Maternal hepatitis B infection and gestational diabetes mellitus.

BACKGROUND/AIMS: This retrospective cohort study was performed to examine the relationship between maternal hepatitis B virus infection, as indicated by the surface antigen status, with the development of gestational diabetes mellitus in a normal-risk Chinese obstetric population. METHODS: Maternal demographics, risk factors, and pregnancy outcome of 13,683 singleton pregnancies delivering in 1998-2001 were analysed according to maternal hepatitis B surface antigen status, which was routinely screened. Multiple logistic regression analysis was performed to examine the role of hepatitis B infection in the development of gestational diabetes mellitus. RESULTS: The 1138 women (8.3%) with hepatitis B infection had lower mean weight and body mass index, similar prevalence of chronic medical diseases and smokers, but increased prevalence of gestational diabetes mellitus, which remained significant (odds ratio 1.24, 95% confidence interval 1.01-1.51) after adjustment for confounding variables. However, there was no difference in pregnancy outcome. CONCLUSIONS: Our results confirmed the independent association between hepatitis B infection with gestational diabetes mellitus. The magnitude of chronic hepatitis B infection in the developing world and certain ethnic groups could have contributed to the high prevalence of gestational and possibly type 2 diabetes in these populations. Further studies on the long-term implications of our finding are warranted.

The impact of maternal HBsAg carrier status on pregnancy outcomes: a case-control study.

BACKGROUND/AIMS: To examine the impact of maternal HBsAg carrier status on pregnancy outcomes. METHODS: Two hundred and fifty-three carriers of hepatitis B surface antigen (HBsAg) with singleton pregnancy, were retrospectively compared with 253 controls matched for age and parity and year of delivery. RESULTS: On univariable analysis, HBsAg carriers had higher incidences of threatened preterm labour at <37 weeks (11.9% vs. 6.3%, P=0.030), preterm birth at <34 weeks (4.7% vs. 1.2%, P=0.033), gestational diabetes mellitus (19.0% vs. 11.1%, P=0.012) and antepartum haemorrhage (11.5% vs. 5.5%, P=0.026). Their infants had lower Apgar scores at the 1st (8.47+/-1.67 vs. 8.87+/-1.07, P=0.001) and 5th minute (9.56+/-1.29 vs. 9.80+/-0.54, P=0.007), and increased incidence of intraventricular haemorrhage (4.7% vs. 0.8%, P=0.007). On multivariable analysis, the association between HBsAg carrier state with antepartum haemorrhage, gestational diabetes mellitus and threatened preterm labour were confirmed. CONCLUSIONS: HBsAg carriers have increased risk of gestational diabetes mellitus, antepartum haemorrhage, and threatened preterm labour. This may be related to the chronic inflammatory state in these subjects. The role of chronic HBV infection in pregnancy complications has to be further elucidated.

Relationship between caloric intake and pregnancy outcome in diet-treated gestational diabetes mellitus.

A prospective observational study was performed to examine the relationship between estimated caloric intake with maternal blood glucose profile and infant outcome in a group of Chinese women with gestational diabetes mellitus (GDM) treated by diet alone. Following the diagnosis of GDM according to the World Health Organization (WHO) criteria, and using a 75 g oral glucose tolerance test (OGTT), 62 non-obese Chinese women who had completed a 5-day dietary survey were recruited into the study. They were categorized by their mean caloric intake over 5 days into tertiles for comparison of gestational weight gain, glycemic control and pregnancy outcome. Subjects in the highest tertile had a mean intake close to the prescribed intake. No differences were seen in maternal characteristics, gestational weight gain, OGTT, other postprandial glucose concentrations, or infant outcome among the tertiles. Our findings indicated that as long as the caloric intake did not exceed that prescribed, the infant outcome remained satisfactory.

Impact of iron deficiency anemia on prevalence of gestational diabetes mellitus.

OBJECTIVE: Increased Hb and ferritin have been associated with gestational diabetes mellitus (GDM). This study was performed to determine whether the prevalence of GDM is influenced by iron deficiency anemia. RESEARCH DESIGN AND METHODS: In a retrospective case-control study, 242 women with iron deficiency anemia (Hb<10 g/dl with features of iron deficiency) were compared with 484 nonanemic women matched for year of birth, who were delivered within the same 24-month period in our hospital, with respect to maternal demographics, infant outcome, and the prevalence of GDM diagnosed according to the World Health Organization criteria. RESULTS: There was no difference in the prepregnancy weight or BMI, but the anemic group had more multiparas and significantly lower gestational weight and BMI increments and prevalence of GDM (odds ratio [OR] 0.52, 95% CI 0.27-0.97), which was inversely correlated (P=0.045) with the duration of anemia. To determine the independent effect of anemia on GDM, multiple logistic regression analysis was performed adjusting for the effects of multiparity and BMI, and anemia was confirmed to be significantly associated with decreased prevalence of GDM (adjusted OR 0.46, 95% CI 0.23-0.90). CONCLUSIONS: The prevalence of GDM is reduced in iron deficiency anemia, which probably served as a surrogate for other factors such as nutritional inadequacy and reduced gestational weight gain. Further studies on the relationship between nutritional improvement and the increasing prevalence of GDM in the developing world are warranted.

HBsAg carrier status and the association between gestational diabetes with increased serum ferritin concentration in Chinese women.

OBJECTIVE: To determine whether the high prevalence of hepatitis B surface antigen (HBsAg) carriage in our population can explain the previous observation of an association between increased maternal serum ferritin concentration and gestational diabetes in Hong Kong Chinese women. RESEARCH DESIGN AND METHODS: A retrospective study was performed on 767 nonanemic women with singleton pregnancy who had iron status assessed at 28-30 weeks. The result of the routine antenatal HBsAg screening was retrieved from patient records. The HBsAg-positive and -negative groups were compared for maternal characteristics, prevalence of gestational diabetes in the third trimester, prevalence of high serum ferritin and iron concentrations, and transferrin saturation, which is defined as a value in the highest quartile established by the measurements obtained from the HBsAg-negative group. RESULTS: The incidences of oral glucose tolerance test and gestational diabetes were significantly increased in the HBsAg-positive group. The HBsAg-positive women with gestational diabetes had significantly increased prevalence of high serum ferritin compared with the HBsAg-negative women, irrespective of the latter's gestational diabetes status. Multiple logistic regression analysis confirmed the independent association between HBsAg carrier status with gestational diabetes (relative risk 3.51, 95% CI 1.83-6.73) but excluded high ferritin as an independent factor. CONCLUSIONS: Our results indicate that maternal HBsAg carriage could explain in part the association between increased serum ferritin concentration with gestational diabetes in Hong Kong Chinese women, and that HBsAg carrier status is an independent risk factor for gestational diabetes.

First-trimester blood pressure and gestational diabetes in high-risk Chinese women.

OBJECTIVE: Gestational diabetes mellitus (GDM) is associated with increased incidence of hypertensive disorders of pregnancy, which is attributed to maternal insulin resistance and hyperinsulinemia. A retrospective case-control study was performed to examine the relationship between first-trimester blood pressure (BP) and the subsequent development of GDM in high-risk Chinese women. METHODS: The systolic and diastolic BP readings at the 9th-12th week of gestation were compared between 67 women with GDM and 64 high-risk controls matched for age (+/- 1 year), height (+/- 1 cm), and booking weight (+/- 1 kg), all with singleton pregnancies and delivered within 1 year. The entire cohort was further categorized into systolic and diastolic BP quartile groups based on reference values established in 215 consecutive pregnant women, and the incidence of GDM was correlated with the quartile ranking. RESULTS: The GDM group had significantly higher systolic BP (114.0 +/- 12.9 mmHg versus 108.0 +/- 10.6 mmHg, P =.004) at the 9th-12th week. There was a positive and significant correlation between the incidence of GDM and systolic BP, but not diastolic BP, quartiles, and systolic BP above the median value (109 mmHg) was associated with increased incidence of GDM. Regression analysis with adjustment for the effects of age over 35 years and weight greater than 75 kg confirmed that systolic BP above median was a significant risk factor for GDM (OR 4.20, 95% CI 1.97, 8.94). CONCLUSION: The correlation between first-trimester systolic BP quartiles and incidence of GDM could be a feature of insulin resistance and hyperinsulinemia before the development of GDM in high-risk Chinese women.

Gestational diabetes and maternal third-trimester blood count.

OBJECTIVE: To examine the effect of gestational diabetes mellitus (GDM) in the third trimester on the maternal blood count in nonanemic women with singleton pregnancies. STUDY DESIGN: In a prospective, observational study, consecutive women without preexisting anemia or hemoglobinopathies, endocrine disorders or diabetes were recruited for blood sampling for complete blood count at 28-30 weeks' gestation, when they were screened for GDM, and again at 36-38 weeks' gestation. The management of pregnancy or GDM was not influenced by the study. After delivery, the blood count results were compared between women with and without GDM. RESULTS: Of the 462 women recruited, 64 (13.8%) were diagnosed with GDM. This group had similar blood counts at 28-30 weeks but significantly higher hemoglobin, red cell count and hematocrit and lower white cell count at 36-38 weeks as compared with the controls. Except for the lower platelet count, these differences appeared to represent an accentuation of the gestation-related changes that were found in the controls. CONCLUSION: The development of GDM in the third trimester is associated with significant changes in blood counts beyond the effect of advancing gestation alone, probably related to the pathologic effect of diabetes.

Maternal hemoglobin and risk of gestational diabetes mellitus in Chinese women.

OBJECTIVE: To examine the relationship between high maternal hemoglobin concentration at the initial antenatal visit and occurrence of gestational diabetes mellitus (GDM) in the third trimester in nonanemic women. METHODS: In a prospective observational study, 762 nondiabetic Chinese women with singleton pregnancies, whose initial visit hemoglobin concentration and mean cell volume were 10 g/dL or more and 80 fL or more, respectively, recruited at 28-30 weeks, had blood drawn for repeat measurement of hemoglobin concentration and iron parameters. These women were categorized by their initial visit hemoglobin concentration into quartiles, and the incidence of GDM was analyzed together with the maternal characteristics and iron status. RESULTS: The final study sample comprised 730 women. Compared with the rest, the group in the highest hemoglobin quartile (more than 13 g/dL) had a significantly higher incidence of GDM (18.7% versus 10.9%, P =.007), as well as greater age, weight, and serum ferritin and iron concentrations. Logistic regression was used to examine the effects of high body mass index (more than 25 kg/m(2)), advanced age (older than 34 years), parity of 1 or more, and hemoglobin in the highest quartile, on the incidence of GDM. Only advanced age (odds ratio 3.79, 95% confidence interval 2.33, 6.17) and hemoglobin in the highest quartile (odds ratio 1.73, 95% confidence interval 1.08, 2.78) emerged to be significant factors. CONCLUSION: A high maternal hemoglobin (more than 13 g/dL) at the initial prenatal visit in Chinese women is an independent risk factor for GDM. This may reflect a better nutritional status in these women, as suggested by the increased iron status.