Risk Factors And Adverse Pregnancy Outcomes Of Gestational Diabetes Mellitus Among Primiparae

Objectives:(1)To study the early pregnancy-related risk factors and predictors of gestational diabetes in primiparous women;(2)To explore the effect of primiparous gestational diabetes on maternal and children’s adverse pregnancy outcomes.Methods:We conducted a method of retrospective case-control study to investigate the risk factors,all patients were included for they had complete clinical records and delivered impatiently at Shaoxing Maternity and Child Health Care Hospital,from January 2020 to December 2020.The study included:age,pre-pregnancy body mass index,last menstrual period,family history of diabetes,fasting glucose and biochemical index levels during early pregnancy,75g oral glucose tolerance test during 24-28 weeks Outcomes;pregnancy outcomes included:premature rupture of membranes,fetal distress,gestational week of delivery,mode of delivery,neonatal birth weight,neonatal hyperbilirubinemia,neonatal hypoglycemia,neonatal admission to NICU,and postpartum hemorrhage.According to the inclusion and exclusion criteria,1221 primigravida were finally included,and the study subjects were divided into gestational diabetes mellitus(GDM)and normal glucose tolerance(NGT)groups based on the results of the 75g oral glucose tolerance test,including 120 cases in the GDM group and 1101 cases in the NGT group.IBM SPSS 26.0 software and Medcalc 19.5.6 were used for statistical analysis of the data.The study of data distribution for continuous variables was first assessed by one-sample Kolmogorov-Smirnov test.Data conforming to normal distribution were expressed by the mean and standard deviation(±SD),and an independent sample t-test was used for comparison between groups;those with non-normal distribution were expressed by median(25th percentile to 75th percentile)[M(P25 to P75)],and comparison between groups was done by The Mann-Whitney test was used for comparison between groups;the count data were expressed as cases(%)and Pearson χ2 test was used for comparison between groups;one-way analysis was used to screen for factors influencing gestational diabetes in primiparous mothers;indicators with P<0.2 in the one-way analysis were included in multi-factor logistic regression analysis to screen for independent factors influencing gestational diabetes in primiparous mothers,and the strength of association between each factor and GDM was calculated.The factors were included in the multivariate logistic regression analysis to screen for independent influences on maternal gestational diabetes,and the strength of association(adjusted odds ratios(AOR))and 95%confidence interval(CI)were calculated for each factor.P<0.05 was considered a statistically significant difference.Results:A total of 1221 primigravida were included,including 120 cases(9.8%)in the GDM group and 1101 cases(90.2%)in the NGT group.The study found that the differences in age,pre-pregnancy body mass index,family history of diabetes,week of delivery,and levels of FPG,TBA,LDL-C,and APOB were statistically significant between the two groups(all p<0.05),while the differences in the remaining indicators were not statistically significant between the two groups(all p>0.05).Logistic regression analysis revealed that age,family history of diabetes,FPG,and APOB were all independent risk factors for the development of GDM in primiparous women(ORs 1.109,3.118,2.073,and 8.748,respectively;P<0.05),and ALB was an independent protective factor(OR 0.926,P=0.033).The critical values for age,FPG,and APOB to predict the development of gestational diabetes in primiparous women were 27.0 years,4.63 mmol/L,and 0.86 g/L,respectively,with sensitivities of 46.67%,42.5%,and 41.67%,specificities of 57.58%,77.11%,and 79.38%,respectively,and areas under the ROC curves of 0.604,0.606,0.614.The combined prediction model of age,family history of diabetes,FPG,APOB,and ALB had a sensitivity of 56.67%,a specificity of 75.02%,and an area under the ROC curve of 0.700,with higher predictive efficacy than each indicator alone.The rate of neonatal admission to NICU[48.3%(58/120)vs.24.3%(268/1101)]and the incidence of neonatal hypoglycemia[10.0%(12/120)vs.3.5%(38/1101)]were significantly higher in the gestational diabetes group than in the NGT group,and the differences were statistically significant(χ2 values of 31.825,10.207,both P<0.05).Conclusions:(1)Age,family history of diabetes,FPG,APOB,and ALB were independent factors influencing the development of gestational diabetes in primiparous mothers;(2)there was a significant positive correlation between the levels of FPG and APOB in early pregnancy and gestational diabetes in primiparous women.(3)Clinical data combined with laboratory test results can improve the efficacy of diagnosing gestational diabetes in primigravida,which is better than a single index test and has a certain diagnostic value.