Association Between Area Under the Curve of Oral Glucose Tolerance Test and the Risk of Preterm Birth Among Women with Gestational Diabetes Mellitus: a Mediation Effect of Gestational Weight Gain

Overview

Journal BMC Pregnancy Childbirth

Publisher Biomed Central

Specialty Gynecology & Obstetrics

Date 2025 Mar 12

PMID 40069626

Authors

Jing Liu

Huibin Li

Xue Wang

Beibei Liu

Dan He

Gang Zhang

Yan Gao

Affiliations

Soon will be listed here.

Abstract

Background: The risk of preterm birth (PTB) is associated with maternal hyperglycemia but differs by combinations of abnormal oral glucose tolerance test (OGTT) values. However, the potential pathway by which maternal hyperglycemia affects PTB is unclear. This study aimed to investigate the association between OGTT-related measures and PTB and evaluate the mediation effect of gestational weight gain (GWG) on the association between maternal hyperglycemia and the risk of PTB in women with gestational diabetes mellitus (GDM).

Methods: This retrospective cohort study included women with GDM from a women's and children's hospital in Chengdu, China, from December 2021 to December 2023. The associations between OGTT-related measures, GWG, and PTB were evaluated by logistic regression analyses. Two-step clustering was used to classify participants by area under the curve (AUC) of the OGTT. SPSS Process Macro was utilized to explore the mediation effect of GWG on the relationship between AUC and PTB.

Results: This study included 1860 women with GDM, of whom 694 (37.3%) women had higher AUC (≥ 17 mmol/L·h), 935 (50.3%) women had insufficient GWG, and 132 (7.1%) women had PTB. Multivariable logistic regression analyses showed that only higher AUC was associated with increased odds of PTB (OR:1.47, 95% CI:1.03 to 2.10; P = 0.036), and no significant associations between other OGTT-related measures and PTB were observed. Besides, GDM women with higher AUC had a higher risk of insufficient GWG (OR:1.23, 95% CI:1.02 to 1.49; P = 0.033), which was associated with increased odds of PTB (OR:2.15, 95% CI:1.47 to 3.14; P < 0.001). Mediation analyses revealed that the effect of AUC on PTB was mainly mediated through GWG (indirect effect: 0.15, bootstrapped 95% CI: 0.08 to 0.24).

Conclusions: This study found that AUC of the OGTT was positively associated with the occurrence of PTB, and GWG mainly mediated this positive association. Effective intervention strategies for GDM should pay close attention to avoiding insufficient GWG when managing their blood glucose, especially for those with higher AUC levels, to reduce the impact of maternal hyperglycemia on the risk of PTB.

References

Safari S, Amini M, Aminorroaya A, Feizi A . Patterns of changes in fasting plasma glucose, hemoglobin A1c and the area under the curve during oral glucose tolerance tests in prediabetic subjects: results from a 16-year prospective cohort study among first-degree relatives of type 2 diabetic.... Acta Diabetol. 2020; 58(3):371-381. DOI: 10.1007/s00592-020-01622-5. View

Brouns F, Bjorck I, Frayn K, Gibbs A, Lang V, Slama G . Glycaemic index methodology. Nutr Res Rev. 2008; 18(1):145-71. DOI: 10.1079/NRR2005100. View

Billionnet C, Mitanchez D, Weill A, Nizard J, Alla F, Hartemann A . Gestational diabetes and adverse perinatal outcomes from 716,152 births in France in 2012. Diabetologia. 2017; 60(4):636-644. PMC: 6518373. DOI: 10.1007/s00125-017-4206-6. 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

Jiang H, Jia Y, Wang X, Zhang C, Li Y, Wang H . Evaluating the application of the 2009 Institute of Medicine gestational weight gain guidelines on pregnant Chinese women. Glob Health Action. 2023; 16(1):2213494. PMC: 10208122. DOI: 10.1080/16549716.2023.2213494. View

. ACOG Committee opinion no. 548: weight gain during pregnancy. Obstet Gynecol. 2012; 121(1):210-2. DOI: 10.1097/01.aog.0000425668.87506.4c. View

van Poppel M, Jelsma J, Simmons D, Devlieger R, Jans G, Galjaard S . Mediators of Lifestyle Behaviour Changes in Obese Pregnant Women. Secondary Analyses from the DALI Lifestyle Randomised Controlled Trial. Nutrients. 2019; 11(2). PMC: 6412227. DOI: 10.3390/nu11020311. View

Yang H . Diagnostic criteria for gestational diabetes mellitus (WS 331-2011). Chin Med J (Engl). 2012; 125(7):1212-3. View

Zhang C, Su S, Liu C, Zhang L, Yang H . [Impact of area under the curve of oral glucose tolerance test on pregnant woman with gestational diabetes mellitus]. Zhonghua Fu Chan Ke Za Zhi. 2015; 50(9):658-63. View

10.

Black M, Sacks D, Xiang A, Lawrence J . Clinical outcomes of pregnancies complicated by mild gestational diabetes mellitus differ by combinations of abnormal oral glucose tolerance test values. Diabetes Care. 2010; 33(12):2524-30. PMC: 2992182. DOI: 10.2337/dc10-1445. View

11.

. Hyperglycemia and Adverse Pregnancy Outcome (HAPO) Study: associations with neonatal anthropometrics. Diabetes. 2008; 58(2):453-9. PMC: 2628620. DOI: 10.2337/db08-1112. View

12.

Metzger B, Lowe L, Dyer A, Trimble E, Chaovarindr U, Coustan D . Hyperglycemia and adverse pregnancy outcomes. N Engl J Med. 2008; 358(19):1991-2002. DOI: 10.1056/NEJMoa0707943. View

13.

Cosson E, Tatulashvili S, Vicaut E, Pinto S, Sal M, Nachtergaele C . Glycemic status during pregnancy according to fasting and post-load glucose values: The association with adverse pregnancy outcomes. An observational study. Diabetes Metab. 2023; 49(5):101469. DOI: 10.1016/j.diabet.2023.101469. View

14.

Ye W, Luo C, Huang J, Li C, Liu Z, Liu F . Gestational diabetes mellitus and adverse pregnancy outcomes: systematic review and meta-analysis. BMJ. 2022; 377:e067946. PMC: 9131781. DOI: 10.1136/bmj-2021-067946. View

15.

Feng H, Zhu W, Yang H, Wei Y, Wang C, Su R . Relationship between Oral Glucose Tolerance Test Characteristics and Adverse Pregnancy Outcomes among Women with Gestational Diabetes Mellitus. Chin Med J (Engl). 2017; 130(9):1012-1018. PMC: 5421169. DOI: 10.4103/0366-6999.204928. View

16.

. WHO: recommended definitions, terminology and format for statistical tables related to the perinatal period and use of a new certificate for cause of perinatal deaths. Modifications recommended by FIGO as amended October 14, 1976. Acta Obstet Gynecol Scand. 1977; 56(3):247-53. View

17.

Zhu Y, Zheng Q, Pan Y, Jiang X, Li J, Liu R . Association between prepregnancy body mass index or gestational weight gain and adverse pregnancy outcomes among Chinese women with gestational diabetes mellitus: a systematic review and meta-analysis. BMJ Open. 2024; 14(2):e075226. PMC: 10875528. DOI: 10.1136/bmjopen-2023-075226. View

18.

Sun Y, Juan J, Xu Q, Su R, Hirst J, Yang H . Increasing insulin resistance predicts adverse pregnancy outcomes in women with gestational diabetes mellitus. J Diabetes. 2019; 12(6):438-446. DOI: 10.1111/1753-0407.13013. View

19.

Wang H, Li N, Chivese T, Werfalli M, Sun H, Yuen L . IDF Diabetes Atlas: Estimation of Global and Regional Gestational Diabetes Mellitus Prevalence for 2021 by International Association of Diabetes in Pregnancy Study Group's Criteria. Diabetes Res Clin Pract. 2021; 183:109050. DOI: 10.1016/j.diabres.2021.109050. View

20.

Luke B . The evidence linking maternal nutrition and prematurity. J Perinat Med. 2006; 33(6):500-5. DOI: 10.1515/JPM.2005.088. View