Study On The Correlation Between OGTT Results And Pregnancy Outcome

Objective:Gestational OGTT is the main method for screening and diagnosis of GDM.Gestational Diabetes Mellitus is one of the important factors that lead to adverse pregnancy outcomes,this study aims to study the relativity between 75 g OGTT results and the pregnancy outcomes,and provide the basis for GDM patients stratified management.Methods:Collect the cases of parturient in the Second Hospital of Hebei Medical University from October 1,2016 to September 30,2019.Exclusion criteria:Lack of OGTT information before or during pregnancy,pregnancy diagnosed diabetes,Patients treated with insulin,twins,and the use of assisted reproductive technology and the combined influence of lipid metabolic diseases(high blood pressure,kidney,cardiovascular disease,abnormal thyroid function,liver disease),etc.GDM,a total of 267 patients,according to the results of OGTT,they were divided into five groups:fasting blood glucose increase(A1,FBG:5.1-6.9mmol/L),blood glucose increase after taking glucose for one hour(A2,1h PG≥10mmol/L),blood glucose increase after taking glucose for two hours(A3,2h PG:8.5～11.0mmol/L),two blood glucose increase(B)and three blood glucose increase(C).At the same time,351 cases of normal pregnancy in the same period were collected as the control group.Results:1.Comparison of general conditions:there were statistically s-ignificant differences in the mean age,pre-pregnancy BMI and pregnancy weight gain of the 6 groups of pregnant women(P<0.05).Duncan mult-iple comparison was conducted among the 6 groups,and there was no significant difference in age among the groups(P>0.05).There were signi-ficant differences in pre-pregnancy BMI between group A1,group B an-d group C and the normal group,with the highest pre-pregnancy BMI(25.15±2.88kg/m~2)in group C and the lowest pre-pregnancy BMI(21.75±4.11 kg/m~2)in the normal group.There was a significant difference bet-ween the group C and the normal group in terms of weight gain during pregnancy,with the group C gaining the least weight during pregnancy(11.86±4.24kg)and the normal group gaining the most weight during pregnancy(14.99±5.39kg).2.Comparison of Hb A1c:hemoglobin levels of pregnant women in 6 groups were not statistically significant(P=0.764).Comparison of Hb A1c levels in the 6 groups of pregnant women show-ed statistical differences(P<0.01).Further,Duncan’s multiple comparison showed that there were significant differences between the group C and the normal group,with the highest(5.76±0.65%)in the group C and the lowest(5.34±0.41%)in the normal group.According to correlation coefficient statistics,hemoglobin level was positively correlated with pr e-pregnancy BMI,but the correlation was not strong(P<0.01,r=0.194).3.Comparison of pregnancy outcomes:chi-square test showed statistically significant differences among the groups in cesarean section rate,preterm delivery,oligohydramnios,neonatal hypoglycemia at term,probability of newborn entering NICU and macrosomia(P<0.05),but no statistically sig-nificant differences in postpartum hemorrhage(P=0.347).Age,pre-pregnancy BMI and weight gain during pregnancy were excluded,and logistic reg-ression was performed to evaluate the outcomes of 6 different pregnanc-ies.Compared with the normal group,the cesarean section rate of group A1,group A2,group A3 and group B showed significant differences,whi chwere 2.734 times(OR=2.734,95%CI=1.615-4.630),3.964 times(OR=3.964,95%CI=1.719-9.140),2.731 times(OR=2.731,95%CI=1.316-5.665)and 4.572times(OR=4.572,95%CI=1.316-5.665),compared with the normal grou p(P<0.01).Group B has the highest risk;Compared with the normal gro up,there were statistically significant differences(P<0.05)in the incidenc e ofhydramnios in group A1,group A2 and group B,which were 2.247 ti mes(OR=2.247,95%CI=1.026-4.920),3.936 times(OR=3.936,95%CI=1.574-9.847)and 2.489 times(OR=2.489,95%CI=1.144-5.414).Compared with the nor-mal group,the NICU rate of neonates in each group increased signifi can-tly(P<0.01).Group A1,group A2,group A3,group B and group C were11.636 times(OR=11.636,95%CI=6.082-22.260),17.197 times(OR=17.197,95%CI=7.648-38.665),8.958 times(OR=8.958,95%CI=3.946-20.335),11.026 times(OR=11.026,95%CI=5.658-21.488),18.189times(OR=18.189,95%CI=5.646-58.592);Compared with the normal group,the incidence of p reterm birth in all groups except group A2 increased with statistical diff erences(P<0.05).The incidence of preterm birth in group A1,group A3,group B and group C was 6.105 times(OR=6.105,95%CI=2.503-14.887),3.552 ti-mes(OR=3.552,95%CI=1.039-12.146),4.921 times(OR=4.921,95%C I=1.940-12.485)and 5.336 times(OR=5.336,95%CI=1.016-28.019)co mparedwith the normal group;The incidence of neonatal hypoglycemia at term in group B was significantly higher than that in the normal gro up(OR=7.497,95%ci=2.033-27.645),with statistical difference(P<0.01).The incidence of macrosomia in A1 and B was 6.028 times(OR=6.028,95%CI=2.596-13.998)and 6.206 times(OR=6.206,95%CI=2.558-15.056)of the normal group.The GDM group was divided into two groups w ith Hb A1c at the threshold of 5.5%.There were statistically significant d iffe-rences in macrosomia between the two groups(P<0.05).There we re no statistically significant differences in cesarean section rate,preterm de-livery,hydramnios,hypoglycemia in full-term neonates,and NICU ad mi-ssion probability of neonates(P values were 0.884,0.258,0.846,1.000,and0.789,respectively).When Hb A1c≥5.5%in gestational diabetes patients,the incidence of macrosomia increased.Conclusions:1.High pre-pregnancy BMI was a risk factor for GDM,and with the increase of pre-pregnancy BMI,abnormal OGTT items increased.2.Patients with three abnormal results of OGTT had difficulty in achieving blood glucose control and higher Hb A1c level.Hb A1c level was positively correlated with pre-pregnancy BMI.3.Patients with two abnormal results of OGTT are more likely to have neonatal hypoglycemia and macrosomia than patients with one abnormal result of OGTT,and the risk of cesarean section is greatly increased.Premature delivery is more likely to occur in patients with fasting blood glucose increase.Patients with increased 1h PG are most likely to have oligoamnios.And patients with three abnormal outcomes of OGTT had a significantly increased risk of neonatal hospitalization.