Incidence And Adverse Pregnancy Outcomes Of Gestationaldiabetes Mellitus:a Cohort Study

Objectives The aim of this study was to establish Ma’anshan Birth Cohort(MABC) and evaluate the adaptability of the criteria of the International Association of Diabetes and Pregnancy Study Group(IADPSG) proposed recently. We investigated the incidence of GDM by this diagnostic criteria and adverse pregnancy outcomes of women with GDM.Methods This study was a branch of a prospective MABC study. Pregnant women were enrolled when they came to Maternal and Child Health Care Centers of Ma’anshan for prenantal health care for the first time. Information was collected by using self-reported questionnaires at each follow-up visit. Gathered information included socidemographic factors, health behaviors before and during pregnancy, pregnancy history, medical history and pregnancy outcomes. Accurate weight and height were measured at every visit. Between 24-28 weeks of gestation, participants accepted GDM screening and diagnosis using the IADPSG criteria. Between 16 th May 2013 and 11 th September 2014, 1 914 women were involved in the analysis. Chi-square analysis was used for exploring the impact of GDM on maternal and child health. Multiple logistic regression analysis was performed for examing the risk factors of GDM.Results A total of 1 914 pregnant women were recruited, of which 87 women had abortion or labor induction. 103 women were lost to follow up, 102 of which changed their hospitals and one woman was not available. 2 women had stillbirth. Among 1 722 live births in Maternal and Child Health Care Centers of Ma’anshan, there were1 702 singleton pregnancies. Among 1 702 women who had singleton live birth, there were 10 women had pregestational diabetes mellitus(PGDM) and 97 women refused to take GDM diagnosis. Finally, data of 1 595 women was analyzed.The study showed that the mean age of 1 595 pregnant women was 26.7 years. There husband had mean age of 28.3 years. 30.2% women got their highest education level in college. As to Per capita income level, the proportion of 2 501~4 000 yuan was 42.3%. Among those women, 31.6% of them were the only child in their family. Promary gradiva accounted for 91.9% of these women. The pregnant women had mean age of menarche of 13.9 years. The mean(SD) height of pregnant women was 160.4(5.4)cm. The mean(SD) weight before pregnancy was 53.6(8.1)kg. The mean(SD) weight of first and second trimester were 55.1(9.1)kg and 64.2(9.2)kg, respectively.The incidence of gestational hypertension was 6.7%. The incidence of preeclampsia was 1.6%, while 2.4% of pregnant women had ICP. The cesarean section rate was 52.7%. 3.9% of infants were preterm. 2.0% of infants were low birth weight, while 7.5% of infants were macrosomia. The birth defect rate was 2.4%.According to the cut off values of IADPSG criteria, the incidence of GDM was 14.7%. The incidence of gestational hypertension was significantly higher among GDM pregnancies(15.3% vs. 5.4%, P<0.001). The cesarean section rate of GDM women was significantly higher than non-GDM women(62.6% vs. 51.0%, P=0.001). The infants of GDM women were more likely to be preterm or macrosomia(8.9% vs. 3.0%, 15.3% vs. 6.1%, P<0.001). Binary logistic regression demonstrated that overweight(RR=2.176, P<0.001), obesity(RR=3.574, P<0.001), age above 35 years( RR=3.716,P < 0.001),weight gain during first and second trimester(RR=1.058,P<0.001)and fasting plasma glucose level in first trimester(RR=2.404,P<0.001) were risk factors of GDM.There were 111 women met the old standard. The women who only met the new standard showed no significant difference in gestational hypertension, preeclampsia, Caesarean, macrosomia and LGA compared with the women who met both standards. The women who only met the new standard had increased risk of gestational hypertension, preterm, macrosomia and LGA than nomal women( RR=2.556,P=0.001;RR=2.034,P=0.035;RR=1.890,P=0.037;RR=1.746,P=0.008).Conclusions Our results indicated that women with GDM identified by IADPSG criteria was related to significantly higher rate of multiple adverse pregnancy outcomes. Such findings provide support for applying IADPSG criteria in Ma’anshan.