[Maternal and fetal outcomes in pregnant women with abnormal glucose metabolism].
OBJECTIVE
To understand the incidence of abnormal glucose metabolism during pregnancy and the maternal and neonatal outcomes after standard management.


METHODS
A retrospective study of maternal and neonatal outcomes was conducted in 1490 pregnant women who were diagnosed and treated for abnormal glucose metabolism and delivered in the Department of Obstetrics and Gynecology of First Hospital of Peking University from Jan 1995 to Dec 2004 by reviewing the medical records. The selected cases consisted of 79 women with diabetes mellitus (DM group), 777 with gestational diabetes mellitus (GDM group), including 355 cases of A1, 316 with A2 and 106 cases unclassified, and 634 with gestational impaired glucose test (GIGT group). Maternal and fetal outcomes were analysed in comparison with the controls of 19 013 pregnant women with normal glucose metabolism who delivered during the same period.


RESULTS
(1) The total incidence of gestational abnormal glucose metabolism was 7.3% and increased gradually from 1995 to 2004. The first stage, from Jan 1995 to Dec 1999, saw a slow increase in the incidence [4.3% (376/8739)]; the second stage, from Jan 2000 to Dec 2001, showed a fast increasing trend. The average incidence was 10.8% (445/4133). The incidence in the third stage kept stable at 8.9% (678/7640) from Jan 2002 to Dec 2004. (2) The incidence of macrosomia, preeclampsia and preterm birth were 12.1% (180/1490), 9.5% (141/1490) and 9.4% (140/1490), which were significantly higher than those women with normal glucose metabolism (P < 0.01). A significant difference was found in the incidence of preeclampsia, preterm birth, intrauterine infection, polyhydramnios and ketonuria among the three groups (P < 0.05), but not in the incidence of macrosomia (P > 0.05). (3) The perinatal mortality rate (PMR) of abnormal glucose metabolism group was 1.19% (18/1513) which was significantly higher in the DM group (4.93%) than GDM (1.14%) and GIGT groups (0.78%, P < 0.01), while the incidence of neonatal asphyxia, hypoglycemia, malformation and admission to NICU in the DM group were all higher than GDM and GIGT groups (P < 0.01). (4) NRDS was found in 9 cases among 1505 neonates (0.6%) and all were delivered preterm.


CONCLUSIONS
(1) The incidence of gestational abnormal glucose metabolism is increasing and the screening and diagnosis of diabetes in pregnancy should be strengthened. (2) Macrosomia, preeclampsia and preterm birth remain the first three common complications even after standardized glycemic management, but the maternal and neonatal complications are reduced in the GIGT group except for macrosomia. Those women in the DM group has a higher rate of maternal and neonatal complications than those in GDM and GIGT groups, so management in these patients should be strengthened. (3) NRDS is no longer a primary neonatal complication provided proper management is performed.
Sun
Wei-Jie
WJ
Department of Obstetrics and Gynaecology, First Hospital, Peking University, Beijing 100034, China.
Yang
Hui-Xia
HX
D001786:Blood Glucose / Q000378:metabolism*; D002681:China / Q000453:epidemiology; D016640:Diabetes, Gestational / Q000097:blood* / Q000453:epidemiology; D005260:Female; D005320:Fetal Macrosomia / Q000097:blood; D018149:Glucose Intolerance / Q000097:blood* / Q000453:epidemiology; D005951:Glucose Tolerance Test; D006801:Humans; D015994:Incidence; D007231:Infant, Newborn; D011225:Pre-Eclampsia / Q000097:blood; D011247:Pregnancy; D011256:Pregnancy Outcome; D012189:Retrospective Studies
D001786:Blood Glucose