Association Between Maternal Glucose/Lipid Metabolism Parameters and Abnormal Newborn Birth Weight in Gestational Diabetes Complicated by Preeclampsia: A Retrospective Analysis of 248 Cases.

INTRODUCTION

Women with gestational diabetes mellitus (GDM) with co-existent preeclampsia (GCP) are at increased risk of giving birth to a baby with an abnormal birth weight. We have analyzed the risk factors for abnormal newborn birth weight (NBW) in women with co-presence of GDM and GCP, focusing on maternal glucose/lipid metabolism, with the aim to optimize the clinical intervention strategy.

METHODS

The clinical data of 248 pregnant women with GCP and their infants were retrospectively analyzed through a comprehensive review of the electronic medical records of Women and Children's Hospital, Xiamen University (Xiamen, China). These women had received prenatal care and had their baby delivered in the hospital between January 2016 and November 2018. Major characteristics assessed were large for gestational age (LGA), small for gestational age (SGA), severe preeclampsia (S-PE), and maternal plasma glucose/lipid profile in late pregnancy. Secondary characteristics were maternal age, height, body mass index (BMI), gestational weight gain (GWG), abortion history, education level, primipara or not, preterm or not, and fetal gender. Regression analysis was used to analyze the association between maternal glucose/lipid metabolism parameters and LGA or SGA.

RESULTS

There was no difference in the ratio of advanced maternal age, primipara, abortion history, preterm delivery, and newborn sex between the control group and the LGA or SGA group. Logistic regression analysis, with such factors as maternal stature, BMI, among others, was applied. Multivariate analysis of SGA infants revealed the following associations: S-PE (odds ratio [OR] 3.226, 95% confidence interval [CI] 1.385-7.515; adjusted OR [AOR] 3.675, 95% CI 1.467-9.207; p  < 0.05); high levels of glycated hemoglobin (HbA1c > 6.5%) (OR 0.436, 95% CI 0.187-1.017; AOR 0.459, 95% CI 0.179-1.173; p  > 0.05); low levels of high-density lipoprotein cholesterol (HDL-C < 1.0 mmol/L) (OR 0.625, 95% CI 0.287-1.361; AOR 0.637, 95% CI 0.267-1.520; p  > 0.05). Multivariate analysis of LGA revealed the following associations: S-PE (OR 30.885, 95% CI 0.398-2.013; AOR 0.974, 95% CI 0.400-2.371; p  > 0.05); high levels of HbA1c (OR 4.542, 95% CI 0.187-11.824; AOR 3.997, 95% CI 1.452-10.998; p  < 0.05); low levels of HDL (OR 3.393, 95% CI 1.362-8.453; AOR 2.900, 95% CI 1.100-7.647; p  < 0.05).

CONCLUSIONS

The results of our analysis revealed that severity of preeclampsia was associated with SGA. The high HbA1c and low HDL-C values found in our analysis were independent risk factors for LGA in women with GCP, while other lipoproteins were not associated with abnormal NBW. These findings suggest that there are differences in the effects of various maternal lipid parameters on NBW.