Response to Comment on Hughes et al. An Early Pregnancy HbA1c≥5.9% (41 mmol/mol) Is Optimal for Detecting Diabetes and Identifies Women at Increased Risk of Adverse Pregnancy Outcomes. Diabetes Care 2014;37:2953–2959

Abstract Aims Universal early-pregnancy screening for overt diabetes reveals intermediate hyperglycaemia [fasting plasma glucose (FPG) (5.1–6.9 mM)]. We evaluated the association between early-pregnancy intermediate hyperglycaemia and adverse pregnancy outcomes among women without gestational diabetes. Methods This retrospective cohort study, conducted at the Obstetrics and Gynaecology Hospital, Shanghai, China, from 2013-2017. All singleton pregnancies with FPG≤6.9mM in early pregnancy and receiving 75-g oral glucose tolerance test (OGTT) were included. Women with pre-pregnancy diabetes were excluded. Subjects with normal OGTT were analysed. Pregnancy outcomes for FPG<5.1 mM and intermediate hyperglycaemia were evaluated. The primary outcomes were large for gestational age (LGA) and primary caesarean section. Multivariate logistic regressions were conducted. Significance was defined as P<0.05. Results Totally, 24479 deliveries were included, of which 23450 (95.8%) had normal OGTTs later in pregnancy (NGT). There were 807 (3.4%) women had FPG=5.1–6.9 mM in early pregnancy. Compared to the NGT group with FPG<5.1 mM in early pregnancy (N=20692), the intermediate hyperglycaemia NGT group (N=693) had a higher age and BMI, and significantly higher rates of LGA, primary caesarean section, preterm birth, preeclampsia and neonatal distress. The rates of primary caesarean section (AOR 1.24, 95% CI 1.05–1.45), preterm birth (AOR 1.75, 95% CI 1.29–2.36) and neonatal distress (adjusted OR 3.29, 95% CI 1.57–6.89) remained significantly higher after adjustments for maternal age, BMI and other potential confounding factors. Conclusions Women with intermediate hyperglycaemia in early pregnancy are at an increased risk for adverse maternal-foetal outcomes, even with normal future OGTTs.

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An Early Pregnancy HbA1c≥5.9% (41 mmol/mol) Is Optimal for Detecting Diabetes and Identifies Women at Increased Risk of Adverse Pregnancy Outcomes

Diabetes Care ◽

10.2337/dc14-1312 ◽

2014 ◽

Vol 37 (11) ◽

pp. 2953-2959 ◽

Cited By ~ 93

Author(s):

Ruth C.E. Hughes ◽

M. Peter Moore ◽

Joanna E. Gullam ◽

Khadeeja Mohamed ◽

Janet Rowan

Keyword(s):

Early Pregnancy ◽

Pregnancy Outcomes ◽

Adverse Pregnancy Outcomes ◽

Increased Risk ◽

Adverse Pregnancy

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Associations of early pregnancy BMI with adverse pregnancy outcomes and infant neurocognitive development

Scientific Reports ◽

10.1038/s41598-021-83430-7 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Yu-Ting Chen ◽

Ting Zhang ◽

Chang Chen ◽

Yin-Yin Xia ◽

Ting-Li Han ◽

...

Keyword(s):

Early Pregnancy ◽

Gestational Age ◽

Pregnancy Outcomes ◽

Overweight And Obesity ◽

Adverse Pregnancy Outcomes ◽

Psychomotor Development ◽

Neurocognitive Development ◽

Development Index ◽

Increased Risk ◽

Adverse Pregnancy

AbstractThe prevalence of overweight and obesity amongst reproductive women has been increasing worldwide. Our aim was to compare pregnancy outcomes and infant neurocognitive development by different BMI classifications and investigate whether early pregnancy BMI was associated with risks of adverse outcomes in a Southwest Chinese population. We analysed data from 1273 women enrolled in the Complex Lipids in Mothers and Babies (CLIMB) randomized controlled trial in Chongqing, China. Maternal BMI was classified as underweight, normal weight and overweight/obese according to the Chinese, WHO Asian, and WHO European standards. For the adverse pregnancy outcomes, after adjustment for potential confounders, an underweight BMI was associated with increased risk of small for gestational age (SGA) babies, and an overweight/obese BMI was associated with increased risk of maternal gestational diabetes mellitus (GDM), caesarean section (C-section), macrosomia and large for gestational age (LGA) babies. For infant neurocognitive development, 1017 mothers and their children participated; no significant differences were seen in the Mental Development Index (MDI) or the Psychomotor Development Index (PDI) between the three BMI groups. Our findings demonstrate that abnormal early pregnancy BMI were associated with increased risks of adverse pregnancy outcomes in Chinese women, while early pregnancy BMI had no significant influence on the infant neurocognitive development at 12 months of age.

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The Need for Personalized Risk-Stratified Approaches to Treatment for Gestational Diabetes: A Narrative Review

Seminars in Reproductive Medicine ◽

10.1055/s-0041-1723778 ◽

2021 ◽

Author(s):

Shamil D. Cooray ◽

Jacqueline A. Boyle ◽

Georgia Soldatos ◽

Shakila Thangaratinam ◽

Helena J. Teede

Keyword(s):

Gestational Diabetes ◽

Pregnancy Outcomes ◽

Population Based ◽

Adverse Pregnancy Outcomes ◽

Therapeutic Interventions ◽

Clinical Prediction Model ◽

Increased Risk ◽

Adverse Pregnancy ◽

The Individual ◽

Personalized Risk

AbstractGestational diabetes mellitus (GDM) is common and is associated with an increased risk of adverse pregnancy outcomes. However, the prevailing one-size-fits-all approach that treats all women with GDM as having equivalent risk needs revision, given the clinical heterogeneity of GDM, the limitations of a population-based approach to risk, and the need to move beyond a glucocentric focus to address other intersecting risk factors. To address these challenges, we propose using a clinical prediction model for adverse pregnancy outcomes to guide risk-stratified approaches to treatment tailored to the individual needs of women with GDM. This will allow preventative and therapeutic interventions to be delivered to those who will maximally benefit, sparing expense, and harm for those at a lower risk.

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Maternal educational inequalities about adverse pregnancy outcomes observed in a rural area of a province of China during a time period (2010–2018)

Journal of Epidemiology & Community Health ◽

10.1136/jech-2021-217754 ◽

2022 ◽

pp. jech-2021-217754

Author(s):

Lixin Li ◽

Yanpeng Wu ◽

Yao Yang ◽

Ying Wu ◽

Yan Zhuang ◽

...

Keyword(s):

Pregnancy Outcomes ◽

Maternal Education ◽

Rural China ◽

Education Level ◽

Adverse Pregnancy Outcomes ◽

Secondary Outcome ◽

Health Examination ◽

Educational Inequalities ◽

Increased Risk ◽

Adverse Pregnancy

BackgroundThe relationship between maternal education and adverse pregnancy outcomes is well documented. However, limited research has investigated maternal educational disparities in adverse pregnancy outcomes in China. This study examined maternal educational inequalities associated with adverse pregnancy outcomes in rural China.MethodsWe conducted a population-based cohort study using participants enrolled in the National Free Preconception Health Examination Project in Yunnan province from 2010 to 2018. The primary outcome was stillbirth, and the secondary outcome was adverse pregnancy outcomes, defined as a composite event of stillbirth, preterm birth or low birth weight. The study was restricted to singleton births at 20–42 weeks’ gestation. Univariate and multivariate log-binomial regression models were performed to estimate crude risk ratios (RRs) and confounding-adjusted RRs (ARRs) for stillbirth and adverse pregnancy outcomes according to maternal education level.ResultsA total of 197 722 singleton births were included in the study. Compared with mid-educated women, low-educated women were at a significantly increased risk of stillbirth (ARR, 1.20; 95% CI, 1.05 to 1.38) and adverse pregnancy outcomes (ARR, 1.11; 95% CI, 1.07 to 1.16). However, the risk of stillbirth (ARR, 1.16; 95% CI, 1.01 to 1.35) was significantly higher for high-educated women compared with mid-educated women.ConclusionCompared with women with medium education level, women with lower education level were more likely to experience adverse pregnancy outcomes, including stillbirth, and women with higher education level were more likely to experience stillbirth.

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Interpregnancy Body Mass Index Changes: Distribution and Impact on Adverse Pregnancy Outcomes in the Subsequent Pregnancy

American Journal of Perinatology ◽

10.1055/s-0038-1670634 ◽

2018 ◽

Vol 36 (05) ◽

pp. 517-521 ◽

Cited By ~ 3

Author(s):

Whitney Bender ◽

Adi Hirshberg ◽

Lisa Levine

Keyword(s):

Body Mass Index ◽

Preterm Birth ◽

Body Mass ◽

Pregnancy Outcomes ◽

Subsequent Pregnancy ◽

Adverse Pregnancy Outcomes ◽

Increased Risk ◽

History Of ◽

Index Changes ◽

Adverse Pregnancy

Objective To examine the change in body mass index (BMI) categories between pregnancies and its effect on adverse pregnancy outcomes. Study Design We performed a retrospective cohort study of women with two consecutive deliveries from 2005 to 2010. Analysis was limited to women with BMI recorded at <24 weeks for both pregnancies. Standard BMI categories were used. Adverse pregnancy outcomes included preterm birth at <37 weeks, intrauterine growth restriction (IUGR), pregnancy-related hypertension, and gestational diabetes mellitus (GDM). Women with increased BMI category between pregnancies were compared with those who remained in the same BMI category. Results In total, 537 women were included, of whom 125 (23%) increased BMI category. There was no association between increase in BMI category and risk of preterm birth, IUGR, or pregnancy-related hypertension. Women who increased BMI category had an increased odds of GDM compared with women who remained in the same BMI category (6.4 vs. 2.2%; p = 0.018). The increased risk remained after controlling for age, history of GDM, and starting BMI (adjusted odds ratio: 8.2; 95% confidence interval: 2.1–32.7; p = 0.003). Conclusion Almost one-quarter of women increased BMI categories between pregnancies. This modifiable risk factor has a significant impact on the risk of GDM.

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