| BackgroundGestational diabetes mellitus(GDM)is a condition in which glucose metabolism is normal before pregnancy and develops only during pregnancy.GDM is the result of multifactorial interaction,and the etiology is multigenic.Although the research on the etiopathogenesis of GDM has been more and more in-depth in the last few years,the aetiology and etiopathology of GDM are still not completely clear,and there is a lack of early prediction of GDM.Hemoglobin(Hb)is a routine obstetric examination program during pregnancy,and the previous focus has been on the impact of anemia on pregnancy outcomes.At present,many studies have begun to focus on the association between Hb and the risk of GDM,and believe that Hb can forecast the development of GDM,but there is no uniform conclusion.PurposeTo explore the relationship between hemoglobin concentration in early pregnancy and the onset of GDM,and to investigate its predictive role for GDM to predict and intervene in GDM early and reduce adverse maternal and infant outcomes.MethodsA retrospective analysis of pregnant women with singleton pregnancies,who were established and had regular birth examinations in our obstetrics outpatient clinic from January 1,2019,to December 31,2021,was able to collect the complete obstetric reports,a total of 335 cases.Based on the OGTT results,114pregnant women with GDM were screened as the case group and the remaining 221 as the control group.Age at delivery,pre-pregnancy body mass index,early pregnancy systolic blood pressure,early pregnancy diastolic blood pressure,gravidity,parity,literacy level,early pregnancy fasting glucose,and early pregnancy hemoglobin were compared among the two groups,Comparisons between groups were made using the Mann-Whitney U test.Logistic regression was used to analyse the effect of Hb concentration in early pregnancy on GDM.,and the relationship between Hb concentration in early pregnancy and the onset of GDM was analysed by dividing BMI into two groups(BMI<24kg/m~2and BMI≥24kg/m~2),finally,receiver operating characteristic(ROC)analysis was taken to analyze the predictive value of Hb on the risk of developing GDM and to obtain cut-off values.Results1.The results of the univariate analysis indicated that the GDM group compared to the normal group,age(30.89±4.65vs28(25,32),P<0.001),pre-pregnancy BMI(23.44(21.63,25.7)vs 21.48(19.47,23.58),gravidity(2.34±1.36 vs 2(1,3),P=0.011),parity(0(0,1)vs 0(0,1),P=0.008),Hb concentration in early pregnancy(131.32±6.61 vs 125(120,129),P<0.001),fasting glucose(5.09(4.9,5.37)vs 4.85(4.63,5.07),P<0.001),diastolic blood pressure in early pregnancy(73(68,77)vs69(65,75),P=0.002),were significantly higher than the normal group.There were no significant differences in first trimester systolic blood pressure(116(110,125)vs 116(108,123),P=0.097),or educational level(P=0.136)between the two groups.2.Logistic regression analysis showed that the OR for early pregnancy Hb was 1.133,95%CI1.083-1.184,P<0.001,the OR for age was 1.09,95%CI 1.014-1.171,P=0.019;the OR for pre-pregnancy BMI was 1.105,95%CI 1.013-1.206,P=0.024;The OR of fasting glucose was 3.961,95%CI 1.786-8.785,P=0.001.That is,age,pre-pregnancy BMI,early pregnancy Hb,and early pregnancy blood glucose were independent risk factors for the development of GDM.3.The Hb concentration in early pregnancy was divided into four groups according to the quartile method to compare the incidence of GDM in each group with different pre-pregnancy BMI.we can see that Hb concentrations in early pregnancy were associated with the development of GDM regardless of pre-pregnancy BMI<24kg/m~2or≥24kg/m~2,and the group with the highest Hb level had the highest risk of developing GDM.4.Hb concentration in early pregnancy was positively correlated with OGTT0h,OGTT1h,and OGTT2h plasma glucose values.5.The area under the curve for Hb was 0.761,95%CI:0.708-0.813,P<0.001,sensitivity was 71.9%,specificity was 70.6%,and the cut-off value was 128.5 g/L.Hb concentration in early pregnancy has a high predictive value for the pathogenesis of GDM.Conclusion1.Hemoglobin concentration in early pregnancy is an independent risk factor for the development of GDM.2.Haemoglobin concentration in early pregnancy can be used as an early predictor of the risk of developing GDM,and the risk of developing GDM is higher when Hb≥128.5 g/L.3.Age,pre-pregnancy BMI,and fasting plasma glucose are the risk factors for diabetes mellitus. |
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