Abstract
Objective: The overall impact of maternal hyperglycemia on maternal and birth outcomes is largely underestimated, therefore quantifying the true burden of hyperglycemia in a whole population it is a challenging task. This study aims at examining the association between blood glucose concentration during pregnancy and a composite score of adverse maternal-birth outcomes in a large-scale prospective cohort study in China.Methods: Pregnant women within “the Born in Guangzhou Cohort Study” China who underwent a standard 75-g oral-glucose-tolerance-test (OGTT) between 22 and 28 gestational weeks were included. A composite score of stillbirth, duration of pregnancy, birth weight, preeclampsia, and cesarean section was developed based on a published maternal-fetal outcomes scale, weighed by the relative severity of the outcomes. Multiple linear regression models were used to assess the associations between OGTT glucose measurements and log composite score. Logistic regression models were used to assess relations with outcome as a categorical variable (0, 1– < 3, and ≥3).Findings: Among 12,129 pregnancies, the composite score ranged from 0 to 100 with a median of 2.5 for non-zero values. Elevated fasting glucose level was associated with higher composite score (adjusted coefficients 0.03 [95% CI, 0.02–0.04] for 1-SD increase). For 1-SD increase in fasting glucose, the risk of having a composite score 1– < 3 and ≥3 rises by 13% (95% CI, 8–17%) and 15% (95% CI, 7–23%), respectively. Similar association and increase in risk was found for 1 and 2-h glucose.Conclusion: Elevated fasting, 1 and 2-h glucose levels are associated with a range of adverse maternal-birth outcomes. The composite score model can be applied to the risk assessment for individual pregnant women and to evaluate the benefits for controlling glucose levels in the population.
Highlights
Gestational diabetes mellitus (GDM) is one of the most prevalent major complications during pregnancy worldwide [1,2,3]
The present study aims to examine the association between blood glucose concentrations during pregnancy, and riskadjusted adverse maternal-birth outcomes represented by a composite score in a large-scale prospective cohort study in China
The data used in the present study is part of the Born in Guangzhou Cohort Study (BIGCS), which is a birth cohort study conducted in the Guangzhou Women and Children’s Medical Center (GWCMC), China
Summary
Gestational diabetes mellitus (GDM) is one of the most prevalent major complications during pregnancy worldwide [1,2,3]. Previous studies have linked maternal hyperglycemia to increased risks of various adverse perinatal outcomes, including macrosomia, large for gestational age (LGA), cesarean section, preterm birth, gestational hypertension and hyperbilirubinemia [3, 4]. The varying strengths of association with these outcomes, which have different levels of severity and consequences, have not been fully appreciated [3, 4, 8]. This has led to difficulties in assessing the influence of maternal hyperglycemia on both maternal and birth outcomes, and developing optimal management of maternal hyperglycemia, as well as evaluating the effectiveness of glucose-lowering interventions in the general pregnant women population. A comprehensive consideration of multiple adverse outcomes, both in pregnant women and in newborns [9], is needed
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