Aims/hypothesis

We aimed to assess maternal–fetal outcomes according to various subtypes of hyperglycaemia in pregnancy.

Methods

We used data from the French National Health Data System (Système National des Données de Santé), which links individual data from the hospital discharge database and the French National Health Insurance information system. We included all deliveries after 22 gestational weeks (GW) in women without pre-existing diabetes recorded in 2018. Women with hyperglycaemia were classified as having overt diabetes in pregnancy or gestational diabetes mellitus (GDM), then categorised into three subgroups according to their gestational age at the time of GDM diagnosis: before 22 GW (GDM_<22); between 22 and 30 GW (GDM_22–30); and after 30 GW (GDM_>30). Adjusted prevalence ratios (95% CI) for the outcomes were estimated after adjusting for maternal age, gestational age and socioeconomic status. Due to the multiple tests, we considered an association to be statistically significant according to the Holm–Bonferroni procedure. To take into account the potential immortal time bias, we performed analyses on deliveries at ≥31 GW and deliveries at ≥37 GW.

Results

The study population of 695,912 women who gave birth in 2018 included 84,705 women (12.2%) with hyperglycaemia in pregnancy: overt diabetes in pregnancy, 0.4%; GDM_<22, 36.8%; GDM_22–30, 52.4%; and GDM_>30, 10.4%. The following outcomes were statistically significant after Holm–Bonferroni adjustment for deliveries at ≥31 GW using GDM_22–30 as the reference. Caesarean sections (1.54 [1.39, 1.72]), large-for-gestational-age (LGA) infants (2.00 [1.72, 2.32]), Erb’s palsy or clavicle fracture (6.38 [2.42, 16.8]), preterm birth (1.84 [1.41, 2.40]) and neonatal hypoglycaemia (1.98 [1.39, 2.83]) were more frequent in women with overt diabetes. Similarly, LGA infants (1.10 [1.06, 1.14]) and Erb’s palsy or clavicle fracture (1.55 [1.22, 1.99]) were more frequent in GDM_<22. LGA infants (1.44 [1.37, 1.52]) were more frequent in GDM_>30. Finally, women without hyperglycaemia in pregnancy were less likely to have preeclampsia or eclampsia (0.74 [0.69, 0.79]), Caesarean section (0.80 [0.79, 0.82]), pregnancy and postpartum haemorrhage (0.93 [0.89, 0.96]), LGA neonate (0.67 [0.65, 0.69]), premature neonate (0.80 [0.77, 0.83]) and neonate with neonatal hypoglycaemia (0.73 [0.66, 0.82]). Overall, the results were similar for deliveries at ≥37 GW. Although the estimation of the adjusted prevalence ratio of perinatal death was five times higher (5.06 [1.87, 13.7]) for women with overt diabetes, this result was non-significant after Holm–Bonferroni adjustment.

Conclusions/interpretation

Compared with GDM_22–30, overt diabetes, GDM_<22 and, to a lesser extent, GDM_>30 were associated with poorer maternal–fetal outcomes.

Graphical Abstract

中文翻译：

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根据妊娠期高血糖诊断时间的孕产妇和新生儿结局：一项针对 2018 年法国 695,912 例分娩的全国横断面研究

目标/假设

我们的目的是根据妊娠期高血糖的各种亚型评估母婴结局。

方法

我们使用了法国国家健康数据系统 (Système National des Données de Santé) 的数据，该系统将出院数据库中的个人数据与法国国家健康保险信息系统联系起来。我们纳入了 2018 年记录的所有妊娠 22 周 (GW) 后分娩的无糖尿病女性。患有高血糖的女性被归类为妊娠期明显糖尿病或妊娠糖尿病 (GDM)，然后根据其妊娠情况分为三个亚组GDM诊断时的年龄：22GW之前（GDM _<22）；22 至 30 吉瓦 (GDM _22-30 ) 之间；以及 30 GW 之后（GDM _>30）。在调整产妇年龄、胎龄和社会经济状况后，估计了结果的调整后患病率（95% CI）。由于进行了多项测试，根据 Holm-Bonferroni 程序，我们认为关联具有统计显着性。为了考虑到潜在的永生时间偏差，我们对 ≥31 GW 的交付量和 ≥ 37 GW 的交付量进行了分析。

结果

研究对象包括 2018 年分娩的 695,912 名女性，其中 84,705 名（12.2%）患有妊娠期高血糖的女性：妊娠期明显糖尿病，0.4%；GDM _< 22，36.8%；妊娠期_22-30岁，52.4%；GDM _> 30，10.4%。_{使用 GDM 22-30}作为参考，对 ≥31 GW 的分娩进行 Holm-Bonferroni 调整后，以下结果具有统计学意义。剖腹产 (1.54 [1.39, 1.72])、大于胎龄 (LGA) 婴儿 (2.00 [1.72, 2.32])、Erb 麻痹或锁骨骨折 (6.38 [2.42, 16.8])、早产 (1.84 [1.84] 1.41, 2.40]）和新生儿低血糖（1.98 [1.39, 2.83]）在患有明显糖尿病的女性中更为常见。_{同样，LGA 婴儿 (1.10 [1.06, 1.14]) 和 Erb 麻痹或锁骨骨折 (1.55 [1.22, 1.99]) 在 GDM <22}中更为常见。_{LGA 婴儿 (1.44 [1.37, 1.52]) 在 GDM >30}中更为常见。最后，妊娠期没有高血糖的女性患子痫前期或子痫 (0.74 [0.69, 0.79])、剖腹产 (0.80 [0.79, 0.82])、妊娠和产后出血 (0.93 [0.89, 0.96])、LGA 新生儿的可能性较小(0.67 [0.65, 0.69])、早产儿 (0.80 [0.77, 0.83]) 和新生儿低血糖 (0.73 [0.66, 0.82])。总体而言，≥37 GW 交付量的结果相似。尽管对于患有明显糖尿病的女性，调整后的围产期死亡患病率估计要高出五倍（5.06 [1.87，13.7]），但在 Holm-Bonferroni 调整后，这一结果并不显着。

结论/解释

与 GDM _22-30相比，明显的糖尿病、GDM _<22以及较小程度的 GDM _>30与较差的母婴结局相关。

图形概要