Association Of Gestational Diabetes Mellitus With Adverse Pregnancy Outcomes And Its Early Prediction

BackgroundGestational diabetes mellitus(GDM)is one of the most common metabolic complications of pregnancy.Because of the lack of clinical symptoms and the difficulty in early diagnosis of GDM,the adverse pregnancy outcomes occur.By predicting GDM Early and investigating its association with adverse maternal and fetal pregnancy outcomes,early intervention and targeted prevention of the development of adverse pregnancy outcomes can reduce adverse maternal and fetal outcomes,this has important implications for both the individual and society.ObjectiveThis study was to analyze the general and clinical data of GDM pregnant women and normal pregnant women,to explore the high risk factors of GDM,and to establish an early prediction model of GDM,the relationship between GDM and adverse pregnancy outcome was analyzed to achieve the goal of early diagnosis and treatment of GDM.MethodsThe first part:the data of 5647 pregnant women who underwent antenatal care and delivered in Shenzhen maternal and Child Health Center from 2019 to 2020 were collected and analyzed retrospectively.According to the results of 75g oral glucose tolerance test(OGTT)at 24-28+6 weeks’ gestation,2768 women with GDM and 2879 women with normal pregnancy were divided into GDM group and normal group.To collect the general clinical data(age,pre-pregnancy weight,height,pre-pregnancy body mass index,times of pregnancy and delivery,past medical history,etc.),results of fasting blood at 24-28+6 weeks of gestation(HbA1c,FPG,OGTT 1h blood glucose,OGTT 2h blood glucose),data on delivery(gestational age,mode of delivery,adverse pregnancy outcome,neonatal weight,neonatal APGAR score).The general data and pregnancy outcomes of GDM group and normal group were compared with each other by IBM SPSS 25.0 software to explore the relationship between GDM and adverse pregnancy outcomes.The second part:taking 369 pregnant women who were registered and given birth in Shenzhen MCH hospital between 2019 and 2020 as the research object,they were divided into GDM group and normal group according to the results of 75g oral glucose tolerance test at 24-28 weeks of gestation,including 187 patients with GDM and 182 normal pregnant women.General clinical data(age,pre-pregnancy weight,height,times of pregnancy and delivery,previous medical history,etc.),FPG and HbAlc at 10-13+6 weeks of gestation were collected,24-28+6 weeks of gestation HbAlc,FPG,OGTT 1h blood glucose,OGTT 2h blood glucose results.The general data of GDM Group and normal group were analyzed by IBM SPSS 25.0 statistical software.The risk factors of GDM were screened by Logistic regression analysis,the predictive value of ROC curve for gestational diabetes mellitus(GDM)was evaluated.P<0.05 showed significant difference.ResultsThere were 1107 pregnant women(39.99%)with soft birth canal laceration in GDM group and 952 pregnant women(33.07%)in normal group.There was significant difference between the two groups(x2=29.218,p<0.001).The average weight ofnewborns in GDM group was 3243.13±496.39 g,and 204 macrosomia(7.37%)were found.The average weight of newborns in normal group was 2754.62±581.51 g,and 151 macrosomia(5.24%)were found,there was significant difference between the two groups(x2=448.273,p<0.001).GDM was associated with hypertensive disorder complicating pregnancy(OR=1.734,95%CI(1.312-2.291),p<0.001).Single factor Logistic regression analysis showed that pre-pregnancy weight,body mass index,parity,HbAlc in early pregnancy and FPG in early pregnancy were associated with GDM(p<0.05),the OR values were 1.002,1.208,0.503,2.855,5.323,respectively,while age,height,education,work or not,nationality were not associated with GDM(P>0.05),multiple Logistic regression analysis showed that FPG,HbA1c,pre-pregnancy weight,pre-pregnancy BMI and parity were the risk factors of GDM(OR=5.323,95%CI 2.901-9.768,p<0.001)HbA1c in early pregnancy was a risk factor for GDM(OR=2.855,95%CI 1.522-5.356,p<0.05),pre-pregnancy weight was a risk factor for GDM(OR=1.002,95%CI 1.001-1.002,p<0.001),BMI was a risk factor for gestational diabetes mellitus(OR=1.208,95%CI 1.119-1.305,p<0.001);One-child multi-parturient(1 delivery times)was a risk factor for GDM(OR=2.219,95%CI 2.894-24.410,p<0.001)The risk factors of GDM were multi-parturient women with two or more births(OR=1.090,95%CI 1.059-8.354,p<0.05),the area under the ROC curve was 0.628,0.645,0.592,0.666 for pre-pregnancy weight,pre-pregnancy BMI,HbA1c in early pregnancy and FPG in early pregnancy,respectively,the sensitivity and specificity were 0.492,0.497,0.465,0.513 and 0.698,0.769,0.654,0.742 respectively.The area under the ROC curve for the prediction of GDM by early pregnancy FPG in combination with pre-pregnancy BMI was 0.702(95%CI 0.649-0.754),with a sensitivity of 0.567 and a specificity of 0.769.The area under the ROC curve was 0.674(95%CI 0.620-0.728)for prediction of GDM by FPG in combination with HbAlc in early pregnancy,whichwas statistically significant(p<0.001),with a sensitivity of 0.583 and a specificity of 0.709.Conclusion1.The risk of soft birth canal laceration,hypertensive disorder complicating pregnancy and fetal macrosomia in GDM is higher than that in normal pregnant women.2.Pre-pregnancy weight,pre-pregnancy BMI,multiple births,FPG in early pregnancy and HbAlc in early pregnancy were independent risk factors for GDM,but its sensitivity and specificity are low.3.The predictive value of FPG in early pregnancy,BMI before pregnancy,FPG in early pregnancy and HbAlc in early pregnancy was higher than that of FPG alone.