Late-Pregnancy Dysglycemia After Negative Testing for Gestational Diabetes and Risk of the Large-for-Gestational-Age Newborns: A Nest Case-Control Study Based on the Xi'an Longitudinal Mother-Child Cohort Study

Overview

Journal Front Pediatr

Specialty Pediatrics

Date 2022 Jun 3

PMID 35656378

Authors

Zhangya He

Yang Mi

HeXiang Yang

Jing Ji

Jiayi Gao

Wanyu Zhang

Pei Wu

Zhangrui Xu

Shanshan Wang

Xiaoqin Luo

Affiliations

Soon will be listed here.

Abstract

Background: The implications of gestational diabetes mellitus (GDM) on the short- and long-term health outcomes of both mother and child have been extensively studied. However, studies related to negative Oral Glucose Tolerance Test (OGTT) results in the second trimester but dysglycemia in late pregnancy on maternal and infant pregnancy outcomes are rare.

Methods: We conducted a nest case-control study within the Xi'an Longitudinal Mother-Child Cohort study (XAMC) to investigate the risk of adverse pregnancy outcomes in mothers and children with maternal negative mid-pregnancy OGTT results but high glycated hemoglobin (HbA) levels (≥5.7%) in late pregnancy. All target women who delivered from January 1st, 2017 to December 31st, 2018 in Northwest Women's and Children's Hospital in Xi'an were enrolled as the case group (HbA ≥ 5.7%). Others with HbA < 5.7% but without GDM were selected as the control group (HbA < 5.7%) by matching with the same delivery period. The logistic regression models were used to find out the risk factors of adverse pregnancy outcomes in the target population.

Results: A total of 2,116 and 1,907 women were finally enrolled in the case and control groups, respectively. Compared to the control group, more newborns with macrosomia (9.2% vs 4.1%, < 0.001) and large for gestational age (LGA) (23.7% vs. 13.5%, < 0.001), but less small for gestational age (SGA) (4.4% vs. 6.1%, = 0.017) were found in the case group. The differences in other outcomes were not statistically significant. The multiple logistic regression analysis showed that gestational age, fetal length, prenatal HbA, and total cholesterol (TG) were independent risk factors for newborns with large-for-gestational-age (LGA). The case group had a 2.516-fold (95% CI, 1.692-3.739) risk of delivering LGA newborns compared to the control group.

Conclusion: The glycemic management during the late pregnancy of non-GDM women should be given special consideration to reduce the risk of overweight offspring at birth.

Citing Articles

Pre-pregnancy body mass index and glycated-hemoglobin with the risk of metabolic diseases in gestational diabetes: a prospective cohort study.

Wang X, Zhang S, Yu W, Li G, Li J, Ji J Front Endocrinol (Lausanne). 2023; 14:1238873.

PMID: 37842297 PMC: 10569468. DOI: 10.3389/fendo.2023.1238873.

References

Schwarzenberg S, Georgieff M . Advocacy for Improving Nutrition in the First 1000 Days to Support Childhood Development and Adult Health. Pediatrics. 2018; 141(2). DOI: 10.1542/peds.2017-3716. View

Starikov R, Dudley D, Reddy U . Stillbirth in the pregnancy complicated by diabetes. Curr Diab Rep. 2015; 15(3):11. DOI: 10.1007/s11892-015-0580-y. View

Bustos M, Venkataramanan R, Caritis S . Nausea and vomiting of pregnancy - What's new?. Auton Neurosci. 2016; 202:62-72. PMC: 5107351. DOI: 10.1016/j.autneu.2016.05.002. View

Zhang S, Wang L, Leng J, Liu H, Zhang T, Li N . Hypertensive disorders of pregnancy in women with gestational diabetes mellitus on overweight status of their children. J Hum Hypertens. 2017; 31(11):731-736. PMC: 5600626. DOI: 10.1038/jhh.2017.17. View

Metzger B, Gabbe S, Persson B, Buchanan T, Catalano P, Damm P . International association of diabetes and pregnancy study groups recommendations on the diagnosis and classification of hyperglycemia in pregnancy. Diabetes Care. 2010; 33(3):676-82. PMC: 2827530. DOI: 10.2337/dc09-1848. View

Pringle K, Lee Y, Weatherall L, Keogh L, Diehm C, Roberts C . Influence of maternal adiposity, preterm birth and birth weight centiles on early childhood obesity in an Indigenous Australian pregnancy-through-to-early-childhood cohort study. J Dev Orig Health Dis. 2018; 10(1):39-47. DOI: 10.1017/S2040174418000302. View

Voigt M, Schneider K, Jahrig K . [Analysis of a 1992 birth sample in Germany. 1: New percentile values of the body weight of newborn infants]. Geburtshilfe Frauenheilkd. 1996; 56(10):550-8. DOI: 10.1055/s-2007-1023283. View

Metzger B . Long-term outcomes in mothers diagnosed with gestational diabetes mellitus and their offspring. Clin Obstet Gynecol. 2007; 50(4):972-9. DOI: 10.1097/GRF.0b013e31815a61d6. View

Schmidt C, Voorhorst I, van de Gaar V, Keukens A, Potter van Loon B, Snoek F . Diabetes distress is associated with adverse pregnancy outcomes in women with gestational diabetes: a prospective cohort study. BMC Pregnancy Childbirth. 2019; 19(1):223. PMC: 6610799. DOI: 10.1186/s12884-019-2376-6. View

10.

Festin M . Nausea and vomiting in early pregnancy. BMJ Clin Evid. 2014; 2014. PMC: 3959188. View

11.

Perna R, Loughan A, Le J, Tyson K . Gestational Diabetes: Long-Term Central Nervous System Developmental and Cognitive Sequelae. Appl Neuropsychol Child. 2014; 4(3):217-20. DOI: 10.1080/21622965.2013.874951. View

12.

Yang J, Cummings E, OConnell C, Jangaard K . Fetal and neonatal outcomes of diabetic pregnancies. Obstet Gynecol. 2006; 108(3 Pt 1):644-50. DOI: 10.1097/01.AOG.0000231688.08263.47. View

13.

Wendland E, Torloni M, Falavigna M, Trujillo J, Dode M, Campos M . Gestational diabetes and pregnancy outcomes--a systematic review of the World Health Organization (WHO) and the International Association of Diabetes in Pregnancy Study Groups (IADPSG) diagnostic criteria. BMC Pregnancy Childbirth. 2012; 12:23. PMC: 3352245. DOI: 10.1186/1471-2393-12-23. View

14.

Emelianova S, Mazzotta P, Einarson A, Koren G . Prevalence and severity of nausea and vomiting of pregnancy and effect of vitamin supplementation. Clin Invest Med. 1999; 22(3):106-10. View

15.

Kerssen A, de Valk H, H A Visser G . Increased second trimester maternal glucose levels are related to extremely large-for-gestational-age infants in women with type 1 diabetes. Diabetes Care. 2007; 30(5):1069-74. DOI: 10.2337/dc05-1985. View

16.

Robertson R, Manges A, Finlay B, Prendergast A . The Human Microbiome and Child Growth - First 1000 Days and Beyond. Trends Microbiol. 2018; 27(2):131-147. DOI: 10.1016/j.tim.2018.09.008. View

17.

Lepercq J, Taupin P, Dubois-Laforgue D, Duranteau L, Lahlou N, Boitard C . Heterogeneity of fetal growth in type 1 diabetic pregnancy. Diabetes Metab. 2001; 27(3):339-44. View

18.

Kim C, Newton K, Knopp R . Gestational diabetes and the incidence of type 2 diabetes: a systematic review. Diabetes Care. 2002; 25(10):1862-8. DOI: 10.2337/diacare.25.10.1862. View

19.

Gao C, Sun X, Lu L, Liu F, Yuan J . Prevalence of gestational diabetes mellitus in mainland China: A systematic review and meta-analysis. J Diabetes Investig. 2018; 10(1):154-162. PMC: 6319492. DOI: 10.1111/jdi.12854. View

20.

Evers I, de Valk H, Mol B, Ter Braak E, Visser G . Macrosomia despite good glycaemic control in Type I diabetic pregnancy; results of a nationwide study in The Netherlands. Diabetologia. 2002; 45(11):1484-9. DOI: 10.1007/s00125-002-0958-7. View