long IPI was associated with higher risk of GDM and preeclampsia,which may help with counseling for those who desire to have the second birth and policy modification for government in IPI issue.Part? High Third Trimester Haemoglobin Concentration-Risk Factor for Gestational Diabetes Mellitus in Kunming Chinese WomenBackground and Objective:Hemoglobin?Hb?is a red blood cell constituent;its concentration is part of hematologic scale,representing physical and nutritional status of an individual.In a pregnant woman.Hb level at first antenatal visit is included in routine laboratory panel to evaluate basic health status and to initiate a plan for appropriate obstetrical care.Whereas maternal anemia certainly provokes an obstetrician's attention due to its well-recognized clinical significance,the status of high Hb concentration does not.Some authors associated between high maternal Hb and adverse perinatal outcomes such as preeclampsia,gestational diabetes mellitus?GDIM?,preterm delivery,etc.A study of 4,985 pregnancies also demonstrated an increased incidence of subsequent hypertensive disorders,intrauterine growth retardation and preterm delivery in women with high Hb levels?13.0-15.Og/dL?,butthe number of studies regarding such relationship is still limited.Lao found that hemoglobin level at the top quartile?>13g/dl?in non-anemic Chinese women is independently associated with GDM diagnosed after 28 weeks gestation.The data in our aforementioned studies indicate that a hemoglobin concentration in the first trimester is a risk factor for GDM.In Indian women with a high background rate of anemia,high hemoglobin level?>10g/dl?has been associated with GDM based on WHO criteria but no significant association was found when Carpenter and Coustan diagnostic criteria of GDM was used.There are no data on the association of a high maternal hemoglobin concentration with GDM,and it is no clear whether a higher maternal hemoglobin associated with increased risk of GDM in the first trimester will last to the third trimester.This study aimed to examine the relationship between hemaglobin concentration in the third trimester and occurrence of gestational diabetes mellitus?GDM?in Kunming of China.Methods:A retrospective cohort study was conducted in 9,877 singleton pregnancies who received antenatal care and were delivered in our hospital from January 1,2005 to December 31,2013.Patients received the 75g oral glucose tolerance test?OGTT?at 28-32 weeks,interpreted by the World Health Organization criteria,maternal hemoglobin concentration were recorded at the OGTT.These women were categorized by their third trimester hemoglobin concentration into quartiles,the incidences of GDM was analyzed together with the maternal characteristics,then determine the role of hemoglobin in the incidence of GDM.Results:1.The maternal body mass index?BMI?were statistically significantly increased with maternal hemoglobin concentration?p=0.000?,Whether at pre-pregnancy?BMI::20.96±4.27?,at OGTT?BMI:25.11±2.92?or before delivery?BMI:27.00±3.01?,the highest BMI was seen in the highest hemoglobin quartile?group 4:Hb>132g/L?.The mean gestational age they received OGTT was at 28 weeks,the OGTT Oh?p=0.018?and 2h?p=0.000?glucose value were increased significantly with maternal hemoglobin concentration.The group 4 has the highest glucose value;2.Compared with the rest,the group in the highest hemoglobin quartile had a significantly higher incidence of GDM?14.7%,p=0.012?;3.Logistic regression analyses were performed to establish independent predictors of GDM,maternal age?odds ratio 2.188,95%confidence interval 1.846-2.593?,family history?odds ratio 1.723,95%confidence interval 1.451-2.046?of diabetes and hemoglobin in the highest quartile?Hb>132g/dl??odds ratio 1.198,95%confidence interval 1.039-1.382?emerged to be significant factors.Conclusion:A high maternal hemoglobin?Hb>132g/dl?at the third trimester in Chinese women is independently associated with GDM,the cause of the increased hemoglobin requires further studies. |
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