Association between maternal pregestational glucose level and adverse pregnancy outcomes: a population-based retrospective cohort study

Abstract

Objective: To investigate the association between maternal pregestational blood glucose level and adverse pregnancy outcomes.

Design: Retrospective cohort study.

Setting: This study was conducted in the Chongqing Municipality of China between April 2010 and December 2016.

Participants: A total of 60 222 women (60 360 pregnancies) from all 39 counties of Chongqing who participated in the National Free Preconception Health Examination Project and had pregnancy outcomes were included.

Primary outcome measures: Adverse pregnancy outcomes included spontaneous abortion, induced abortion or labour due to medical reasons, stillbirth, preterm birth (PTB), macrosomia, large for gestational age, low birth weight (LBW) and small for gestational age.

Results: Of the 60 360 pregnancies, rates of hypoglycaemic, normoglycaemia, impaired fasting glycaemia (IFG) and diabetic hyperglycaemic before conception were 5.06%, 89.30%, 4.59% and 1.05%, respectively. Compared with women with normoglycaemia, women with pregestational glucose at the diabetic level (≥7.0 mmol/L) might have a higher rate of macrosomia (6.18% vs 4.16%), whereas pregestational IFG seemed to be associated with reduced risks of many adverse outcomes, including spontaneous abortion, induced abortion due to medical reasons, PTB and LBW. After adjusting for potential confounders, pregestational diabetic hyperglycaemic was remained to be significantly associated with an increased risk of macrosomia (adjusted risk ratio 1.49, 95% CI 1.07 to 2.09). Abnormal maternal glucose levels before pregnancy (either hypoglycaemic or hyperglycaemic) seemed to have no significant negative effect on spontaneous abortion or induced abortion due to medical reasons.

Conclusion: Although without overt diabetes mellitus, women with once diabetic fasting glucose level during their preconception examinations could be associated with an increased risk for macrosomia. Uniform guidelines are needed for maternal blood glucose management during pre-pregnancy care to improve pregnancy outcomes.

Keywords: diabetes in pregnancy; epidemiology; public health; reproductive medicine.

Figure 1

Flowchart for the study population. BMI, body mass index; NFPHEP, National Free Preconception Health Examination Project.

Figure 2

Cumulative occurrence of macrosomia according to pregestational glucose. IFG, impaired fasting glycaemia.

Figure 3

Subgroup analysis of macrosomia in the pregestational diabetic compared with the pregestational normoglycaemia. Interval: the period between the date of glucose testing and the date of the last menstrual period of pregnant women. ¹After adjusting maternal age, BMI, ethnicity, education level, occupation, place of residence, smoking, passive smoking, alcohol, parity, gravidity, history of preterm birth, history of abortion (spontaneous and induced), hypertension and neonate sex. *Additional adjustment for the gestational age in days. aRR, adjusted risk ratio; BMI, body mass index.