Metabolic features and pregnancy outcomes of pregnant women with hyperglycemia

Abstract

Objective To analyze metabolic features and pregnancy outcomes of pregnant women with hyperglycemia. Methods One hundred and thirty pregnant women were enrolled between August 2005 and December 2006 and divided into the normal glucose tolerance group (NGT group, n=26), impaired glucose tolerance group (IGT group, n=42), and gestational diabetes mellitus group (GDM group, n=62) based on 75 g oral glucose tolerance test. Serum fasting glucose and insulin, HbA1c, lipid spectrum, and C–reactive protein were measured. Pre–pregnant BMI, ratio of advanced age pregnant women, HOMA–IR, HOMA–B, and ISI were calculated. Family history of diabetes and adverse pregnancy outcomes were recorded. ANOVA , χ2 test, and Logistic regression analysis were used for data analysis. Results Among three groups of GDM, IGT and NGT, serum fasting glucose((5.1±1.0), (4.7±1.0), and(4.0±0.5)mmol/L, respectively) and insulin((9±4), (9±4), and(6±4)mU/L, respectively), HbA1c((5.67±0.76)%, (5.62±0.61)%, and (4.03±0.27)%, respectively), total cholesterol((5.5±1.3), (5.1±1.2), and(4.2±1.1)mmol/L, respectively), LDL–C((3.1±1.0), (2.8±0.8), and(2.3±0.8)mmol/L, respectively), C–reactive protein(2.7, 3.8, and 1.8 mg/L, respectively), HOMA–IR(1.9, 1.8, and 0.9, respectively), pre–pregnant BMI((24.4±4.0), (24.3±2.8), and (22.2±2.8)kg/m2, respectively), the rate of cesarean delivery(71.0%, 52.4%, and 19.2%, respectively), infant birth weight((3304±608), (3345±463), and (2988±672)g, respectively), maternal complication rate (69.4%, 54.8%, and 23.1%, respectively), and neonatal complication rate(29.0%, 28.6%, and 3.8%, respectively) were increased in the GDM and IGT groups, although ISI(0.023, 0.024, and 0.052, respectively) was significantly decreased.HOMA–B(295.75, 168.76, and 126.25, respectively) was significantly different between the three groups. Family history of diabetes was more commonly seen in the GDM group(38.7%) than the NGT group(11.5%). Logistic analysis showed that adverse maternal–infant pregnancy outcomes were significantly related with pre–pregnant BMI, age and HbA1c. Conclusions Severe insulin resistance, β cell dysfunction, increased pre–pregnant BMI, lipid disorders, and hereditary susceptibility may be the main metabolic features of women with pregnant hyperglycemia. Pre–pregnant BMI, maternal age and HbA1c could be the risk factors of adverse maternal–neonatal complications. Key words: Hyperglycemia; Pregnancy complications; Metabolism; C–reactive protein; Pregnancy outcome