Wei-Wei Zhu

Evaluation of the Value of Fasting Plasma Glucose in the First Prenatal Visit to Diagnose Gestational Diabetes Mellitus in China

OBJECTIVE To evaluate the value of fasting plasma glucose (FPG) value in the first prenatal visit to diagnose gestational diabetes mellitus (GDM). RESEARCH DESIGN AND METHODS Medical records of 17,186 pregnant women attending prenatal clinics in 13 hospitals in China, including the Peking University First Hospital (PUFH), were examined. Patients with pre-GDM were excluded; data for FPG at the first prenatal visit and one-step GDM screening with 75-g oral glucose tolerance test (OGTT) performed between 24 and 28 weeks of gestation were collected and analyzed. RESULTS The median ± SD FPG value was 4.58 ± 0.437. FPG decreased with increasing gestational age. FPG level at the first prenatal visit was strongly correlated with GDM diagnosed at 24–28 gestational weeks (χ2 = 959.3, P < 0.001). The incidences of GDM were 37.0, 52.7, and 66.2%, respectively, for women with FPG at the first prenatal visit between 5.10 and 5.59, 5.60 and 6.09, and 6.10–6.99 mmol/L. The data of PUFH were not statistically different from other hospitals. CONCLUSIONS Pregnant women (6.10 ≤ FPG < 7.00 mmol/L) should be considered and treated as GDM to improve outcomes; for women with FPG between 5.10 and 6.09 mmol/L, nutrition and exercise advice should be provided. An OGTT should be performed at 24–28 weeks to confirm or rule out GDM. Based on our data, we cannot support an FPG value ≥5.10 mmol/L at the first prenatal visit as the criterion for diagnosis of GDM.

Fasting Plasma Glucose at 24–28 Weeks to Screen for Gestational Diabetes Mellitus: New evidence from China

OBJECTIVE To evaluate the usefulness of a fasting plasma glucose (FPG) at 24–28 weeks’ gestation to screen for gestational diabetes mellitus (GDM). RESEARCH DESIGN AND METHODS The medical records and results of a 75-g 2-h oral glucose tolerance test (OGTT) of 24,854 pregnant women without known pre-GDM attending prenatal clinics in 15 hospitals in China were examined. RESULTS FPG cutoff value of 5.1 mmol/L identified 3,149 (12.1%) pregnant women with GDM. FPG cutoff value of 4.4 mmol/L ruled out GDM in 15,369 (38.2%) women. With use of this cutoff point, 12.2% of patients with mild GDM will be missed. The positive predictive value is 0.322, and the negative predictive value is 0.928. CONCLUSIONS FPG at 24–28 weeks’ gestation could be used as a screening test to identify GDM patients in low-resource regions. Women with an FPG between ≥4.4 and ≤5.0 mmol/L would require a 75-g OGTT to diagnose GDM. This would help to avoid approximately one-half (50.3%) of the formal 75-g OGTTs in China.

Risk of adverse pregnancy outcomes stratified for pre-pregnancy body mass index

Abstract Objective: To estimate the risk of adverse maternal and perinatal outcomes in women with different pre-pregnancy body mass index (BMI). Methods: We conducted a cohort study with 14 451 singleton pregnancies in 15 medical centers in Beijing between 20 June 2013 and 30 November 2013 using cluster random sampling. We divided participants into four groups based on pre-pregnancy BMI: Group A (underweight): BMI < 18.5 kg/m2, Group B (normal): 18.5–23.9 kg/m2, Group C (overweight): 24–27.9 kg/m2, Group D (obesity): ≥28 kg/m2. We used multivariate analysis to evaluate the association of the risk of adverse pregnancy outcomes and pre-pregnancy BMI. Results: The prevalence of maternal overweight and obesity was 14.82% (2142/14 451) and 4.71% (680/14 451) in the study population, respectively. Higher pre-pregnancy BMI is associated with higher prevalence of gestational diabetes (GDM), macrosomia, Cesarean section (C-section), preeclampsia and postpartum hemorrhage. Pre-pregnancy overweight or obesity increases the risk of adverse pregnancy outcomes, regardless of GDM status. Conclusions: Pre-pregnancy overweight or obesity is associated with increased risk of adverse pregnancy outcomes. Nutrition counseling is recommended before pregnancy in women who have overweight or obesity.

Diagnosis of Gestational Diabetes Mellitus in China

After the publication of the Hyperglycemia and Adverse Pregnancy Outcome (HAPO) study (1), the International Association of the Diabetes and Pregnancy Study Groups (IADPSG) (2) formulated consensus guidelines for the testing and diagnosis of gestational diabetes mellitus (GDM). These have been adopted by the American Diabetes Association (3). The Ministry of Health (MOH) of China also recommended that new testing and diagnostic criteria based on the IADPSG …

The Predictive Effects of Early Pregnancy Lipid Profiles and Fasting Glucose on the Risk of Gestational Diabetes Mellitus Stratified by Body Mass Index.

This study aimed at evaluating the predictive effects of early pregnancy lipid profiles and fasting glucose on the risk of gestational diabetes mellitus (GDM) in patients stratified by prepregnancy body mass index (p-BMI) and to determine the optimal cut-off values of each indicator for different p-BMI ranges. A retrospective system cluster sampling survey was conducted in Beijing during 2013 and a total of 5,265 singleton pregnancies without prepregnancy diabetes were included. The information for each participant was collected individually using questionnaires and medical records. Logistic regression analysis and receiver operator characteristics analysis were used in the analysis. Outcomes showed that potential markers for the prediction of GDM include early pregnancy lipid profiles (cholesterol, triacylglycerols, low-density lipoprotein cholesterol/high-density lipoprotein cholesterol ratios [LDL-C/HDL-C], and triglyceride to high-density lipoprotein cholesterol ratios [TG/HDL-C]) and fasting glucose, of which fasting glucose level was the most accurate indicator. Furthermore, the predictive effects and cut-off values for these factors varied according to p-BMI. Thus, p-BMI should be a consideration for the risk assessment of pregnant patients for GDM development.

Comparing the Diagnostic Criteria for Gestational Diabetes Mellitus of World Health Organization 2013 with 1999 in Chinese Population

IntroductIon Gestational diabetes mellitus (GDM) was earlier defined as “hyperglycemia first recognized during pregnancy” and has more recently been described by American Diabetes Association (ADA) (2012) as diabetes diagnosed during pregnancy that is not clearly overt diabetes.[1] The hyperglycemia and adverse pregnancy outcomes study (HAPO) demonstrated that the risk of adverse maternal, fetal, and neonatal outcomes continuously increase as a function of maternal glycemia at 24−28 weeks, even within ranges previously considered normal for pregnancy.[2] After reviewing the results of the HAPO study, many international diabetes study groups, including the International Association of Diabetes and Pregnancy Study Groups and ADA have adopted the 75 g oral glucose tolerance test (OGTT) at 24−28 weeks as a screening and diagnostic test and defined new cut‐off values for GDM diagnosis. The Ministry of Health of China published the criteria for GDM, that is the same as the ADA criteria on July 1, 2011. World Health Organization (WHO) has recommended the 75 g OGTT with different cut‐off values as a diagnostic test since 1999, changed its recommendation on 2013. In Hongkong and Yunnan province in China, most hospital adopted the WHO 1999 criteria, nevertheless, there is no evidence of multicenter and large sample to show that the GDM population within the same ethnic group diagnosed by the new WHO criteria matches those diagnosed by the old one and consistency between the two criteria has not been reported. Thus, we conducted this study to analyze the two criteria in Chinese pregnant women.

High Prevalence of Gestational Diabetes Mellitus in Beijing: Effect of Maternal Birth Weight and Other Risk Factors

Background: Gestational diabetes mellitus (GDM) is associated with both short- and long-term adverse health consequences for both the mother and her offspring. The aim was to study the prevalence and risk factors for GDM in Beijing. Methods: The study population consisted of 15,194 pregnant women attending prenatal care in 15 hospitals in Beijing, who delivered between June 20, 2013, and November 30, 2013, after 28 weeks of gestation. The participants were selected by cluster sampling from the 15 hospitals identified through random systematic sampling based on the number of deliveries in 2012. A questionnaire was designed to collect information. Results: A total of 2987 (19.7%) women were diagnosed with GDM and 208 (1.4%) had diabetes in pregnancy (DIP). Age (OR: 1.053, 95% CI: 1.033–1.074, P < 0.01), family history of diabetes mellitus (OR: 1.481, 95% CI: 1.254–1.748, P < 0.01), prepregnancy body mass index (BMI) (OR: 1.481, 95% CI: 1.254–1.748, P < 0.01), BMI gain before 24 weeks (OR: 1.126, 95% CI: 1.075–1.800, P < 0.01), maternal birth weight (P < 0.01), and fasting plasma glucose at the first prenatal visit (P < 0.01) were identified as risk factors for GDM. In women with birth weight <3000 g, GDM rate was significantly higher. Conclusions: One out of every five pregnant women in Beijing either had GDM or DIP and this constitutes a huge health burden for health services. Prepregnancy BMI and weight gain before 24th week are important modifiable risk factors for GDM. Ensuring birth weight above 3000 g may help reduce risk for future GDM among female offsprings.

Effects of intervention to mild GDM on outcomes

Abstract Objective: To evaluate pregnancy outcomes in women with gestational diabetes mellitus (GDM) diagnosed by the IADPSG criteria at 24–28 weeks of gestation but with fasting plasma glucose (FPG) less than 4.4 mmol/L. Research design and methods: A retrospective study was conducted. Medical records of 25 674 pregnant women attending the Peking University First Hospital (PUFH) were analyzed. Women with FPG value <4.4 mmol/L were segregated into those with and without GDM based on the IADPSG criteria. Pregnancy outcomes in the form of birth weight, neonatal hypoglycemia and cesarean delivery were compared between the two groups. Results: The incidence of macrosomia between GDM 7.1% (treated 6.9%; untreated 7.2%) was not different from the non GDM group 6.3%, similarly neonatal hypoglycemia 1.9% (treated 2.0%; untreated 1.7%) was were not significantly different from the non GDM group 1.1%. Rate of cesarean delivery in the untreated GDM group 59.7% was significantly higher compared to both with treated GDM (48.4%) and the non GDM group (47.6%). Conclusions: There is no difference in the incidence of select adverse pregnancy outcomes amongst Chinese women with mild GDM (FPG<4.4 mmol/L) with or without intervention compared to women without GDM.

Adverse pregnancy outcome among women with pre-gestational diabetes mellitus: a population-based multi-centric study in Beijing.

Abstract Objective: To investigate the prevalence of pre-gestational diabetes mellitus (pGDM) incidence and to evaluate whether the 2-h plasma glucose value of the oral glucose tolerance test (OGTT) should be used to diagnose pGDM during pregnancy. Design: Observational cohort study of 15 194 women in 15 medical centers in Beijing from 20 June 2013 to 30 November 2013. The incidence of adverse pregnancy outcomes among women with pGDM was compared stratified according to diagnostic time and criteria. Results: The prevalence of pGDM was 1.4% (208/15 194), of which only 32.2% (67/208) were diagnosed before pregnancy. The incidence of cesarean delivery (53.8% versus 67.2% and 66.3%), preeclampsia (1.9% versus 11.9% and 8.0%), insulin required (38.5% versus 65.7% and 52.8%) in those with 2-h plasma glucose ≥11.1 mmol/L during is lower than those with pGDM known prior pregnancy or diagnosed during pregnancy according to hemoglobin A1c (HbA1C) ≥ 6.5% or fasting plasma glucose (FPG) ≥ 7.0 mmol/L. Conclusions: More than two-thirds of pGDM patients were diagnosed during pregnancy. FPG should be used as screening test to identify pGDM at first antenatal care. An abnormal 2-h glucose value only may not be suitable to diagnose pGDM during pregnancy in China.

Maternal and neonatal outcomes in multiple pregnancy: A multicentre study in the Beijing population

Objective To compare the adverse maternal and neonatal outcomes of multiple pregnancy and singleton pregnancy from multiple medical centers in Beijing. Methods Data concerning maternal and neonatal adverse outcomes in multiple and singleton pregnancies were collected from 15 hospitals in Beijing by a systemic cluster sampling survey conducted from 20 June to 30 November 2013. The SPSS software (version 20.0) was used for data analysis. The χ2 test was used for statistical analyses. Results The rate of caesarean deliveries was much higher in women with multiple pregnancies (85.8%) than that in women with singleton pregnancies (42.6%, χ2 = 190.8, P < 0.001). The incidences of anemia (χ2 = 40.023, P < 0.001), preterm labor (χ2 = 1021.172, P < 0.001), gestational diabetes mellitus (χ2 = 9.311, P < 0.01), hypertensive disorders (χ2 = 122.708, P < 0.001) and post-partum hemorrhage (χ2 = 48.550, P < 0.001) was significantly increased with multiple pregnancy. In addition, multiple pregnancy was associated with a significantly higher rate of small-for-gestational-age infants (χ2 = 92.602, P < 0.001), low birth weight (χ2 = 1141.713, P < 0.001), and neonatal intensive care unit (NICU) admission (χ2 = 340.129, P < 0.001). Conclusions Multiple pregnancy is a significant risk factor for adverse maternal and neonatal outcomes in Beijing. Improving obstetric care for multiple pregnancy, particularly in reducing preterm labor, is required to reduce the risk to mothers and infants.