Late-Pregnancy Dysglycemia After Negative Testing for Gestational Diabetes and Risk of the Large-for-Gestational-Age Newborns: A Nest Case-Control Study Based on the Xi'an Longitudinal Mother-Child Cohort Study

Zhangya He; Yang Mi; Hexiang Yang; Jing Ji; Jiayi Gao; Wanyu Zhang; Pei Wu; Zhangrui Xu; Shanshan Wang; Xiaoqin Luo

doi:10.3389/fped.2022.829706

Late-Pregnancy Dysglycemia After Negative Testing for Gestational Diabetes and Risk of the Large-for-Gestational-Age Newborns: A Nest Case-Control Study Based on the Xi'an Longitudinal Mother-Child Cohort Study

Front Pediatr. 2022 May 17:10:829706. doi: 10.3389/fped.2022.829706. eCollection 2022.

Authors

Zhangya He^{1

2}, Yang Mi³, Hexiang Yang^{1

2}, Jing Ji^{1

2

3}, Jiayi Gao^{1

2

4}, Wanyu Zhang^{1

2

5}, Pei Wu^{1

2}, Zhangrui Xu^{1

2}, Shanshan Wang^{1

2}, Xiaoqin Luo^{1

2}

Affiliations

¹ Department of Nutrition and Food Safety, School of Public Health, Xi'an Jiaotong University, Xi'an, China.
² Key Laboratory for Disease Prevention and Control and Health Promotion of Shaanxi Province, Xi'an, China.
³ Department of Obstetrics and Gynecology, Northwest Women's and Children's Hospital, Xi'an, China.
⁴ Emergency Medical Center, Xi'an Public Health Center, Xi'an, China.
⁵ Department of Shaanxi Health Supervision Center, Xi'an, China.

Abstract

Background: The implications of gestational diabetes mellitus (GDM) on the short- and long-term health outcomes of both mother and child have been extensively studied. However, studies related to negative Oral Glucose Tolerance Test (OGTT) results in the second trimester but dysglycemia in late pregnancy on maternal and infant pregnancy outcomes are rare.

Methods: We conducted a nest case-control study within the Xi'an Longitudinal Mother-Child Cohort study (XAMC) to investigate the risk of adverse pregnancy outcomes in mothers and children with maternal negative mid-pregnancy OGTT results but high glycated hemoglobin (HbA_1c) levels (≥5.7%) in late pregnancy. All target women who delivered from January 1st, 2017 to December 31st, 2018 in Northwest Women's and Children's Hospital in Xi'an were enrolled as the case group (HbA_1c ≥ 5.7%). Others with HbA_1c < 5.7% but without GDM were selected as the control group (HbA_1c < 5.7%) by matching with the same delivery period. The logistic regression models were used to find out the risk factors of adverse pregnancy outcomes in the target population.

Results: A total of 2,116 and 1,907 women were finally enrolled in the case and control groups, respectively. Compared to the control group, more newborns with macrosomia (9.2% vs 4.1%, P < 0.001) and large for gestational age (LGA) (23.7% vs. 13.5%, P < 0.001), but less small for gestational age (SGA) (4.4% vs. 6.1%, P = 0.017) were found in the case group. The differences in other outcomes were not statistically significant. The multiple logistic regression analysis showed that gestational age, fetal length, prenatal HbA_1c, and total cholesterol (TG) were independent risk factors for newborns with large-for-gestational-age (LGA). The case group had a 2.516-fold (95% CI, 1.692-3.739) risk of delivering LGA newborns compared to the control group.

Conclusion: The glycemic management during the late pregnancy of non-GDM women should be given special consideration to reduce the risk of overweight offspring at birth.

Keywords: GDM; children; cohort; dysglycemia; obesity.