Preconception diabetes mellitus and adverse pregnancy outcomes in over 6.4 million women: A population-based cohort study in China


Autoři: Yumei Wei aff001;  Qin Xu aff003;  Huixia Yang aff001;  Ying Yang aff002;  Long Wang aff003;  Huan Chen aff006;  Craig Anderson aff006;  Xinyue Liu aff007;  Geng Song aff001;  Qian Li aff004;  Qiaomei Wang aff008;  Haiping Shen aff008;  Yiping Zhang aff008;  Donghai Yan aff008;  Zuoqi Peng aff003;  Yuan He aff003;  Yuanyuan Wang aff003;  Ya Zhang aff003;  Hongguang Zhang aff003;  Xu Ma aff002
Působiště autorů: Peking University First Hospital, Beijing, China aff001;  China DOHaD Research Center, National Human Genetic Resources Center, Beijing, China aff002;  National Research Institute for Health and Family Planning, Beijing, China aff003;  Graduate School of Peking Union Medical College, Beijing, China aff004;  School of Public Health, Institute of Epidemiology and Statistics, Lanzhou University, Lanzhou, China aff005;  The George Institute for Global Health (Australia) Beijing Representative Office, Sydney, Australia aff006;  Pharmaceutical Outcomes and Policy, College of Pharmacy, University of Florida, Gainesville, Florida, United States of America aff007;  Department of Maternal and Child Health, National Health and Family Planning Commission of the PRC, Beijing, China aff008
Vyšlo v časopise: Preconception diabetes mellitus and adverse pregnancy outcomes in over 6.4 million women: A population-based cohort study in China. PLoS Med 16(10): e1002926. doi:10.1371/journal.pmed.1002926
Kategorie: Research Article
doi: 10.1371/journal.pmed.1002926

Souhrn

Background

Diabetes mellitus (DM) increases the risk of adverse maternal and neonatal outcomes, and optimization of glycemic control during pregnancy can help mitigate risks associated with diabetes. However, studies seldom focus precisely on maternal blood glucose level prior to pregnancy. We aimed to evaluate the associations between preconception blood fasting plasma glucose (FPG) level and subsequent pregnancy outcomes.

Methods and findings

We conducted a population-based retrospective cohort study among 6,447,339 women aged 20–49 years old who participated in National Free Pre-Pregnancy Checkups Project and completed pregnancy outcomes follow-up between 2010 and 2016 in China. During the preconception health examination, serum FPG concentration was measured, and self-reported history of DM was collected. Women were classified into three groups (normal FPG group: FPG < 5.6 mmol/L and no self-reported history of DM; impaired fasting glucose [IFG]: FPG 5.6–6.9 mmol/L and no self-reported history of DM; and DM: FPG ≥ 7.0 mmol/L or self-reported history of DM). The primary outcomes were adverse pregnancy outcomes, including spontaneous abortion, preterm birth (PTB), macrosomia, small for gestational age infant (SGA), birth defect, and perinatal infant death. Logistic regression model was used to calculate odds ratio (OR) and 95% confidence interval (CI) after adjusting for confounding variables. The mean age of women was 25.24 years, 91.47% were of Han nationality, and 92.85% were from rural areas. The incidence of DM and IFG was 1.18% (76,297) and 13.15% (847,737), respectively. Only 917 (1.20%) women reported a history of DM (awareness of their DM status), of whom 37.28% (337) had an elevated preconception FPG level (≥ 5.6 mmol/L), regarded as noncontrolled DM. A total of 1,005,568 (15.60%) women had adverse pregnancy outcomes. Compared with women with normal FPG, women with IFG had higher risks of spontaneous abortion (OR 1.08; 95% CI 1.06–1.09; P < 0.001), PTB (1.02; 1.01–1.03; P < 0.001), macrosomia (1.07; 1.06–1.08; P < 0.001), SGA (1.06; 1.02–1.10; P = 0.007), and perinatal infant death (1.08; 1.03–1.12; P < 0.001); the corresponding ORs for women with DM were 1.11 (95% CI 1.07–1.15; P < 0.001), 1.17 (1.14–1.20; P < 0.001), 1.13 (1.09–1.16; P < 0.001), 1.17 (1.04–1.32; P = 0.008), and 1.59 (1.44–1.76; P < 0.001). Women with DM also had a higher risk of birth defect (OR 1.42; 95% CI 1.15–1.91; P = 0.002). Among women without self-reported history of DM, there was a positive linear association between FPG levels and spontaneous abortion, PTB, macrosomia, SGA, and perinatal infant death (P for trend <0.001, <0.001, <0.001, 0.001, <0.001). Information about hypoglycemic medication before or during pregnancy was not collected, and we cannot adjust it in the analysis, which could result in underestimation of risks. Data on 2-hour plasma glucose level and HbA1c concentration were not available, and the glycemic control status was evaluated according to FPG value in women with DM.

Conclusions

Women with preconception IFG or DM had higher risk of adverse pregnancy outcomes, including spontaneous abortion, PTB, macrosomia, SGA, and perinatal infant death. Preconception glycemic control through appropriate methods is one of the most important aspects of preconception care and should not be ignored by policy makers.

Klíčová slova:

Diabetes mellitus – Economic analysis – China – Miscarriage – Pregnancy – Preterm birth – Hypertensive disorders in pregnancy – Birth defects


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Štítky
Interní lékařství

Článek vyšel v časopise

PLOS Medicine


2019 Číslo 10

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