Adverse Pregnancy Outcomes and Its Associated Factors in Gestational Diabetes Mellitus with Isolated Fasting Hyperglycemia

Abstract

Background Due to possible neglect of elevated fasting glucose, poor intra-pregnancy glycemic control may occur in gestational diabetes mellitus (GDM) women with isolated fasting hyperglycemia, but whether it is related to adverse pregnancy outcomes, and associated factors need to be evaluated further. Objective To explore the prevalence of adverse pregnancy outcomes in GDM with simple isolated fasting hyperglycemia and its influencing factors. Methods A total of 411 GDM patients with isolated fasting hyperglycemia who had prenatal examination in Northwest Women and Children's Hospital between June 2020 and March 2021 were selected, and followed up until delivery. Clinical data and pregnancy outcomes (normal and adverse) were collected. Multivariate Logistic regression was used to examine the factors associated with adverse pregnancy outcomes. Results Among the 411 cases, 245 received standardized glycemic management, 157 (38.2%) of whom achieved adequate glycemic control, but other 88 cases (21.4%) still had poor glycemic control; the other 166 cases (40.4%) did not receive standardized blood glucose management. Three hundred and twenty-three (78.6%) patients had adverse pregnancy outcomes, and other 88 (21.4%) had normal pregnancy outcomes. Patients with normal and adverse pregnancy outcomes had statistically significant differences in mean maternal age, prevalence of pre-pregnancy maternal obesity, intra-pregnancy glycemic management, mean fasting glucose, one- and two-hour plasma glucose level during the OGTT, prevalence of HbA1c≥5.5%, serum total protein, serum albumin, prevalence of hypoproteinemia and the AUC of the time-blood glucose curve of the OGTT (P<0.05) . Multivariate Logistic regression analysis showed that pre-pregnancy maternal overweight or obesity〔OR=2.89, 95%CI (1.45, 5.78) , P=0.003〕, intra-pregnancy glycemic management 〔poor glycemic control: OR=3.64, 95%CI (1.64, 8.06) , P=0.001; non-management: OR=3.46, 95%CI (1.91, 6.25) , P<0.001〕, prenatal HbA1c〔OR=2.38, 95%CI (1.06, 5.34) , P=0.035〕, hypoproteinemia〔OR=2.25, 95%CI (1.15, 4.41) , P=0.018〕, and elevated AUC of the time-blood glucose curve of the OGTT〔OR=1.23, 95%CI (1.03, 1.47) , P=0.024〕 were associated with increased risk of adverse pregnancy outcomes. Conclusion Pre-pregnancy maternal overweight or obesity, uncontrolled or non-management of blood glucose during pregnancy, high prenatal HbA1c values, hypoproteinemia, and high AUC of the time-blood glucose curve of the OGTT may be high risk factors for adverse outcomes in GDM with isolated fasting hyperglycemia. To improve the rate of normal maternal and neonatal outcomes, clinical guidance should be given to pregnant women to maintain a normal pre-pregnancy weight and to standardizedly manage the blood glucose.

Keywords

• diabetes, gestational|pregnancy outcome|isolated fasting hyperglycemia|overweight|glycosylated hemoglobin|hypoproteinemia|root cause analysis