Preventive Effect Of Comprehensive Management Before Pregnancy On Gestational Diabetes

BackgroundWith the opening of two-child policy and the changing of lifestyle,the incidence of overweight / obesity,elderly pregnant women has gradually increased,and the incidence of gestational diabetes mellitus(GDM)has also increased year by year.Not only affects pregnancy outcomes,but also has a profound impact on the long-term metabolic status of the two generations of mothers and children,and the transmission of these metabolic diseases from generation to generation has greatly increased the burden on society.Therefore,the prevention of gestational diabetes has a far-reaching effect than simply controlling blood glucose itself.However,there is no consensus on the timing and intervention methods of prevention and their effects at present.The high-risk groups of gestational diabetes did not get the popularization of professional knowledge before pregnancy,and not take the initiative to seek relevant prevention strategies at medical institutions,they usually chose more routine follow-up visits to obstetrics after pregnancy,resulting in early failure to get timely Interventions,until routine oral glucose tolerance test(OGTT)screening during 24-28 weeks of pregnancy suggests gestational diabetes,despite the active control of stable blood glucose in the third trimester,the risk of metabolic disorders in the mother and child generations still exists.In recent years,many high-risk groups of gestational diabetes have strengthened the comprehensive management of patients through the cooperation of obstetrics and endocrinology in our hospital,and have achieved certain results.This study retrospectively analyzed the case data of pregnant women at high risk of gestational diabetes in our hospital in recent years,to analyze whether such comprehensive management is effective,with a view to summing up experience and promoting future work.Objective1.To analyze the relationship between the number of risk factors and the risk of GDM or ODM.2.To compare the effect of lifestyle-based comprehensive management before pregnancy on the incidence of GDM or ODM,blood glucose,blood lipids,and blood pressure at mid-late pregnancy in high risk groups.3.To explore whether comprehensive management before pregnancy can better control weight gain during pregnancy,improve pregnancy outcomes and neonatal complications.4.To analyze the effects of pre-pregnancy comprehensive intervention on insulin use and postpartum glucose tolerance in patients with GDM or ODM.5.To analyze whether the risk factors meet the standard would have influnence on the prevalence of GDM or ODM.MethodsFrom January 2016 to March 2019,a total of high-risk gestational diabetes patients who have been successfully pregnant after undergoing comprehensive management based on lifestyle intervention in our outpatient department or inpatient department in the Third Affiliated Hospital of Guangzhou Medical University were selected.Of the 302 cases,115 cases were regularly follow up in our hospital,single pregnancy and smooth delivery,and more than 80% of the complete data were defined as intervention group.And from May to July 2019,we selected about 500 high-risk groups from 1541 people who delivered in the obstetrics and gynecology department of our hospital.445 cases meeting the entry and discharge criteria,In this 445 high-risk population,we matched the intervention group with age,parity,body mass index(BMI)before pregnancy,weight before pregnancy,number of high-risk factors,whether abnormal blood glucose tolerance or insulin resistance existed before pregnancy,pre-pregnancy fasting blood glucose,pre-pregnancy triglyceride,and cholesterol levels using 1: 1 propensity score matching(PSM).92 pairs of high-risk pregnant women were matched,of which the intervention group was defined as group A and the control group was defined as group B.Compare the glucose and lipid metabolism levels,glycated hemoglobin,and hemoglobin of Groups A and B at 24 to 28 gestational weeks,and calculate the incidence of gestational diabetes and overt diabetes mellitus(ODM),the rate of insulin use and activation time,and the maximum daily dose of insulin in the two groups,Blood pressure,delivery mode,gestational week,gestation weight gain(GWG)and excess weight growth rate during pregnancy,neonatal weight,incidence of maternal and child complications,and postpartum glucose tolerance test results in pregnant women with gestational diabetes or overt diabetes mellitus.Compare the impact of the number of risk factors and whether the risk factors up to standard before pregnancy on the disease.Results1.There were 115 people in the intervention group and 445 people in the control group before matching.The 445 high-risk groups in the control group were divided into high-risk groups with 1,2,3 and 4 or more risk factors according to the numbers of risk factors,in which the prevalence of GDM or ODM was 22.22%,41.04 %,62.82% and 95%,respectively.The prevalence of GDM or ODM of high-risk groups with different risk factors(1,2,3,4 and above)were not the same(P <0.05).The prevalence of risk groups with 4 or more risk factors were higher than those with 3,2 and 1(P'<0.05),The prevalence of risk groups with 3 risk factors had a higher prevalence rate than groups with 2 and 1(P'<0.05).The prevalence of risk groups with 2 high-risk factors was higher than groups with 1(P'<0.05).2.There were no differences in age and fasting blood glucose pre-pregnancy between the two groups before matching(P>0.05).The times of deliveries,weight before pregnancy,BMI before pregnancy,number of risk factors,incidence of abnormal blood glucose tolerance and insulin resistance before pregnancy,pre-pregnancy triglyceride and cholesterol were unevenly distributed between the two groups(P <0.05),using the PSM propensity score 1: 1,92 pairs were finally matched.There were no differences between the two groups after matching in all the above variables(P> 0.05).3.The incidence of GDM or ODM in the high-risk group of control groups before and after matching was higher than that in the pre-pregnancy intervention group(P <0.05).The control group OGTT 0h blood glucose,hemoglobin,and glycated hemoglobin at 24-48 weeks were higher than the intervention group before matching(P <0.05),and the control group OGTT 0h and 2h blood glucose,glycated hemoglobin at 24-48 weeks were still higher than the pre-pregnancy intervention group after matching(P <0.05).There were no differences in pre-pregnancy triglyceride and cholesterol,blood pressure and OGTT 1h blood glucose at 24-28 weeks between the two groups before and after matching(P > 0.05).4.There were no differences in weight of childbirth,gestational weight gain,birthing method,pregnancy gestation week,newborn weight,maternal complications(postpartum hemorrhage,premature rupture of m embranes,pregnancy-induced hypertension,preterm birth,oligohydramnios),newborns pediatric complications(fetal distress,neonatal asphyxia,fetal growth restriction,low birth weight infants,macrosomia,and fetal malformations)before matching(P >0.05).The gestational weight gain,the incidence of pregnancy-induced hypertension,and the incidence of total neonatal complications in intervention group were significantly lower than those in control group after matching(P <0.05).The proportion of excessive weight gain during pregnancy before and after matching was significantly lower in the intervention group than in the control group,the differences were statistically significant(P < 0.05).5.There were no statistical differences in the rate of insulin use,the initial gestational week of insulin,and the maximum daily dose of insulin in GDM or ODM patients in two groups after matching(P >0.05).The rate of following the doctor's order to return to hospital for OGTT at 6 weeks postpartum was significantly higher in intervention group than in control group(P <0.05),but there were no significant differences in fasting blood glucose,2 hours postprandial blood glucose,and incidence of abnormal glucose tolerance at 6 weeks postpartum(P>0.05).6.After intervention,61 cases(66.30%)of the A group met the standard of three items including weight management,pre-pregnancy blood glucose,and insulin resistance,19 cases(20.65%)met the two standards,and 11 cases(11.96%)met the one standard.1 case(1.09%)was failed to achieve one standard.The prevalence of GDM or ODM in Group A with more than 1,2,and 3 standards achieved after interventions were significantly lower than that of matched high-risk groups in Group B(P <0.05).Conclusion1.The more numbers of risk factors,the greater the possibility of suffering from GDM or ODM.2.After comprehensive management before pregnancy,people at high risk for gestational diabetes can effectively reduce the incidence of gestational diabetes and overt diabetes mellitus.It can also control blood glucose better and stablely.3.The comprehensive management of high-risk populations before pregnancy can better control weight gain during pregnancy,and reduce the incidence of mother and child complications to a certain extent.4.Patients diagnosed with GDM or ODM who had undergone comprehensive pre-pregnancy management followed the doctor's instructions to review OGTT at 6 weeks postpartum were with higher compliance.The influence of the comprehensive management before pregnancy on blood glucose value and the incidence of abnormal glucose tolerance in 6 weeks postpartum was not found.Greater benefits may require longer follow-up to find.5.In this study,on the basis of lifestyle intervention,as long as the measures that help to achieve the pre-pregnancy weight management,blood glucose and insulin resistance to the standard have certain prevention significance for GDM or ODM.Therefore,we encourage high-risk groups to plan pregnancy,and finish a comprehensive risk factor assessment before pregnancy,under the management of a professional physician,to intervene against risk factors,optimize health behaviors and improve pre-pregnancy health care,try to conceive in the best state of health,and improve adverse pregnancy outcomes.