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Epidemiology/Health Services Research
Maternal glycemic parameters and adverse pregnancy outcomes among high-risk pregnant women
  1. Yanwei Zheng1,
  2. Yun Shen2,3,
  3. Susu Jiang1,
  4. Xiaojing Ma3,
  5. Jiangshan Hu1,
  6. Changbin Li1,
  7. Yajuan Huang1,
  8. Yincheng Teng1,
  9. Yuqian Bao3,
  10. Jian Zhou2,3,
  11. Gang Hu2,
  12. Minfang Tao1
  1. 1Department of Obstetric and Gynaecology, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, Shanghai, China
  2. 2Chronic Disease Epidemiology, Pennington Biomedical Research Center, Baton Rouge, Louisiana, USA
  3. 3Department of Endocrinology and Metabolism, Shanghai Clinical Center for Diabetes, Shanghai Diabetes Institute, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, Shanghai, China
  1. Correspondence to Dr Jian Zhou; zhoujian{at}sjtu.edu.cn; Dr Minfang Tao; taomf{at}sjtu.edu.cn

Abstract

Objective We aimed to investigate the association between maternal glycemic parameters and adverse pregnancy outcomes among high-risk pregnant women.

Research design and methods A total of 1976 high-risk pregnant women were enrolled between 2015 and 2017. All participants received a 75 g oral glucose tolerance test during the 24–30 gestational weeks and complete birth and delivery information was collected. Adverse pregnancy outcomes were defined as premature birth, birth weight >90th percentile, primary cesarean section, and pre-eclampsia. Logistic regression models were used to assess the association between five maternal glycemic parameters during pregnancy (fasting glucose, 1-hour glucose, 2-hour glucose, HbA1c, and serum 1,5-anhydroglucitol (1,5-AG)) and adverse pregnancy outcomes.

Results Of 1976 participants, 498 were diagnosed with gestational diabetes. The multivariable-adjusted ORs of adverse pregnancy outcomes for each one unit increase (1 mmol/L, 1%, or 1 µg/mL) were 2.32 (95% CI 1.85 to 2.92) for fasting glucose, 1.07 (95% CI 1.01 to 1.15) for 1-hour glucose, 1.03 (95% CI 0.96 to 1.10) for 2-hour glucose, 1.77 (95% CI 1.34 to 2.33) for HbA1c, and 0.96 (95% CI 0.94 to 0.98) for 1,5-AG, respectively. When all five glycemic parameters were simultaneously entered into the multivariable-adjusted model, only fasting glucose was significantly associated with total and individual adverse pregnancy outcomes. Receiver operating characteristic curve showed that fasting glucose plus any one of other four glycemic parameters had significantly enhanced the sensitivity of detecting adverse pregnancy outcomes.

Conclusions Fasting glucose at 24–30 gestational weeks was strongly associated with adverse pregnancy outcomes. Fasting glucose combined with one additional glycemic measurement showed non-inferiority indicating that post-load glycemic measurement was not necessary in detecting adverse pregnancy outcomes among high-risk pregnant women.

  • gestational diabetes mellitus

This is an open access article distributed in accordance with the Creative Commons Attribution 4.0 Unported (CC BY 4.0) license, which permits others to copy, redistribute, remix, transform and build upon this work for any purpose, provided the original work is properly cited, a link to the licence is given, and indication of whether changes were made. See: https://creativecommons.org/licenses/by/4.0/.

https://doi.org/10.1136/bmjdrc-2019-000774

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    Footnotes

    • YZ and YS contributed equally.

    • Contributors MT and JZ designed the study. YZ, SJ and CL acquired data. YZ and YS performed statistical analyses, and drafted the manuscript. XM, YH, YB and YT designed the study and critically revised the manuscript for important intellectual content. GH critically revised the manuscript for important intellectual content. MT and JZ were the guarantors of this work and, as such, had full access to all the data in the study and took responsibility for the integrity of the data and the accuracy of the data analysis.

    • Funding This study was supported by Shanghai Health and Family Planning Commission (20184Y0362).

    • Disclaimer The funding sources had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.

    • Competing interests None declared.

    • Patient consent for publication Obtained.

    • Ethics approval This study was approved by the Ethics Committee of Shanghai Jiao Tong University Affiliated Sixth People’s Hospital (2015-KY-012).

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data availability statement Data are available on reasonable request.