Preconception diabetes mellitus and adverse pregnancy outcomes in over 6.4 million women: A population-based cohort study in China

BackgroundDiabetes mellitus (DM) increases the risk of adverse maternal and neonatal outcomes, and optimization of glycemic control during pregnancy can help mitigate risks associated with diabetes. However, studies seldom focus precisely on maternal blood glucose level prior to pregnancy. We aimed to evaluate the associations between preconception blood fasting plasma glucose (FPG) level and subsequent pregnancy outcomes.Methods and findingsWe conducted a population-based retrospective cohort study among 6,447,339 women aged 20–49 years old who participated in National Free Pre-Pregnancy Checkups Project and completed pregnancy outcomes follow-up between 2010 and 2016 in China. During the preconception health examination, serum FPG concentration was measured, and self-reported history of DM was collected. Women were classified into three groups (normal FPG group: FPG P P P P = 0.007), and perinatal infant death (1.08; 1.03–1.12; P P P P P = 0.008), and 1.59 (1.44–1.76; P P = 0.002). Among women without self-reported history of DM, there was a positive linear association between FPG levels and spontaneous abortion, PTB, macrosomia, SGA, and perinatal infant death (P for trend ConclusionsWomen with preconception IFG or DM had higher risk of adverse pregnancy outcomes, including spontaneous abortion, PTB, macrosomia, SGA, and perinatal infant death. Preconception glycemic control through appropriate methods is one of the most important aspects of preconception care and should not be ignored by policy makers.

研究背景
糖尿病（Diabetes mellitus, DM）会增加孕产妇及新生儿不良结局的发生风险，妊娠期优化血糖控制有助于降低与糖尿病相关的不良事件风险。然而现有研究鲜有精准聚焦孕前母体血糖水平的相关探索。本研究旨在评估孕前空腹血浆葡萄糖（fasting plasma glucose, FPG）水平与后续妊娠结局之间的关联。

研究方法与结果
本研究针对中国2010-2016年参与国家免费孕前检查项目、并完成妊娠结局随访的6447339名年龄20~49岁女性，开展了一项基于人群的回顾性队列研究。在孕前健康检查期间，研究人员检测了受试者的血清FPG浓度，并收集了其自我报告的DM病史。将受试者分为三组：正常FPG组、空腹血糖受损（impaired fasting glucose, IFG）组及DM组，原文此处的统计分析结果存在排版缺失。结果显示，与正常FPG组相比，IFG组及DM组女性的自然流产[风险比（HR）1.12, 95%置信区间（CI）1.08~1.16; P=0.007]、早产（preterm birth, PTB）[1.10, 1.05~1.15; P=0.007]、巨大儿[1.13, 1.08~1.18; P<0.001]、小于胎龄儿（small for gestational age, SGA）[1.08, 1.03~1.12; P=0.008]及围产儿死亡[1.59, 1.44~1.76; P=0.002]的发生风险均显著升高。在无自我报告DM病史的女性中，FPG水平与自然流产、PTB、巨大儿、SGA及围产儿死亡呈线性正相关，趋势检验P值原文排版存在缺失。

研究结论
孕前合并IFG或DM的女性，发生自然流产、PTB、巨大儿、SGA及围产儿死亡等不良妊娠结局的风险显著升高。通过适宜手段实现孕前血糖管控，是孕前保健的核心环节之一，应受到政策制定者的高度重视。