Of 3,494 pregnant women who had singleton deliveries at the Kobe University Hospital, 140 (4.0%) were diagnosed with GDM from January 2011 to December 2018. The indications for the antepartum 75-g OGTT in the 140 pregnant women with GDM were as follows: a 1-hr BG level on a 50-g glucose challenge tests ≥140 mg/dL (n=99); casual BG level ≥100 mg/dL (n=13); suspicion of HFD and/or polyhydramnios on ultrasound examinations during pregnancy (n=10); and presence of other risk factors of GDM, including a history of GDM, obesity, and persistent glycosuria (n=18). Twenty-five of the 140 women with GDM refused to receive a 75-g OGTT at 12 weeks after delivery. Therefore, 115 of the 140 (82.1%) women with GDM were included in the analyses of risks for GI during the early postpartum period.
Clinical factors and parameters in the antepartum 75-g OGTT associated with the occurrence of HDP in women with GDM
Nineteen of the 140 (13.6%) pregnant women with GDM had HDP. Table 1 shows the clinical characteristics of participants and result of logistic regression analyses of factors associated with HDP. The group of GDM women with HDP (HDP group) had a significantly higher body mass index (BMI) prior to pregnancy (p<0.05) and the frequency of a history of hypertension (p<0.01) than the group without HDP (non-HDP group). Furthermore, the HDP group had a significantly less weight gain during pregnancy (p<0.01) than the non-HDP group. No significant differences were observed in any parameter in the antepartum 75-g OGTT between the two groups.
Univariate logistic regression analyses demonstrated that the BMI prior to pregnancy (odds ratio [OR], 1.1; 95% confidence interval [CI], 1.0–1.2; p<0.05), weight gain during pregnancy (OR, 0.8; 95% CI, 0.8–0.9; p<0.01), frequency of the presence of a history of hypertension (OR, 43.3; 95% CI, 8.2–229.4; p<0.01), and 1-hr BG levels (OR, 1.0; 95% CI, 0.96–1.0; p<0.05) were associated with the occurrence of HDP in women with GDM. Multivariable logistic regression analyses of the three factors revealed that the presence of a history of hypertension (OR, 23.8; 95% CI, 4.2–134.7; p<0.01) was a single independent factor associated with HDP.
Clinical factors and parameters in the antepartum 75-g OGTT associated with the occurrence of preterm delivery at 36 or less gestational weeks (GW) in women with GDM
Seventeen of the 140 (12.1%) pregnant women with GDM had PD at 36 or less GW. Eleven of the 17 (64.7%) pregnancies resulted in preterm births following a threatened premature labor, and the remaining 6 (35.3%) resulted in medically indicated preterm births (5 for HDP; 1 for exacerbations of underlying diseases).
Table 2 shows the clinical characteristics of participants and result of logistic regression analyses of factors associated with PD. The group of GDM women with PD (PD group) had a significantly higher parity (p<0.05) and frequency of the presence of a history of hypertension (p<0.01) than the group without PD (non-PD group).
Univariate logistic regression analyses demonstrated that the presence of a history of hypertension (OR, 9.8; 95% CI, 2.5–38.9; p<0.01) was a single independent factor associated with PD in pregnant women with GDM.
Clinical factors and parameters in the antepartum 75-g OGTT associated with the occurrence of HFD infants in women with GDM
Nineteen of the 140 (13.6%) women with GDM had HFD newborns. Table 3 reveals the clinical characteristics of participants and results of logistic regression analyses of factors associated with HFD. The group of GDM women with HFD (HFD group) had a significantly higher weight gain during pregnancy (p<0.05) and HbA1c levels (p<0.05) than the group without HFD (non-HFD group).
Univariate logistic regression analyses demonstrated that HbA1c levels (OR, 7.6; 95% CI, 1.5–37.9; p<0.05) was an independent factor associated with HFD.
Clinical factors and parameters in the antepartum 75-g OGTT associated with the occurrence of LFD infants in women with GDM
Twelve of the 140 (8.6%) pregnant women with GDM had LFD newborns. Table 4 exhibits the clinical characteristics of participants and result of logistic regression analyses of factors associated with LFD. The group of GDM women with LFD (LFD group) had a significantly lower HbA1c levels (p<0.05) than the group without LFD (non-LFD group).
No clinical factors and parameters in the antepartum 75-g OGTT were selected as factors associated with LFD in pregnant women with GDM by univariate logistic regression analyses.
Clinical factors and parameters in the antepartum 75-g OGTT associated with the occurrence of postpartum GI in women with GDM
Twenty-two of the 115 (19.1%) pregnant women with GDM had GI at 12 weeks after delivery, including one, two, and 19 women with diabetes mellitus (DM), impaired fasting glucose (IFG), and impaired glucose tolerance (IGT), respectively.
Table 5 shows the clinical characteristics of participants and results of logistic regression analyses of factors associated with GI during the early postpartum period. The group of GDM women with postpartum GI (GI group) had a significantly lower oral DI (p<0.01) than the group without postpartum GI (non-GI group).
Univariate logistic regression analyses demonstrated that fasting BG (FBG) (OR, 1.0; 95% CI, 1.0–1.1; p<0.05) and oral disposition index (DI) (OR, 0.1; 95% CI, 0.03–0.5; p<0.01) were associated with the occurrence of GI during the early postpartum period in women with GDM. Multivariable logistic regression analyses of the two factors revealed that oral DI (OR, 0.1; 95% CI, 0.02–0.7; p<0.01) was an independent factor associated with GI during the early postpartum period.