Maternal Hyperglycemia And Adverse Pregnancy Outcomes

OBJECTIVES:The aim of this study is to evaluate the associations between maternal glucose levels and adverse pregnancy outcomes in the first affiliated hospital of Kunming Medical University.MATERIAL AND METHODS:We conducted a retrospective cohort study on12,473consecutive singleton pregnant women who has done their regular antenatal visit and delivered in the first affiliated Hospital of Kunming Medical University from January2003to December2011. The eligible pregnant women underwent a standard75gm. oral glucose-tolerance test at22-32weeks of gestation. For the categories analysis, each measure of glycemia was divided into seven categories. The categories for fasting plasma glucose level were defined as the same as the HAPO study. The2-hours of plasma glucose level were measured and reflected data were approximately the same number of women in each category as did the fasting plasma glucose measured. We assigned women between category4to category7who had gestational diabetes mellitus diagnosed by World Health Organization criteria to receive the food advice, monitoring blood glucose level and insulin therapy if needed. Primary outcomes were large for gestational age (LGA), macrosomia, small for gestational age (SGA), primary cesarean delivery. Secondary outcomes were preeclampsia, preterm delivery, preterm premature rupture of membranes, premature rupture of membranes, asymptomatic bacteriuria, neonatal hypoglycemia, hyperbilirubinemia (need for treatment of phototherapy) and need treatment for intensive neonatal care. Odds ratio were calculated for pregnancy outcomes associated with an increase in the fasting and2-hours’plasma glucose levels.RESULTS:1. Total no of22,504pregnant women, who were delivered during this period. Among this the remaining12,473pregnant women were available for data analysis. The mean age of participants was29.2years and the mean fasting and2-hours plasma glucose level were4.0mmol/L and6.3mmol/L respectively. The mean birth weight was3212.0±437.1gm. at39weeks of gestation. The incidence of gestational diabetes mellitus in the study period was12.3%(1528/12473).2. For the fasting plasma glucose level, frequencies in the lowest (<4.20mmol/L) and highest category (5.60～6.09mmol/L) respectively, where8.6%and20.3%for LGA,2.4%and12.7%for macrosomia, however, for the2-hours plasma glucose level, category1to category3 were the observational groups and category4to category7were the interventional groups. While the LGA incidences reduce from15.2%in category3to10.7%in category4(7.80-8.29mmol/L) and9.7%in category7(9.8to11.09mmol/L) and macrosomia incidences moderated from4.4%in category3to2.3%in category4and3.2%in category7. Low and high glucose levels were associated with increased risk of SGA newborn and primary cesarean section respectively. The incidence of primary cesarean section moderated from44.6%in category3to40.7in category4and39.1%in category5. There were strong correlation with secondary outcomes such as (preterm delivery, premature rupture of membranes, neonatal hypoglycemia, hyperbilirubinemia which was needed a treatment of intensive neonatal care) across the categories of maternal2-hours plasma glucose (y>0.900, P<0.05).3. We were calculated the adjusted odds ratios for adverse pregnancy outcomes associated with an increase in the fasting2-hours plasma glucose levels of1mmol/L for LGA, the odds ratios were1.44(95%Cl1.28to1.62) and1.09(1.03to1.15), for macrosomia1.82(1.48to2.22) and1.13(1.03to1.25), for SGA0.79(0.70to0.90) and0.88(0.83to0.9) for primary cesarean section1.10(1.02to1.19) and1.01(0.98to1.04). Significant associations were also evaluate for secondary outcomes, although it was tended to be weaker. 4. There were significant differences between males and females in the birth weight (3264.9±443.1vs.3155.5±423.4, P=0.000), length (50.0±2.1vs.49.2±2.0, P=0.000), gestational age (mean rank6135.57vs.6345.03, p=0.001), the primary cesarean rate (39.2%vs.35.9%, p=0.001), PHD (2.6%vs.3.3%, p=0.031), preeclampsia (1.7%vs.2.2%, p=0.046), and the percentage of infants who had LGA (10.9%vs.9.2%, p=0.001), macrosomia (4.2%vs.1.8%, p=0.000), need for treatment of intensive neonatal care (10.0%vs8.4%, p=0.001), and no significant differences between males and females in maternal characteristics (P>0.05), IGT (12.3%vs.12.2%, p=0.746), PROM (17.5%vs.17.2%, p=0.693), PPROM (2.4%vs.2.2%, p=0.441), SGA (9.2%vs.8.3%, p=0.095), preterm delivery (5.5%vs.4.8%, p=0.075), neonatal hypoglycemia (1.9%vs.1.5%, p=0.088),hyperbilirubinemia need for treatment of phototherapy (8.4%vs.8.0%, p=0.381),. In contrast impaired glucose tolerance was only a predictor of macrosomia (OR=1.88,95%Cl1.02-3.47) exclusively in female fetuses.CONCLUSIONS:1. our results indicate strong, continuous associations of maternal glucose levels below the diagnostic of diabetes by WHO criteria with adverse pregnancy outcomes.2. However, although treatment of gestational diabetes mellitus did reduce the frequencies of large for gestational age and macrosomia to the normal range of our hospital. It did not significantly reduce perinatal morbidity. While maternal glucose levels were higher than the diagnostic of diabetes by WHO criteria.3. The incidence of adverse pregnancy outcomes in males was higher than in females in line with a higher sexual frailty of male fetuses.