Effect Of HbA1c-based Blood Glucose Control On Pregnancy Outcomes In Maternal Women With Gestational Diabetes Mellitus

Research BackgroundGestational Diabetes Mellitus(GDM)is defined as glucose intolerance of variable severity with onset or first recognition during pregnancy.The incidence rate of GDM in China has been increasing year by year.It has become an important public health problem that harms the health of pregnant women and their offspring.GDM causes adverse pregnancy outcomes in pregnant women and newborns,including macrosomia,maternal birth and cesarean section,increased amniotic fluid,neonatal distress,and neonatal hypoglycemia.The goal of GDM treatment is to maintain blood glucose levels achieving targets through lifestyle interventions(including medical nutrition therapy,exercise and weight management)and/or medications.Currently,Self-monitored blood glucose(SMBG)is the preferred method for monitoring blood glucose levels in GDM patients.Although HbA1c has been widely used in GDM pregnant women for blood glucose monitoring,it is only a second-line method.Furthermore,the benefits and risks of glycemic control targets based on the current HbA1c standard cut-off value have not been systematically evaluated,and further research is needed.Research objectivesThis is a retrospective study.Based on the currently recommended HbA1c standard cut-off value(<5.5%)in clinical practice in China,the effect of blood glucose level in the third trimester on the pregnancy outcomes in pregnant women with GDM was analyzed.This study will provide theoretical basis for promoting the application of HbA1c in glycemic management and pregnancy outcomes prediction in GDM patients.Research methodsIn this study,453 patients diagnosed with GDM(excluding all other diseases and complications before and after pregnancy)and 367 healthy pregnant women received by Nanfang Hospital in from January 2014 to July 2017 were selected and investigated.Based on the HbAle levels determined after hospitalization waiting for delivery or in the latest time(not more than one week before delivery),all 453 GDM patients were divided into two groups.BGRT group are GDM patients with blood glucose reaching the target(HbA1c<5.5%,n=204).BGNRT group are GDM patients with blood glucose not reaching the target(HbA1c≥5.5%,n=249).The 367 healthy pregnant women were used as the CONTROL group.Medical records(including the basic conditions,pregnancy status,perinatal physical and laboratory test results and delivery situation of maternal women,and the neonatal conditions)of all pregnant women and newborns were investigated to understand the effect of HbA1c-based blood glucose control on pregnancy outcomes.All data were analyzed by SPSS 20.0 statistical software.The t-test and x2 test were used to compare the measurement data and enumeration data,respectively.The logistic regression was used to analyze the relationship between the blood glucose control during pregnancy and the adverse pregnancy outcomes.The results were expressed as X± SD and a p<0.05 was indicated to be statistically significance.Results(1)The average age of the respondents was 29.67±4.40 years old.The distribution ratios of the subjects in the age group of 31-35 years old and of>36 years old group in BGRT and BGNRT group was significantly higher than that in CONTROL group(P<0.05).The GDM patients in BGNRT group have significantly higher body weight and body mass index(BMI)than GDM patients in BGRT group and healthy pregnant women in CONTROL group(P<0.05).The gestational weight gain of GDM patients in BGRT group was lower than that of GDM patients in BGNRT and pregnant women in CONTROL group(P<0.05).The HbAle level of GDM patients in BGRT group(4.97±0.16%)was significantly lower(P<0.05)than that of pregnant women in CONTROL group(5.25±0.49%).However,the HbA1c level of GDM patients in BGNRT group(6.06±0.26%)was significantly higher(P<0.05)than that of pregnant women in CONTROL group.(2)The ratio of multiple pregnancies in GDM women in BGRT group was significantly higher than that in GDM women in BGNRT group and healthy pregnant women in CONTROL group(P<0.05).However,the GDM women in BGNRT group had higher ratio of adverse pregnancy history than GDM women in BGRT group and healthy pregnant women in CONTROL group(P<0.05).(3)The incidence of cesarean section in pregnant women in BGNRT group(29.7%)was significantly higher than that in BGRT group and CONTROL group(P<0.05).The amount of postpartum hemorrhage in maternal women in BGRT and BGNRT groups was significantly higher than that in CPONTROL group(P<0.05).However,no difference was found regarding the incidence rate of postpartum hemorrhage betvween groups(P>0.05).The incidence of focal calcification and chorioamnion in the late placenta of pregnant women in BGRT and BGNRT group was both significantly lower than that in CONTROL group(P<0.05).The incidence of placental floor inflammation in pregnant women in CONTROL and BGRT group was significantly higher than that in BGNRT group(P<0.05).There xwas no statistically significant difference in the incidence of placental hematoma,late placental focal infarction,focal calcification or infarction and fetal membrane inflammation in pregnant women between groups(P>0.05).(4)The body weight,body length and head circumference of newborns and proportion of macrosomia in BGNRT group was significantly higher than those in BGRT group and CONTROL group(P<0.05).However,the body weight,body length and head circumference of newborns and proportion of macrosomia in BGRT group was not statistically different to those in CONTROL group(P>0.05).The Apgar 1 minute score of neonates in BGRT group was higher than that in BGNRT group and CONTROL group(P<0.05).The incidence rate of premature rupture of fetal membranes in BGRT group was significantly higher than that in BGNRT and CONTROL group(P<0.05).The infection rate in BGNRT group(16.9%)was significantly higher(P<0.05)than that in BGRT group(10.8%)and CONTROL group(8.7%).The incidence rate of neonatal brain injury in BGRT and BGNRT group was 13.7%and 12.4%,respectively,which was significantly higher(P<0.05)than that in CONTROL group(7.4%).There was no statistically significant difference(P>0.05)between groups regarding the neonatal hypoglycemia and hyperglycemia,premature birth rate,distribution of abnormal umbilical cord,amniotic fluid pollution and its specific classification,distribution of bloody amniotic fluid,amniotic fluid volume and intrauterine distress,acidosis,pulmonary abnormalities,and retinal hemorrhage.(5)After adjusting for all the influencing factors,the logistic regression model analysis found that BGNRT group compared with BGRT group,AOR of giant children was 3.275(P<0.05),AOR?of late placental focal infarction xwas 0.267(P<0.05)and’AOR of neonatal hyperglycemia was 0.202(P<0.05).Conclusion(1)Based on the HbA1c standard cut-off value of the current glycemic control target for GDM women in China,blood glucose control not reaching the target significantly increased the rate of neonatal physique(body weight,body length and head circumference),macrosomia,cesarean section and infection rate,but decreased the incidence of placental floor inflammation.(2)Based on the HbAle standard cut-off value of the current glycemic control target for GDM women in China,the GDM pregnant women xwith blood glucose control reaching the target or not have increased amount of postpartum hemorrhage and rate of neonatal brain injury than healthy pregnant women.However,they have reduced incidence of late placental focal calcification and chorionic inflammation than healthy pregnant women.(3)Logistic regression analysis showed that blood glucose control not reaching the target in pregnant women with GDM significantly increased the risk of macrosomia.