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    • Participant baseline characteristics and outcome measures ar

    2018-11-07

    Participant baseline characteristics and outcome measures are summarized in Tables 1 and 2. The mean FPG, 1h, and 2h plasma prostaglandin receptors levels were 4.3mmol/l, 7.7mmol/l, and 6.6mmol/l, respectively. Using the IADPSG criteria, there were 1779 (N=12,889, 13.8%) women diagnosed with GDM who received a subsequent diet and exercise advice (425 with FPG≥5.1mmol/l, 1354 with FPG<5.1mmol/l and abnormal post-load glucose). Eleven (11/12,889, 0.1%) women went on to receive insulin therapy. The overall prevalence of LGA, C-section, and SPTB was 10.5% (1325/12,594), 34.8% (4383/12,614), and 3.4% (426/12,655), respectively (Table 2). Table 3 shows the association between maternal glucose and perinatal outcomes. For birthweight and birthweight Z score, the coefficients for 1-SD increase in all OGTT measures glucose were significant. Among the categorical outcomes, the associations were strongest for LGA (ORs for each 1-SD increase in glucose level range, 1.17 to 1.37). For cesarean section and spontaneous preterm birth, the associations were weaker. The associations between fasting glucose and birthweight, birthweight Z score, and LGA were strongest for fasting glucose as compared to both post-load glucose concentrations. No statistical evidence of an interaction of glucose measurements (fasting, 1h, and 2h) with maternal income and education was found (Appendix Tables 2 and 3). Results of analyses restricted to women underwent OGTT at 24–28 gestation\'s weeks did not change significantly (Appendix Table 4). When we restricted to the women without a GDM diagnosis, we found that the association between fasting glucose and birthweight or LGA is still stronger than post-load glucose in non-GDM women (Appendix Table 5). When we used the GDM status as a proxy of use of treatment (yes or no) and included in model for adjustment, the results were similar to findings when the analysis was restricted to women without GDM (Appendix Table 6). The ROC curves evaluating the performance of OGTT glucose measurements for predicting perinatal outcomes are shown in Fig. 2. For LGA, the AUC of FPG was significantly higher than 1h (0.611 vs. 0.566, P<0.0001) and 2h (0.611 vs. 0.551, P<0.0001) glucose measurements and did not significantly increase after adding 1h and 2h measurements to the FPG predictive model. The AUCs for other two outcomes were all smaller than LGA. Similar results were found when the analysis restricted to women underwent OGTT at 24–28 gestation\'s weeks (Appendix Fig. 1) and women without GDM (Appendix Fig. 2). Although the P value for the comparison of FPG with OGTT measurements in women without GDM is <0.05, the confidence intervals was rather close and the significance is more likely to be caused by large sample size. To assess the contribution of each glucose measure in identifying risk of outcomes, we classified participants into eight categories according to IADPSG diagnostic criteria. Fig. 3 and Appendix Table 7 showed the respective GDM prevalence and adjusted OR (used no-GDM as reference) for outcome measures by diagnostic category. LGA prevalence was significantly higher among women with abnormal FPG (≥5.1mmol), irrespective of 1h or 2h post-load glucose levels (prevalence range 19.68%–26.67%, ORs range 1.72–2.62 in women with i-IFG, IFG+IGT1, IFG+IGT2, or IFG+IGT1+2). Among women with FPG<5.1mmol, the prevalence of LGA was relatively low, even for those abnormal 1h or/and 2h glucose level (prevalence 10.1%,13.8%, 8.9%, and 8.4% for no-GDM, i-IGT1, i-IGT2, i-IGT1+2 group; ORs [95%CI] were 1.27[0.92, 1.75] for i-IGT1, 0.87[0.62,1.20] for i-IGT2 and 0.77[0.53,1.11] for i-IGT1+2). Similar results were observed for cesarean section although there was no significant association for i-IFG, IFG+IGT1, IFG+IGT2, or IFG+IGT1+2. Women with two abnormal glucose measures seem to have a higher risk of SPTB.
    Discussion In this large-scale prospective cohort study, we observed continuous associations of fasting, 1h and 2h post-load glucose with LGA. Weaker associations were observed for cesarean section and spontaneous preterm birth. FPG have a comparable discriminative power for prediction of LGA to the combination of fasting, 1h, and 2h glucose values during OGTT. These findings are broadly consistent with those reported in a comparable Asian cohort prostaglandin receptors study and recent systematic review (Aris et al., 2014; Farrar et al., 2016).