Gymnastik- och idrottshögskolan, GIH

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Random capillary glucose levels throughout pregnancy, obstetric and neonatal outcomes, and long-term neurodevelopmental conditions in children: a group-based trajectory analysis.
Karolinska Institutet, Stockholm, Sweden.
Umeå University, Umeå, Sweden.
Swedish School of Sport and Health Sciences, GIH, Department of Physical Activity and Health. Department of Neurobiology, Care Sciences and Society (NVS), Karolinska Institutet, Stockholm, Sweden..ORCID iD: 0000-0001-7209-741x
Karolinska Institutet, Stockholm, Sweden.
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2023 (English)In: BMC Medicine, E-ISSN 1741-7015, Vol. 21, no 1, article id 260Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Gestational diabetes mellitus (GDM) is associated with both short- and long-term risks, although it is unknown if risks vary by severity, timing, and duration of gestational hyperglycemia. We aimed to identify trajectories of random capillary glucose (RCG) levels throughout pregnancy and assess their associations with both obstetric/neonatal outcomes and children's risk of neurodevelopmental conditions (NDCs) (i.e., autism, intellectual disability, and attention-deficit/hyperactivity disorders [ADHD]).

METHODS: A population-based cohort study was conducted involving 76,228 children born to 68,768 mothers without pregestational diabetes. Group-based trajectory modeling was utilized to identify distinct glucose trajectories across RCG values throughout the course of pregnancy. The associations between these trajectory groups and obstetric/neonatal outcomes as well as children's NDCs were then assessed using generalized estimating equation models with a logit link. The Benjamini-Hochberg (BH) procedure was employed to adjust P-values for multiple comparisons, controlling the false discovery rate (FDR).

RESULTS: Five distinct glucose trajectory groups were identified, each with varying percentages diagnosed with GDM. Their associations with obstetric/neonatal outcomes as well as children's NDCs varied. For example, when compared to the "Persistently Low" group, other groups exhibited varying degrees of increased risk for large-for-gestational-age babies, with the exception of the "High in Early Pregnancy" group. Compared to the "Persistently Low" group, all other trajectory groups were associated with NDC outcomes, except the "High in Mid-Pregnancy" group. However, none of the associations with offspring NDCs remained significant after accounting for the FDR correction.

CONCLUSIONS: Persistent high glucose levels or moderately elevated glucose levels throughout pregnancy, as well as transient states of hyperglycemia in early or mid-pregnancy, were found to be associated with increased risks of specific obstetric and neonatal complications, and potentially offspring NDCs. These risks varied depending on the severity, timing, duration, and management of hyperglycemia. The findings underscore the need for continuous surveillance and individualized management strategies for women displaying different glucose trajectories during pregnancy. Limitations such as potential residual confounding, the role of mediators, and small sample size should be addressed in future studies.

Place, publisher, year, edition, pages
BioMed Central (BMC), 2023. Vol. 21, no 1, article id 260
Keywords [en]
Attention-deficit/hyperactivity disorder, Autism, Intellectual disability, Maternal glucose levels, Neonatal outcomes, Obstetric outcomes
National Category
Obstetrics, Gynecology and Reproductive Medicine Endocrinology and Diabetes
Research subject
Medicine/Technology
Identifiers
URN: urn:nbn:se:gih:diva-7733DOI: 10.1186/s12916-023-02926-3ISI: 001032094700006PubMedID: 37468907OAI: oai:DiVA.org:gih-7733DiVA, id: diva2:1792432
Available from: 2023-08-29 Created: 2023-08-29 Last updated: 2023-09-12

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Wang, Rui

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