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

English version

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
prolekare.web.journal.doi_sk: https://doi.org/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:

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

Zdroje

1. Alexopoulos AS, Blair R, Peters AL. Management of Preexisting Diabetes in Pregnancy: A Review. JAMA. 2019;321(18):1811–9. doi: 10.1001/jama.2019.4981 31087027

2. Zimmet P, Alberti KG, Shaw J. Global and societal implications of the diabetes epidemic. Nature. 2001;414(6865):782–7. doi: 10.1038/414782a 11742409

3. Danaei G, Finucane MM, Lu Y, Singh GM, Cowan MJ, Paciorek CJ, et al. National, regional, and global trends in fasting plasma glucose and diabetes prevalence since 1980: systematic analysis of health examination surveys and epidemiological studies with 370 country-years and 2.7 million participants. Lancet. 2011;378(9785):31–40. doi: 10.1016/S0140-6736(11)60679-X 21705069

4. Cho NH, Shaw JE, Karuranga S, Huang Y, da Rocha Fernandes JD, Ohlrogge AW, et al. IDF Diabetes Atlas: Global estimates of diabetes prevalence for 2017 and projections for 2045. Diabetes Res Clin Pract. 2018;138 : 271–281. doi: 10.1016/j.diabres.2018.02.023 29496507

5. Zhou Q, Wang Q, Shen H, Zhang Y, Zhang S, Li X. Prevalence of Diabetes and Regional Differences in Chinese Women Planning Pregnancy: A Nationwide Population-Based Cross-sectional Study. Diabetes care. 2017;40(2):e16–e18. doi: 10.2337/dc16-2188 27899491

6. Albrecht SS, Kuklina EV, Bansil P, Jamieson DJ, Whiteman MK, Kourtis AP, et al. Diabetes trends among delivery hospitalizations in the U.S., 1994–2004. Diabetes care. 2010;33(4):768–773. doi: 10.2337/dc09-1801 20067968

7. Chan JC, Malik V, Jia W, Kadowaki T, Yajnik CS, Yoon KH,et al. Diabetes in Asia: epidemiology, risk factors, and pathophysiology. JAMA. 2009;301(20):2129–40. doi: 10.1001/jama.2009.726 19470990

8. Yajnik CS, Deshmukh US. Maternal nutrition, intrauterine programming and consequential risks in the offspring. Rev Endocr Metab Disord. 2008;9(3):203–11. doi: 10.1007/s11154-008-9087-z 18661241

9. Murphy HR, Roland JM, Skinner TC, Simmons D, Gurnell E, Morrish NJ, et al. Effectiveness of a regional prepregnancy care program in women with type 1 and type 2 diabetes: benefits beyond glycemic control. Diabetes care. 2010;33(12):2514–20. doi: 10.2337/dc10-1113 21115765

10. Egan AM, Danyliv A, Carmody L, Kirwan B, Dunne FP. A Prepregnancy Care Program for Women With Diabetes: Effective and Cost Saving. J Clin Endocrinol Metab. 2016;101(4):1807–15. doi: 10.1210/jc.2015-4046 26918293

11. Corrado F, Pintaudi B, D’Anna R, Santamaria A, Giunta L, Di Benedetto A. Perinatal outcome in a Caucasian population with gestational diabetes and preexisting diabetes first diagnosed in pregnancy. Diabetes Metab. 2016;42(2):122–5. doi: 10.1016/j.diabet.2015.11.007 26718735

12. Zhang S, Wang Q, Shen H. Design of the National Free Preconception Health Examination Project in China. Zhonghua Yi Xue Za Zhi. 2015;95(3):162–5. 25877024

13. Liu J, Zhang S, Liu M, Wang Q, Shen H, Zhang Y. Maternal pre-pregnancy infection with hepatitis B virus and the risk of preterm birth: a population-based cohort study. Lancet Glob Health. 2017;5(6):e624–e632. doi: 10.1016/S2214-109X(17)30142-0 28495266

14. Yang Y, He Y, Li Q, Wang Y, Peng Z, Xu J, et al. Preconception blood pressure and risk of preterm birth: a large historical cohort study in a Chinese rural population. Fertil Steril. 2015;104(1):124–30. doi: 10.1016/j.fertnstert.2015.03.024 25936235

15. Wang QM, Zhang M, Zhang SK, Hu M, Liu N, Kang XX, et al. Establishment of quality assurance system of the National Free Preconception Health Examination Project in China. Zhonghua Yi Xue Za Zhi. 2015;95 : 166–168.

16. Standards of Medical Care in Diabetes-2017: Summary of Revisions. Diabetes care. 2017;40(Suppl 1):S4–S5. doi: 10.2337/dc17-S003 27979887

17. Yan J, Yang H. Gestational diabetes in China: challenges and coping strategies. Lancet Diabetes Endocrinol. 2014;2(12):930–1. doi: 10.1016/S2213-8587(14)70154-8 25218730

18. Farrar D, Simmonds M, Bryant M, Sheldon TA, Tuffnell D, Golder S, et al. Hyperglycaemia and risk of adverse perinatal outcomes: systematic review and meta-analysis. BMJ. 2016;354:i4694. doi: 10.1136/bmj.i4694 27624087

19. Farrar D, Fairley L, Santorelli G, Tuffnell D, Sheldon TA, Wright J, et al. Association between hyperglycaemia and adverse perinatal outcomes in south Asian and white British women: analysis of data from the Born in Bradford cohort. Lancet Diabetes Endocrinol. 2015;3(10):795–804. doi: 10.1016/S2213-8587(15)00255-7 26355010

20. You H, Bogg L, De Costa A, Dong H. Rural maternal mortality ratio in China. Lancet Glob Health. 2014;2(8):e451–2. doi: 10.1016/S2214-109X(14)70232-3 25103517

21. Gao Y, Zhou H, Singh NS, Powell-Jackson T, Nash S, Yang M, et al. Progress and challenges in maternal health in western China: a Countdown to 2015 national case study. Lancet Glob Health. 2017;5(5):e523–e536. doi: 10.1016/S2214-109X(17)30100-6 28341117

22. Sugrue R, Zera C. Pregestational Diabetes in Pregnancy. Obstet Gynecol Clin North Am. 2018;45(2):315–331. doi: 10.1016/j.ogc.2018.01.002 29747733

23. International Association of Diabetes and Pregnancy Study Groups Consensus Panel, Metzger BE, Gabbe SG, Persson B, Buchanan TA, Catalano PA, et al. 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. doi: 10.2337/dc09-1848 20190296

24. National Collaborating Centre for Women’s and Children’s Health (UK). Diabetes in Pregnancy: Management of Diabetes and Its Complications from Preconception to the Postnatal Period. London: National Institute for Health and Care Excellence (UK); 2015.

25. Hod M, Kapur A, Sacks DA, Hadar E, Agarwal M, Di Renzo GC, et al. The International Federation of Gynecology and Obstetrics (FIGO) Initiative on gestational diabetes mellitus: A pragmatic guide for diagnosis, management, and care. Int J Gynaecol Obstet. 2015;131 Suppl 3:S173–211.

26. Xu Y, Wang L, He J, Bi Y, Li M, Wang T, et al. Prevalence and control of diabetes in Chinese adults. JAMA. 2013;310(9):948–59. doi: 10.1001/jama.2013.168118 24002281