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Abstract
Background
The aim of this study was to observe clinical outcomes of the mother and her infant who were possibly exposed to high blood glucose at least 2-3 months in the early and midterm pregnancy by checking gestational weeks (GW) and the first HbA1c level at initial diagnosis of gestational diabetes (GDM).
Methods
A total of 107 GDM patients and their newborns were subject of this study. GDM patients were newly diagnosed at the Holy Family Hospital of Catholic University from January 2003 until December 2007 and continuously managed in the diabetes center. Patients medical records were retrospectively reviewed to evaluate GW and HbA1c level at the time of diagnosis, and clinical outcomes of mother and newborn baby.
Results
The proportion of subjects who had been diagnosed of having GDM according to GW was 7.5%, in less than 24th week of pregnancy; 55.1% in the 24-28th week; 28.0% in the 29-32nd week; and 9.4% 33rd week or more. There were 39 out of 107 subjects (36.4%) with HbA1c levels ≥6.5% and 26 out of 39 subjects (24.3%) with HbA1c levels ≥7.0%. In clinical outcomes of newborn by HbA1c levels, the frequency of delivery of large for gestational age (LGA) infant was higher in mothers diagnosed with GDM after 29th week of pregnancy or with HbA1c levels 7.0% or more (P<0.001).
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Table 1.
Neonatal outcomes according to glycated hemoglobin (HbA1c) concentration of Gestational Diabetes
| Items | All subjects | HbA1c <6.5% (n=68) | HbA1c 6.5-7% (n=13) | HbA1c ≥7% (n=26) | P |
|---|---|---|---|---|---|
| Gestational age at diagnosis (weeks)∗ | 28.5±5.4 | 27.8±3.6 | 28.1±2.5 | 29.9±1.5 | NS |
| No of family history, n (%) | 11 (10.3) | 7 (10.3) | 2 (15.4) | 2 (7.7) | NS |
| No of Preterm delivery <37 weeks, n (%) | 13 (12.2) | 4 (5.9) | 4 (30.8) | 5 (19.2) | NS |
| No of Preeclampsia, n (%) | 4 (3.7) | 1 (1.5) | 1 (7.7) | 2 (7.7) | NS |
| Gestational age at birth (weeks)∗ | 38.4±1.6 | 38.6±1.5 | 38.3±1.0 | 38.0±2.2 | NS |
| Apgar score 1 min∗ | 7.5±1.2 | 7.4±1.0 | 7.8±0.8 | 7.1±2.0 | NS |
| 5 min∗ | 8.6±1.1 | 8.6±1.0 | 9.0±0.3 | 8.4±1.8 | NS |
| Large for gestational age (≥90th centile), n (%) | 17 (15.9) | 3 (4.4) | 3 (23.1)† | 11 (42.3)‡ | <0.001 |
| Small for gestational age (≤10th centile), n (%) | 3 (2.8) | 0 (0) | 2 (15.4) | 1 (3.9) | NS |
| Malformation, n (%) | 3 (2.8) | 2 (2.9) | 1 (7.7) | 0 (0) | NS |
| Hemoglobin (mg/dL)∗ | 16.5±5.1 | 15.4±1.6 | 16.6±1.6 | 16.9±2.0 | NS |
| Neonatal hypoglycemia, n (%) | 13 (12.2) | 5 (7.4) | 5 (38.5) | 3 (11.5) | NS |
Table 2.
The number of gestational diabetes according to glycated hemoglobin (HbA1c) concentration and gestational weeks at the time of diagnosis
| Gestational age (weeks) | HbA1c <6.5% (n=68) | HbA1c 6.5-7% (n=13) | HbA1c >7% (n=26) |
|---|---|---|---|
| <24 (n=8) | 6/8 | 0/8 | 2/8 |
| 24-28 (n=59) | 43/59 | 7/59∗ | 9/59† |
| 29-32 (n=30) | 16/30 | 5/30 | 9/30 |
| 33-36 (n=8) | 3/8 | 1/8 | 4/8 |
| >37 (n=2) | 0/2 | 0/2 | 2/2† |
| P value | 0.04 | 0.74 | 0.02 |
Table 3.
The frequency of large for gestational age neonates according to glycated hemoglobin (HbA1c) concentration and gestational age at diagnosis of gestational diabetes
| Gestational age (weeks) | HbA1c <6.5% | HbA1c 6.5-7% | HbA1c ≥7% |
|---|---|---|---|
| <23 (n=1) | 0 (0.0) | 0 (0.0) | 1 (5.9) |
| 24-28 (n=2) | 1 (5.9) | 1 (5.9) | 0 (0.0) |
| 29-32 (n=6) | 1 (5.9) | 0 (0.0) | 5 (29.4) |
| 33-36 (n=6) | 1 (5.9) | 2 (11.8) | 3 (17.7) |
| >37 (n=2) | 0 (0.0) | 0 (0.0) | 2 (11.8) |
| Total | 3 (17.6) | 3 (17.6) | 11 (64.7)∗ |
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