Gestational diabetes mellitus in previous pregnancy associated with the risk of large for gestational age and macrosomia in the second pregnancy.

IF 4.6 2区医学 Q2 ENDOCRINOLOGY & METABOLISM Frontiers in Endocrinology Pub Date : 2025-02-03 eCollection Date: 2025-01-01 DOI:10.3389/fendo.2025.1474694

Ying Wang, Juan Yang, Yuzhen Liu, Ao Yang, Yuqing Deng, Chang Xu, Shilin Zhong

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Abstract

Background: Since the implementation of China's new birth policy, the incidence of large for gestational age (LGA) and macrosomia associated with gestational diabetes mellitus (GDM) has increased. It remains unclear whether a history of GDM in a previous pregnancy raises the risk of LGA or macrosomia in Chinese women planning two or more pregnancies.

Aim: To analyze the association between previous GDM and the risk of LGA and macrosomia in second pregnancy.

Method: A retrospective study was conducted on a cohort of 3,131 women who had experienced two consecutive singleton births. The incidences of LGA and macrosomia in the second pregnancy were compared between women with and without previous GDM. The relationship between previous GDM and the occurrence of LGA and macrosomia was analyzed using multivariate logistic regression and stratified analysis.

Results: The incidence of LGA and macrosomia during the second pregnancy was significantly higher in women with previous GDM (22.67% and 10.25%, respectively) compared to those without prior GDM (15.34% and 5.06%, respectively) (P < 0.05). After adjusting for potential confounders, previous GDM was significantly associated with LGA (aOR: 1.511, 95% CI: 1.066-2.143) and macrosomia (aOR: 1.854, 95% CI: 1.118-3.076) in the second pregnancy. Stratified analysis revealed that these associations were present only in women without previous LGA, those with GDM, appropriate gestational weight gain (AGWG), non-advanced maternal age, and male newborns during the second pregnancy (P < 0.05). Compared to excessive GWG (EGWG), AGWG correlated with lower risks for LGA and macrosomia during the second pregnancy in women without prior GDM, an association not observed in those with previous GDM. Among women without previous GDM, if the pre-pregnancy BMI is normal, the risk of LGA and macrosomia is significant lower in AGWG compared with EGWG (P< 0.001), while this difference was no significant among women with prior GDM (P>0.05).

Conclusion: Previous GDM is strongly linked to LGA and macrosomia in subsequent pregnancies. However, this relationship is influenced by GWG, prior LGA history, fetal sex, and maternal age. Managing weight alone may not sufficiently reduce the risk of LGA or macrosomia for women with a history of GDM.

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妊娠期糖尿病与第二次妊娠发生大胎龄和巨大儿的风险相关。

背景：中国新生育政策实施以来，与妊娠期糖尿病（GDM）相关的大胎龄儿（LGA）和巨大儿的发病率有所上升。目前尚不清楚既往妊娠的GDM史是否会增加计划两次或两次以上妊娠的中国妇女发生LGA或巨大儿的风险。目的：分析既往GDM与二胎LGA和巨大儿风险的关系。方法：对3131名连续两次单胎分娩的妇女进行回顾性研究。比较有和无既往GDM妇女第二次妊娠LGA和巨大儿的发生率。采用多因素logistic回归和分层分析分析既往GDM与LGA和巨大儿发生的关系。结果：既往有GDM的妊娠期LGA和巨大儿的发生率（分别为22.67%和10.25%）明显高于无GDM的妊娠期LGA和巨大儿的发生率（分别为15.34%和5.06%）（P < 0.05）。在对潜在混杂因素进行调整后，先前的GDM与第二次妊娠的LGA （aOR: 1.511, 95% CI: 1.066-2.143）和巨大儿（aOR: 1.854, 95% CI: 1.118-3.076）显著相关。分层分析显示，这些相关性仅存在于既往无LGA、GDM、适当妊娠增重（AGWG）、非高龄产妇和第二次妊娠时的男性新生儿中（P < 0.05）。与过度GWG （EGWG）相比，AGWG与没有GDM的妇女在第二次妊娠期间发生LGA和巨大儿的风险较低相关，而在有GDM的妇女中没有观察到这种关联。在未发生GDM的女性中，如果孕前BMI正常，AGWG组LGA和巨大儿的发生风险显著低于EGWG组（P< 0.001），而在有GDM的女性中差异无统计学意义（P< 0.05）。结论：先前的GDM与LGA和随后妊娠的巨大儿密切相关。然而，这种关系受GWG、LGA史、胎儿性别和母亲年龄的影响。对于有GDM病史的女性，仅控制体重可能不足以降低LGA或巨大儿的风险。

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来源期刊

Frontiers in Endocrinology Medicine-Endocrinology, Diabetes and Metabolism

CiteScore

5.70

自引率

9.60%

发文量

3023

审稿时长

14 weeks

期刊介绍： Frontiers in Endocrinology is a field journal of the "Frontiers in" journal series. In today’s world, endocrinology is becoming increasingly important as it underlies many of the challenges societies face - from obesity and diabetes to reproduction, population control and aging. Endocrinology covers a broad field from basic molecular and cellular communication through to clinical care and some of the most crucial public health issues. The journal, thus, welcomes outstanding contributions in any domain of endocrinology. Frontiers in Endocrinology publishes articles on the most outstanding discoveries across a wide research spectrum of Endocrinology. The mission of Frontiers in Endocrinology is to bring all relevant Endocrinology areas together on a single platform.