Higher (AUC) from the oral glucose tolerance test is associated with increased odds of preterm birth (PTB).
Women with higher AUC (≥ 17 mmol/L·h) had 47% greater odds of experiencing PTB compared to those with lower AUC.
Insufficient (GWG) was observed in 50.3% of participants and is linked to an increased risk of PTB.
Women with higher AUC had a 23% higher risk of insufficient GWG.
The relationship between AUC and PTB is mainly mediated by GWG, suggesting GWG plays a critical role in this association.
Simplified
BACKGROUND: The risk of (PTB) is associated with maternal hyperglycemia but differs by combinations of abnormal oral glucose tolerance test (OGTT) values. However, the potential pathway by which maternal hyperglycemia affects PTB is unclear. This study aimed to investigate the association between OGTT-related measures and PTB and evaluate the mediation effect of (GWG) on the association between maternal hyperglycemia and the risk of PTB in women with (GDM).
METHODS: This retrospective cohort study included women with GDM from a women's and children's hospital in Chengdu, China, from December 2021 to December 2023. The associations between OGTT-related measures, GWG, and PTB were evaluated by logistic regression analyses. Two-step clustering was used to classify participants by (AUC) of the OGTT. SPSS Process Macro was utilized to explore the mediation effect of GWG on the relationship between AUC and PTB.
RESULTS: This study included 1860 women with GDM, of whom 694 (37.3%) women had higher AUC (≥ 17 mmol/L·h), 935 (50.3%) women had insufficient GWG, and 132 (7.1%) women had PTB. Multivariable logistic regression analyses showed that only higher AUC was associated with increased odds of PTB (OR:1.47, 95% CI:1.03 to 2.10; P = 0.036), and no significant associations between other OGTT-related measures and PTB were observed. Besides, GDM women with higher AUC had a higher risk of insufficient GWG (OR:1.23, 95% CI:1.02 to 1.49; P = 0.033), which was associated with increased odds of PTB (OR:2.15, 95% CI:1.47 to 3.14; P < 0.001). Mediation analyses revealed that the effect of AUC on PTB was mainly mediated through GWG (indirect effect: 0.15, bootstrapped 95% CI: 0.08 to 0.24).
CONCLUSIONS: This study found that AUC of the OGTT was positively associated with the occurrence of PTB, and GWG mainly mediated this positive association. Effective intervention strategies for GDM should pay close attention to avoiding insufficient GWG when managing their blood glucose, especially for those with higher AUC levels, to reduce the impact of maternal hyperglycemia on the risk of PTB.
Key numbers
1.47
Increase in Odds of
Odds Ratio for among women with higher (≥ 17 mmol/L·h)
2.15
Increase in Odds of with Insufficient
Odds Ratio for among women with insufficient
694 of 1860
Proportion of Women with Higher
Number of women with higher out of total participants
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