Analysis On The Risk Factors Of Macrosomia In Women With Gestational Impaired Glucose Tolerance And Gestational Diabetes Mellitus

Objective: GDM is defined as the first recognition of glucose intolerance abnormity during pregnancy. The mechanism is indefinite, may be relative to insulin resistance. Studies show that DM family history, advanced age, pre-pregancy obesity are major risk factors for GDM. This condition is associated with adverse outcomes of pregnancy such as hypertensive disorder complicating pregnancy, macrosomia, shoulder dystocia, fetal anomaly, fetal growth restriction. Macrosomia is one of the most common complication of GDM. macrosomia in women with gestational impaired glucose tolerance and gestational diabetes mellitus increase obstetric complications and medical malpractice. Analysis on the macrosomia in women with gestational impaired glucose tolerance and gestational diabetes mellitus and women have non-macrosomia with GDM or GIGT. Discussion the conditions and methods of reduce of macrosomia occurred in women with gestational impaired glucose tolerance and gestational giabetes mellitus have important significance.Methods: A retrospective analysis on medical records of 146 cases with GDM and GIGT from January 1,2007 to April 30,2009.Among 146 cases of GDM and GIGT. All cases are singleton preganancies,diabetes mellitus is initiated or detected during pregnancy.146 cases who were diagnosed as GIGT or GDM were divided into 2 groups: groupⅠconsisted of 36 cases with macrosomia and groupⅡconsisted of 110 women without macrosomia.Statisticly Analysis: Quantitive variabes were expressed as mean±standard deviation,the groups were compared with T-test,chi-square test,logistic correlation analysis(using SPSS 13.0 software).P<0.05 was considered as statistical significant.Results:①Single factors analysis showed that there was statistical dignificance between case group and control group in DM family history,weight more than 90Kg,previous child with birth weight>4000g, weight before pregnancy, base BMI, weight increase during pregnancy,labor BMI (P < 0.05). There were no significant differences in recurrent spontaneous abortion, stillbirth,maternal age, height of body(P>0.05).②There was statistical significant difference between the two gurops of fasting glucose values and OGTT 1h glucose levels (P<0.05). There was no ststistical significant between the two gurops of OGTT 2h and OGTT 3h glucose levels(P>0.05).③Our hosipital diagnosis of GDM according to the diagnostic criteria of ADA. Regrouping the women with gestational impaired glucose tolerance and gestational diabetes mellitus according to the criterial of ADA, original GDM patients did not missed, 3 cases of GIGT were found the fasting plasma glucose≥5.3mmol/L can be diagnosis GDM.Two cases of this have abnormoity about OGTT 1h glucose levels(1 cases complicated by macrosomia).1 cases have abnormoity about OGTT 2h glucose levels.④There was statistical significant difference between the two gurops of gestional hypertension, dystocia, delivery delayed, polyhydramnios, placental weight (P<0.05). There was no ststistical significant between the two gurops of PROM, premature birth,postpartum hemorrhage, shoulder dystocia(P > 0.05).⑤ There was statistical significant difference between the two gurops of degree of amniotic fluid(P<0.05). There was no ststistical significant between the two gurops of neonatal asphyxia, neonatal ketoacidosis, neonatal hypoglycemia(P>0.05).⑥Logistic regression analysis shows previous child with birth weight>4000g, weight increase during pregnancy, fasting glucose values, DM family history were independent risk factors of macrosomia in women with gestational impaired glucose tolerance and gestational diabetes.Conclusion:①The factors like previous child with birth weight>4000g, weight increase during pregnancy, fasting glucose values, DM family history were independent risk factors of macrosomia in women with gestational impaired glucose tolerance and gestational diabetes.②Those factors as weight more than 90Kg,weight before pregnancy, base BMI,labor BMI, and OGTT 1h glucose levels can not be entered into the model, they may be the confounding factors to macrosomia in women with gestational impaired glucose tolerance and gestational diabetes mellitus.③According to ADA diagnostic criteria,it is practicable to omit 3-hour post glucose ingestion value of the OGTT in women.