The Relationship Between The Timing Of Gestational Diabetes Mellitus Diagnosis And HbA1c Level And Perinatal Outcome

BackgroundGestational diabetes mellitus (GDM) is a common complication of pregnancy, and its morbidity is increasing recently. Gestational diabetes has serious impact on mother and fetus, the major impact on pregnant women including:Increasing the incidence of spontaneous abortion at early pregnancy, especially in patients with bad blood glucose control; Diabetic pregnant women always accompanied by Vasculopathy which may make patients predispose to pre-eclampsia,the incidence of pre-eclampsia sometimes will up to more than 50%;The rates of infection, polyhydramnios, macrosomia, DKA are also higher than that in normal pregnant women.GDM women with hypoimmunity is easily complicated by infection, particularly urinary tract infections. The incidence of polyhydramnios is 10 times more than non-diabetic pregnant women,which may be related to fetal hyperglycemia and hyperosmolar of diuretic. The increaseing incedince of macrosomia may cause more dystocia,injury of parturient canal,operations and so on.The major impact on fetus including:increasing incidence of neonatal respiratory distress syndrome and neonatal hypoglycemia.Numerous studies have showed that high level of blood glucose may have higher risk of prenatal complications.Maternal blood glucose with ideal control throughout pregnancy can reduce adverse perinatal outcomes.Glycohemoglobin Alc (HbAlc) levels which reflects blood glucose levels in recent 2-3 months has been a good test for Blood Glucose Monitoring for pregnant women with abnormal glucose intolerance. Some research has found that the level of HbAlc at early pregnancy or before pregnancy is related with much complications including macrosomia,preeclampsia in pregnant women with impaired glucose tolerance.The gestational weeks was seldom concerned when researchers studied the relationship between HbAlc and Perinatal outcomes of GDM women.MethodsThe aim of this study was to observe clinical outcomes of the mother and her infant by checking gestational weeks (GW) and the first HbAlc level at initial diagnosis of gestational diabetes (GDM).A total of 119 GDM patients were subject of this study. GDM patients were diagnosed at Women's Hospital,school of medicine,Zhejiang University from January 2007until January2009. Patient's medical records were retrospectively reviewed to evaluate GW, HbAlc level at the time of diagnosis, and clinical outcomes of mother and newborn baby.ResultsThe proportion of subjects who had been diagnosed of having GDM according to GW was 8.4%, in less than 24th week of pregnancy; 67.2% in the 24-28th week; 14.3% in the 29-32nd week; and 8.4% in the 33rd week or more. There were 45 out of 119 subjects (36.4%) with HbAlc levels>6.0% and 25 out of119 subjects (6.5%) with HbAlc levels>6.5%.The women who was diagnosed in the 24-28th week were mostly with HbAlc levels<6.0.There was statistically significant difference in frequency of preterm delivery, preeclampsia, macrosomia and neonatal hypoglycemia between subjects with HbAlc levels 6.0-6.5% or HbAlc> 6.5% and HbAlc levels<6.0%.In clinical outcomes of newborn by HbAlc levels, the frequency of delivery of macrosomia was higher in mothers diagnosed with GDM after 29th week of pregnancy or with HbAlc levels> 6.5%.ConclusionIf the diagnosis of GDM was delayed, HbAlc level and the risk for adverse prenatal outcome such as preterm delivery, preeclampsia, macrosomia and neonatal hypoglycemia seemed to be higher, so it may be necessary to screen GDM early and to Control the blood glucose reasonably,then the prenatal complications would be reduced.