The influence of fasting and post-load glucose levels on maternal and neonatal outcomes in women with hyperglycaemia in pregnancy in Uganda: A prospective observational cohort study

The Impact of Gestational Diabetes Mellitus on the Development of Preeclampsia in Twin Pregnancies: A Retrospective Cohort Study Conducted at a Tertiary Hospital

Purpose

This study aimed to examine the effects of gestational diabetes mellitus (GDM) on the risk of pregnancy complications in twin pregnancies and to investigate the relationship between glycemic levels and the risk of preeclampsia (PE) and abnormal fetal growth.

Patients and Methods

A retrospective cohort study of 736 twin pregnancies was conducted at a tertiary hospital. Propensity score matching and multivariable logistic models were utilized to compare maternal and neonatal outcomes between twin pregnancies with GDM and those without GDM. Multivariable logistic regressions were performed to address the intertwin correlation between glycemic levels and the primary outcomes.

Results

There was no significant difference in the risk of PE between non-GDM and GDM pregnancies (OR, 0.70; 95% CI: 0.38-1.27; P = 0.238). No statistically significant differences were observed in the prevalence of small for gestational age and large for gestational age between the study groups. A comparative analysis of twin pregnancies affected by PE and GDM versus those without GDM revealed that the former group exhibited similar maternal and neonatal outcome risks. Women with fasting blood glucose levels from 5.1 mmol/L (92mg/dL) to less than 5.3 mmol/L (95.6mg/dL) had a significantly higher risk of PE compared with women without GDM (OR, 2.90; 95% CI: 1.12-7.51; P = 0.028). In subgroups of glycosylated hemoglobin (HbA1c), HbA1c ≥ 5.5% had the highest risk of PE in the second and third trimesters compared with women without GDM (OR, 4.90; 95% CI: 1.00-24.12; P = 0.05).

Conclusion

The risk of PE was not increased in twin pregnancies complicated with GDM, but significantly increased in women with an HbA1c ≥5.5%. No significant associations were observed between the co-occurrence of GDM and PE and the incidence of pregnancy complications in twin pregnancies. Strict glycemic control may decrease the risk of PE in twin pregnancies with GDM.

Five-year risk of all-cause death and cardiovascular events in women with gestational diabetes and hypertensive disorders of pregnancy

BACKGROUND

. The long-term impact of gestational complications on cardiovascular outcomes in women remains a subject of debate.

AIM

To assess the 5-year risk of cardiovascular events and all-cause mortality in women with gestational diabetes and hypertension.

METHODS

Retrospective study utilising an health research network(TriNetX). The primary outcome was the composite risk of a cardiovascular event within 5 years with secondary outcomes being its components (all-cause death, acute heart failure, myocardial infarction, ischaemic stroke). Women were categorised into 8 different groups based on the ICD-codes for pregnancy related complications recorded 9 months before the delivery:1) gestational diabetes,2) gestational hypertension,3) gestational diabetes with gestational hypertension,4) gestational diabetes with gestational hypertension without pre-eclampsia or eclampsia,5) gestational diabetes with pre-eclampsia or eclampsia,6) gestational hypertension without pre-eclampsia or eclampsia,7) pre-eclampsia or eclampsia,and 8) no gestational complications. Cox-regression analyses were used to produce hazard ratios (HRs) and 95 % confidence intervals (CI) before and after propensity score matching (PSM).

RESULTS

We identified, 24,402 women with gestational diabetes and gestational hypertension and 920,478 without gestational complications. After PSM, compared to women without pregnancy complications, women with gestational diabetes and gestational hypertension had a higher 5-year risk of composite outcome(HR 2.25,95 %CI 2.02-2.51), all-cause death(HR 1.64,95 %CI 1.31-2.06), acute heart failure(HR 2.06,95 %CI 1.69-2.52), myocardial infarction(HR 2.46,95 %CI 1.93-3.14), and ischemic stroke(HR 2.37,95 %CI 2.06-2.74). Women who experienced pre-eclampsia or eclampsia showed the highest risk of primary and secondary outcomes.

CONCLUSIONS

Gestational complications are associated with worse long-term cardiovascular outcomes. There is a clear call to action required to improve the longitudinal management of gestational complications to improve women's long-term health.

Application value of serum S100B combined with glucose metabolism indexes in predicting adverse pregnancy outcomes of patients with severe preeclampsia

S100 calcium-binding protein B (S100B) and glucose control are reflective of maternal-fetal risks. We investigated the value of serum S100B combined with fasting blood glucose (FBG)/hemoglobin A1c (HbA1c) in evaluating the pregnancy outcomes of patients with severe preeclampsia (SPE). The clinical characteristics of SPE patients/controls were collected. FBG/HbA1c and serum S100B levels were measured, with their correlations analyzed. SPE patients were subdivided into adverse/non-adverse outcome groups based on follow-up results. The value of different indexes in predicting pregnancy outcomes was analyzed. SPE patients showed higher systolic blood pressure, diastolic blood pressure, urine protein, and body mass index and lower platelets, gestational age at delivery, and infant birth weight than healthy controls. FBG and HbA1c were positively correlated with serum S100B. SPE patients with adverse outcomes exhibited increased serum S100B and FBG/HbA1c levels. The area under the curve of serum S100B + FBG/HbA1c in evaluating adverse pregnancy outcomes of SPE patients was 0.8412 (77.05% sensitivity/84.21% specificity), higher than either alone. Serum S100B and FBG/HbA1c were independent risk factors for adverse outcomes of SPE patients. Overall, serum S100B positively-correlates with FBG/HbA1c in SPE patients. Serum S100B and FBG/HbA1c are independent risk factors, and their combination has high value on predicting adverse pregnancy outcomes of SPE patients.