The results of baseline maternal characteristics of Chinese women with DIP were shown in Table 1.The mean age, height, pregestational BMI, gestational age at delivery, gravidae, and parity was 31.24 ( ± 4.37) years, 1.58.53 ( ± 5.02) cm, 22.37 ( ± 3.17) kg/m2, 38.36 ( 1.52) weeks, 2.49 (±1.56) times and 0.48 ( ± 0.58) times, respectively. The incidence of NH among Chinese women with DIP was 6.47% and NHB was 6.42%, with a 1.15% combined incidence of both.
Table 1
Characteristics of participants and delivery information(n=8504)
Characteristic
|
Classification
|
No. (%)
|
Age, years
|
<18
|
1 (0.01)
|
|
18-24
|
343 (4.03)
|
|
25-29
|
2872 (33.77)
|
|
30-34
|
3383 (39.78)
|
|
35-39
|
1547 (18.19)
|
|
40-44
|
329 (3.87)
|
|
≥45
|
29 (0.34)
|
Height, cm
|
<155
|
1529 (17.98)
|
|
155-159
|
3232 (38.01)
|
|
160-164
|
2652 (31.19)
|
|
165-169
|
919 (10.81)
|
|
≥170
|
151 (1.78)
|
|
Unknown
|
21 (0.25)
|
Pregestational BMI, kg/m2
|
<18.5
|
664 (7.81)
|
|
18.5-24.9
|
6043 (71.06)
|
|
25.0-29.9
|
1425 (16.76)
|
|
≥30.0
|
175 (2.06)
|
|
Unknown
|
197 (2.32)
|
Gestational age at delivery, weeks
|
<30
|
15 (0.18)
|
|
30-31
|
29 (0.34)
|
|
32-34
|
195 (2.29)
|
|
35-36
|
449 (5.28)
|
|
37-40
|
7752 (91.16)
|
|
>40
|
64 (0.75)
|
Gravidae
|
1
|
2803 (32.96)
|
|
2
|
2226 (26.18)
|
|
3
|
1561 (18.36)
|
|
4
|
1008 (11.85)
|
|
≥5
|
897 (10.55)
|
|
Unknown
|
9 (0.11)
|
Parity
|
0
|
4772 (56.11)
|
|
1
|
3408 (40.08)
|
|
2
|
296 (3.48)
|
|
3
|
18 (0.21)
|
|
≥4
|
1 (0.01)
|
|
Unknown
|
9 (0.11)
|
Delivery mode
|
Spontaneous delivery
|
3715 (43.69)
|
|
Cesarean operation
|
4789 (56.31)
|
Univariate analysis of maternal demographic information showed that pregnant women who were older, more gravidae, heavier pre-pregnancy weight, larger pre-pregnancy BMI, and BMI more than 30kg/m2 were more likely to have NH. In clinical variables, the risk of NH can also be aggravated by more weight gain during pregnancy, insulin use, gestational hypertension, pre-eclampsia, higher OGTT 1-h glucose, higher OGTT 2-h glucose, smaller gestational age, and preterm delivery. Among the obstetric factors, cesarean section, pregnancy with scar uterus, placenta previa, threatened premature labor (TPTL), fetal distress, abnormal placental morphology, chorioamnionitis, and postpartum hemorrhage were more likely to lead to NH. In neonatal outcomes, the birth length, Apgar 1min ≤7, Apgar 5min ≤7, gender (female), macrosomia, neonatal asphyxia, neonatal respiratory distress (NRDS), pneumonia, hypoxic ischemic encephalopathy (HIE), CHD, anemia, and hyperbilirubinemia were more likely to develop hypoglycemia in neonates. Data with statistical differences were shown in Table 2.
In the maternal factor, height, parity, age > 35 years, family history of diabetes, and OGTT fasting glucose had no significant effect on NH. Other complications during pregnancy (ICP, thalassemia in pregnancy, hysteromyoma, anemia in pregnancy, hypothyroidism during pregnancy, viral hepatitis type B, thrombocytopenia in pregnancy, Group B Streptococcus (GBS) infection) had no significant effect on neonatal hypoglycemia. Among the obstetric factors and neonatal outcome, premature rupture of membranes (PROM), oligohydramnios, polyhydramnios, placental abruption, umbilical cord around neck, neonatal weight, head circumference, Apgar 10min ≤7, and FGR had no significant difference in the influence of NH (Table S1).
Larger gestational weeks (OR 0.81, 95%CI 0.77-0.87), elevated OGTT 2-h glucose (OR 1.32, 95%CI 1.20-1.45), pre-eclampsia (OR 1.49, 95%CI 1.00-2.22), cesarean section (OR 2.34, 95%CI 1.87-2.94), placenta previa (OR 1.61, 95%CI 1.04-2.22), TPTL (OR 1.58, 95%CI 1.16-2.15), fetal distress (OR 1.46, 95%CI 1.11-1.95), abnormal placental morphology (OR 1.47, 95%CI 1.11-1.91), neonatal gender(female) (OR 1.38, 95%CI 1.05-1.80), septicemia (OR 2.46, 95%CI 1.26-4.82), HIE (OR 6.70, 95%CI 2.60-17.27), CHD (OR 3.00, 95%CI 2.10-4.29), anemia (OR 4.90, 95%CI 2.13-11.26), and hyperbilirubinemia were statistically significant and associated with NH in multivariate analysis. These factors increased the risk of NH (Fig. 2). Postpartum hemorrhage (OR 1.00, 95%CI 1.00-1.00) had little effect on the occurrence of hypoglycemia.
Univariate analysis of the independent variables that we included, parity, GWG, and BMI > 30kg/m2, were associated with NHB. In addition, having gestational hypertension, higher OGTT fasting glucose, higher OGTT 1-h glucose, and higher OGTT 2-h glucose were more likely to develop NHB. We conducted continuous variable analysis for gestational age and classified variable analysis for preterm delivery, and there were differences in the incidence of NHB between the both (P < 0.05).
NHB is at higher risk through cesarean section, PROM, scar uterus, placenta previa, TPTL, fetal distress, oligohydramnios, placental abruption, abnormal placental morphology, chorioamnionitis, umbilical cord around neck, and postpartum hemorrhage effects.
In neonatal outcomes, the lower neonatal weight, shorter birth length, Apgar 1min ≤7, Apgar 5min ≤7, and Apgar 10min ≤7 had an impact on the development of NHB. Neonates with FGR, asphyxia, NRDS, septicemia, pneumonia, HIE, CHD, anemia, or hypoglycemia were more likely to develop NHB. All significant data results were presented in Table 2 and Table S1.
A new risk assessment regression model for NHB was established. Our results showed that premature delivery (OR 2.98, 95%CI 1.87-4.47), PROM (OR 1.80, 95%CI 1.42-2.30), abnormal placental morphology (OR 1.41, 95%CI 1.02-1.98), FGR (OR 2.79, 95%CI 1.51-5.17), neonatal pneumonia (OR 4.45, 95%CI 2.88-6.86), CHD (OR 7.76, 95%CI 5.50-10.70), anemia (OR 6.16, 95%CI 2.34-16.22), and hypoglycemia (OR 1.73, 95%CI 1.21-2.47) increased the risk of NHB. Larger gestational weeks (OR 0.85, 95%CI 0.76-0.95) and increased parities (OR 0.73, 95%CI 0.58-0.91) decreased the incidence of bilirubinemia in the newborn (Fig. 3).