Pregnancy Outcomes And Risk Assessment Model Of Gestational Diabetes Mellitus In Guangxi,South China

Part 1 A composite risk assessment model to screen for gestational diabetes mellitus among Guangxi women.Objective In this population-based cohort study we examined the risk factors of gestational diabetes mellitus(GDM),and to develop a simple and convenient clinical prediction model for GDM.Methods We recruited pregnant women in the First Affiliated Hospital of Guangxi Medical University and Maternal & Child Health Hospitals of Nanning,Liuzhou,Qinzhou,Yulin,Guigang,Wuzhou and Yuzhou.A total of 578 pregnant women were selected after screening according to the inclusion criteria and exclusion criteria.The study population included GDM group(n=114)and not-GDM group(n=464).Statistical analysis was performed by t-test,Chi-square tests,Fisher exact test and logistic regression analyses,respectively.Two-side alpha level of 0.05 was considered statistically significant for all statistical tests.Hosmer-Lemeshow goodness-of-fit test and Receiver Operating Characteristic(ROC)were used to assess the logistic regression model.20%random samples were used for further internal validation.Results1.In this study,we found women with advanced age(RR=1.101,95%CI:1.044,1.161),increased pre-pregnant BMI(RR=1.111,95%CI:1.033,1.194),increased fasting plasma glucose level in the first 20 weeks of gestation(RR=3.474,95%CI:2.234,5.403),increased total white blood cells in the first 20 weeks of gestation(RR=1.182,95%CI:1.058,1.321),pre-pregnant genital tract inflammatory(RR=2.602,95%CI:1.534,4.415),hormone used one month before pregnancy(RR=2.970,95%CI:1.206,7.312)and family history of diabetes(RR=3.573,95%CI:1.677,7.615)had high risk of GDM.2.The prediction model for GDM was: Logit P =-11.644+0.100* age+0.718* pre-pregnant genital tract inflammatory +1.089* hormone used one month before pregnancy +1.077* family history of diabetes +1.245* fasting plasma glucose level in the first 20 weeks of gestation +0.167* white blood cell in the first 20 weeks of gestation.P value of Hosmer-Lemeshow goodness-of-fit test was 0.408.The AUC-ROC was 0.768(95%CI:0.716,0.820).When Youden's index was maximum,the critical point of model score was-1.11,and the sensitivity,specificity,positive predictive value and negative predictive value of this prediction model were 59.26%,89.58%,61.54% and 88.66%,respectively.Conclusion This model may provide a significant prognostic and applied value for predicting GDM and help the clinician to identify women at high or low risk for GDM early in pregnancy in order to individualized intervention,reducing pregnancy complications and improving maternal and infant health.Part 2 The outcomes of gestational diabetes mellitus according to the current diagnostic criterionObjective To analyze the prevalence and outcomes of gestational diabetes mellitus according to the current diagnostic criterion of GDM among women coming from Guangxi Birth Cohort Study.Methods In this cohort study,a total of 1490 pregnant women were selected.The study population included GDM group(n=312)and not-GDM group(n=1178).Perctentile method was used to classify the OGTT glucose levels.Statistical analysis were performed by t-test,Chi-square tests,Fisher exact test and logistic regression analyses,respectively.Two-side alpha level of0.05 was considered statistically significant for all statistical tests.Results1.The prevalence of GDM in our study was 20.82%(346/1662).2.Comparison of GDM group and not-GDM group did not reveal significant differences in preterm birth,macrosomia,low birth weight,Apgar<7at 1 minute and postpartum hemorrhage(p>0.05).Women with GDM had no risk of caesarean section(RR=1.148,95%CI: 0.857,1.539).3.Women whose OGTT 1-h glucose level ?10.09mmol/L or?10.89mmol/L had high risks of preterm birth(?10.09mmol/L,RR=2.049,95%CI:1.141,3.678;? 10.89mmol/L,RR=2.80,95%CI:1.396,5.635,respectively),and had no risk of other adverse pregnancy outcomes(p>0.05).4.Women whose OGTT 2-h glucose level ?8.61mmol/L or ?9.3mmol/L had high risks of preterm birth(? 8.61mmol/L,RR=2.169,95%CI:1.218,3.861;?9.30 mmol/L,RR=2.639,95%CI: 1.311,5.312,respectively),and had no risk of other adverse pregnancy outcomes(p>0.05).ConclusionWe found women with GDM had no risk of adverse pregnancy outcomes in our study.Whereas,women whose OGTT 1-h glucose or 2-h glucose level higher than the level of current diagnostic criterion had high risks of preterm birth.This indicated us that We should pay attention to management hyperglycemia women.Large multicenter studies are necessary to clarify whether too much women were intervented by GDM intervention and management and causing health resources waste.