Association Between Maternal Fasting Plasma Glucose And Adverse Pregnancy Outcomes And Management In Gestational Diabetes Mellitus

BACKGROUNDGDM is defined as diabetes diagnosed in the second or third trimester of pregnancy that is not clearly pre-gestational diabetes.GDM is associated with a high risk of maternal and fetal adverse outcomes,including hypertensive disorders of pregnancy,stillbirth,congenital anomalies,neonatal hypoglycemia,macrosomia,and respiratory distress syndrome.In addition,GDM may increase the risk of obesity,hypertension,impaired glucose tolerance(IGT),type 2 diabetes and neuropsychiatric complications in offspring later in childhood and adulthood.As GDM is of particular concern worldwide,screening and diagnosis of GDM are carried out globally,and the prevalence of diabetes in pregnancy has been increasing in the world.Currently,much controversy exists in the researches about the diagnosis and treatment of GDM.Glucose monitoring aiming for the targets is also variable according to different guidelines.In recent years,an increasing number of studies have focused on the treatment of GDM.Fortunately,some studies have demonstrated that diet and/or insulin control may reduce the incidence of adverse pregnancy outcomes and the risk of future T2DM.Then,how about the implement of these effective strategies in the real world of clinical practice?No research focusing on this issue,which in-deed is the factor that truly affects prognosis in GDM patients,is currently available.On the other hand,researchers have paid more attention to association between adverse pregnancy outcomes and plasma glucose values,as indicated by the results of oral glucose tolerance tests(OGTTs).No reports exploring association between the FPG level detected on the last test performed before delivery and adverse pregnancy outcomes have been published.OBJECTIVEThe aims of our study were to investigate prevalence of GDM inpatients,maternal and neonatal outcomes in GDM inpatients for recent years and to analyze hospitalized management of GDM.We also attempted to investigate the risks of adverse pregnancy and outcomes associated with last FPG before delivery in a single center from China.METHODSWe retrospectively collected data of 996 inpatients with single pregnancy diagnosed as GDM and terminated pregnancies in Shandong Provincial Hospital from Jan 2011 to Dec 2015.The pregnancy outcomes were analyzed in comparison with the controls of 996 pregnant women with normal glucose metabolism who were matched from the same delivery year for age.We investigate prevalence of GDM inpatients,pregnancy outcomes,and hospitalized management.Logistic regression analysis was used to evaluate association between last fasting plasma glucose(FPG)performed within one week before delivery and adverse pregnancy outcomes.RESULTS1.Prevalence of GDM inpatientsOf the 30191 inpatients in the Department of Obstetrics and Gynecology of Shandong Provincial Hospital from Jan 2011 to Dec 2015,1330 inpatients were diagnosed as GDM.Overall prevalence of GDM inpatients is 4.4%.Except slightly fall of prevalence in 2014,prevalence of GDM inpatients showed an increasing trend,rising from 2.11%of 2011 to 6.38%of 2015.2.Pregnancy outcomesWe included 1,992 women in our primary analyses.Among these inpatients,996 women were diagnosed,and 996 were pregnant women with normal glucose metabolism.Women with GDM were more likely to have adverse pregnancy outcomes compared with women with normal glucose metaboslism,including hypertensive disorders in pregnancy and macrosomic(P<0.01).Based on last FPG values performed within one week before pregnancies,we divided 969 GDM women into good control group(FPG ?5.3mmol/L)and poor control group(FPG>5.3mmol/L).Rates of adverse pregnancy outcomes such as hypertensive disorders in pregnancy were significantly higher in poor control group than in good control group(P<0.05)We next evaluated the effect of management of GDM on the pregnancy outcomes.GDM women who received treatment had significantly lower rate of adverse pregnancy outcomes such as premature and hypertensive disorders in pregnancy.However,rates of women with hydramnios,macrosomia and postpartum hemorrhage were greater in the treatment group(P>0.5).3.Treatment regimens of GDMAmong the GDM inpatients,616 of GDM group received dietary intervention(42.8%)or insulin treatment(19.1%),and 9.6%(96)received only routine care.Notably,the proportion of the inpatients who had no medical records on glycemic control was high to 28.5%.4.FPG levels and management of GDMAmong GDM inpatients,27(2.7%)women didn't perform last FPG within one week before termination of pregnancy.The proportion of women whose FPG values didn't achieve recommended level as proposed by the ADA criteria is 40.1%,while 57%of GDM women's FPG values did achieve good control.Proportion of FPG levels performed before termination of pregnancy achieved recommended targets was increasing.4.Associations between pregnancy outcomes and FPG valuesMultiple logistic regression analysis showed that last FPG values before pregnancies were significantly associated with stillbirth,premature,admission of neonatal care and RDS.CONCLUSIONS1.Prevalence of GDM inpatients showed an increasing trend for recent five years.2.GDM inpatients have higher rates of adverse pregnancy outcomes than those controls,and the differences are significant.3.Proportion of GDM inpatients received treatment on glycemic control is low.4.Poor control of FPG values is an independent risk factor of some adverse pregnancy outcomes.5.GDM patients need to strengthen management and glycemic control during pregnancy in order to obtain better pregnancy outcomes.