Pregnancy outcomes and influencing factors of gestational diabetes mellitus women with isolated fasting hyperglycemia / 中华围产医学杂志

ABSTRACT

Objective To explore the factors influencing pregnancy outcome of gestational diabetes mellitus (GDM) patients with isolated fasting hyperglycemia.Methods Medical records of 1 059 GDM patients with isolated fasting hyperglycemia,who gavc birth at Peking University First Hospital between January 2012 and December 2015,were retrospectively reviewed.Clinical data,including maternal age,pre-pregnancy body mass index (BMI),fasting plasma glucose (FPG) in the first trimester,results of oral glucose tolerance tests (OGTT),area under the curve (AUC) of OGTT,glycosylated hemoglobin (HbAlc),re-tested FPG (within one week after OGTT) and insulin usage,were analyzed.Patients with or without adverse pregnancy outcome,including first cesarean section,larger for gestational age,preterm birth,hypertensive disorders of pregnancy,dystocia or birth trauma,neonatal hypoglycemia and neonatal hyperbilimbinemia,were respectively divided into two groups.T or Chi-square test was used for univariate analysis.Logistic regression was used for multivariate analysis.Results Among the 1 059 patients,18 (1.7％) received insulin therapy and 591 had adverse pregnancy outcome (55.8％).Univariate analysis showed that the percentages of patients whose age ≥ 35 years old,pre-pregnancy BMI ≥ 25,AUC ≥ 13 mmol/L · h or HbAlc ≥ 5.5％ were higher in the group with adverse pregnancy outcome than in those without adverse pregnancy outcome [21.7％ (128/591) vs 13.2％ (62/468),x2=12.548;28.9％ (171/591) vs 16.2％ (76/468),x2=23.535;87.5％ (517/591) vs 78.4％ (367/468),x2=15.542;32.9％ (155/471) vs 26.2％ (99/377),x2=4.514;all P＜0.05].The average values of OGTT-1 h and OGTT-2 h in patients with adverse pregnancy outcome were higher than in those without [(8.27 ± 1.14) vs (8.11 ±-1.19) mmol/L,t=-0.367;(7.01 ±0.85) vs (6.88±0.87) mmol/L,t=-0.517;both P＜0.05].Multivariate analysis showed that pre-pregnancy BMI＜25 and AUC＜13 mmol/L · h were protective factors for adverse pregnancy outcomes [OR (95％CI):0.498 (0.355-0.698) and 0.431 (0.247-0.752),both P＜0.01].Conclusions Pre pregnancy BMI＜25 and AUC＜13 mmol/L · h are protective factors for adverse pregnancy outcomes in GDM patients with isolated fasting hyperglycemia.Clinical practitioners may regard this group of women as relatively low-risk to avoid unnecessary intervention.