Abstract
Purpose
This study aimed to evaluate the impact of the timing of diabetes diagnosis on maternal and fetal outcomes.
Methods
The data were collected from pregnant women diagnosed with pregestational diabetes mellitus (PGDM) who were hospitalized at Dongguan People's Hospital between June 2016 and December 2023. Based on the timing of diagnosis, women were categorized into two groups: those diagnosed before pregnancy and those diagnosed during pregnancy. General clinical characteristics, glycemic control, pregnancy complications, and maternal and fetal outcomes were compared between the two groups to assess the influence of diagnosis timing on pregnancy outcomes.
Results
Between 2016 and 2023, a total of 415 pregnant women with PGDM were included in this study. Among them, 242 (58.31%) were diagnosed before pregnancy, while 173 (41.69%) were diagnosed during pregnancy, resulting in a preconception diabetes awareness rate of 58.31%. Education level was significantly associated with the timing of diabetes diagnosis (P = 0.002). In addition, women diagnosed during pregnancy had significantly higher HbA1c levels before delivery when compared with those diagnosed before pregnancy (6.70% vs. 6.20%, P < 0.001), indicating more severe glycemic dysregulation. Consequently, this group also exhibited a higher rate of diabetes-related hospitalizations during pregnancy (42.77% vs. 22.73%, P < 0.001) and an increased risk of macrosomia (20.23% vs. 10.74%, P = 0.007).
Conclusion
Pregnant women diagnosed with diabetes during pregnancy exhibited more severe perinatal glucose metabolism disorders and a higher rate of macrosomia. Early diagnosis and management of diabetes—especially before conception—helped improve perinatal glycemic control, potentially reducing healthcare burdens and the incidence of macrosomia.
Keywords: Pregestational diabetes mellitus, Maternal and fetal outcomes, Timing of diagnosis, Preconception screening, Perinatal management
What does this study add to the clinical work
| The findings of this study indicated that improving the early diagnosis of diabetes might have helped mitigate perinatal glycemic dysregulation and reduced the risk of macrosomia, underscoring the importance of preconception diagnosis. These results offered new perspectives and potential strategies for optimizing perinatal care in women with PGDM. |
Introduction
Pregnant women with pregestational diabetes mellitus (PGDM) faced heightened risks during pregnancy due to prolonged exposure to hyperglycemic environments and severe glucose metabolism disorders. This significantly increased the likelihood of adverse maternal and fetal outcomes, including preterm birth, macrosomia, and fetal developmental anomalies [1–3]. According to the International Diabetes Federation (IDF), the prevalence of PGDM doubled, rising from 0.5% (95% CI 0.1–1.0) in 1990 to 1.0% (95% CI 0.6–1.5) in 2020 [4]. Although diabetes became a global epidemic, approximately 44.7% of individuals with diabetes remained undiagnosed [5, 6]. In China, only about 1.2% of PGDM patients were diagnosed before pregnancy, which was significantly below the ideal level [7].
Poor glycemic control was closely associated with several adverse maternal and fetal outcomes [7–9]. Research indicated that fasting blood glucose levels in women diagnosed during pregnancy were closely associated with adverse maternal and fetal outcomes, including preterm birth and macrosomia [7, 10]. A study from Brazil indicated that the median gestational age at which women were diagnosed with diabetes during pregnancy was 12.3 weeks (8.3–19.0), with the majority (52.5%) first receiving specialized diabetes prenatal care in late pregnancy [11]. The diagnosis of diabetes during pregnancy posed challenges for glycemic management in PGDM patients. Therefore, those diagnosed during pregnancy may face higher pregnancy risks. However, there was still a lack of relevant research discussing the timing of diabetes diagnosis on pregnancy.
Therefore, this study collected medical records of women who were hospitalized at Dongguan People's Hospital between June 2016 and December 2023. The analysis focused on the diagnosis of diabetes before pregnancy and the impact of the timing of diabetes diagnosis on maternal and fetal outcomes. The aim was to provide new insights and strategies for the perinatal management of women with PGDM.
Methods
Study design
The study collected data from pregnant women diagnosed with PGDM who were hospitalized for delivery or pregnancy termination at Dongguan People's Hospital between June 2016 and December 2023. Participants were categorized based on the timing of their diabetes diagnosis. The diagnosed before pregnancy group included women who had been diagnosed with diabetes and were aware of their condition prior to pregnancy. The diagnosed during pregnancy group included women who met the diagnostic criteria for diabetes before pregnancy but were not diagnosed until after conception during routine prenatal screening. This study was approved by the Medical Ethics Committee of Dongguan People's Hospital (Approval No: KYKT2024-006).
Inclusion and exclusion criteria
Inclusion criteria:
Singleton pregnancy.
Fulfilled the diagnostic criteria for PGDM as outlined in the Guidelines for the Diagnosis and Treatment of Hyperglycemia in Pregnancy (2022) [12].
Had complete clinical data.
Exclusion criteria:
Pregnancies with twins or high-order multiples.
Pregnancies in women diagnosed with GDM or impaired glucose tolerance.
Presence of severe neurological or psychiatric disorders that hindered the ability to understand or communicate clearly.
Incomplete clinical data.
Diagnostic standards
The diagnostic criteria for PGDM, as outlined in the Guidelines for the Diagnosis and Treatment of Hyperglycemia in Pregnancy [12], were as follows:
Pregnant women who had been diagnosed with diabetes prior to pregnancy.
For those not diagnosed before pregnancy, PGDM was diagnosed during pregnancy if blood glucose levels met any of the following criteria: ① fasting plasma glucose (FPG) ≥ 7.0 mmol/L (after fasting for more than 8 h but not excessively long); ② random plasma glucose ≥ 11.1 mmol/L accompanied by typical symptoms of hyperglycemia or a hyperglycemic crisis; ③ glycated hemoglobin (HbA1c) ≥ 6.5%.
Observational indicators
All information was collected from the maternal antenatal care records and electronic medical records at the time of hospital admission.
Based on the first antenatal check-up and the electronic medical records at admission, general clinical data were collected, including maternal age, occupation, education level, weight gain during pregnancy, prepregnancy body mass index (BMI), pregnancy BMI, history of chronic diseases (such as chronic hypertension, hyperlipidemia, type of diabetes, and duration of diabetes), obstetric history, mode of conception (assisted reproductive technology or natural conception), as well as the number of hospitalizations during pregnancy and hospitalization costs. Chronic hypertension was defined as a systolic blood pressure ≥ 140 mmHg or a diastolic blood pressure ≥ 90 mmHg before 20 weeks of gestation [13]. BMI was calculated as weight (kg) divided by height (m) squared, with obesity defined as a BMI ≥ 28 kg/m2 [14].
Glycemic control targets: According to the 2022 Guidelines for the Diagnosis and Management of Hyperglycemia in Pregnancy, the optimal control standards were defined as follows: FPG < 5.3 mmol/L, 2-h postprandial blood glucose < 6.7 mmol/L, or HbA1c levels maintained below 6%[15].
Outcome definitions: The outcome indicators observed in this study included gestational age at delivery, newborn birth weight, spontaneous abortion, induction of labor, stillbirth, cesarean delivery, vaginal delivery, preterm birth, preeclampsia, gestational hypertension, macrosomia, neonatal respiratory distress syndrome, fetal developmental abnormalities, and neonatal transfer rates. Spontaneous abortion referred to fetal death occurring before 28 weeks of gestation [16]. Induced labor was defined as the use of artificial methods to stimulate uterine contractions to terminate the pregnancy after 13 weeks due to maternal or fetal indications [17]. Stillbirth referred to intrauterine fetal death occurring after 28 weeks of gestation [18]. Preterm birth was defined as delivery occurring between 28 and 36 + 6 weeks of gestation [19]. Gestational hypertension was defined as new-onset hypertension after 20 weeks of gestation, with a systolic blood pressure ≥ 140 mmHg or diastolic blood pressure ≥ 90 mmHg [13]. Preeclampsia was characterized by hypertension (systolic blood pressure ≥ 140 mmHg or diastolic blood pressure ≥ 90 mmHg) occurring after 20 weeks of gestation, accompanied by random urine protein (+ +), or urine protein ≥ 0.3 g/24 h [13]. Polyhydramnios referred to an amniotic fluid volume exceeding 2000 mL during pregnancy [20]. Macrosomia was defined as a newborn birth weight ≥ 4000 g [21]. Neonatal respiratory distress syndrome was characterized by symptoms such as tachypnea, cyanosis, and respiratory failure after birth [22]. Fetal abnormalities referred to structural, functional, or metabolic anomalies detected before birth [23]. Neonatal transfer referred to newborns requiring evaluation by a neonatologist and subsequent transfer to the neonatal intensive care unit for further treatment after delivery.
Statistical methods
The data presented in this paper were statistically evaluated using SPSS version 27.0 software. Quantitative data that followed a normal distribution were expressed as mean ± standard deviation (Mean ± SD), whereas those that did not follow a normal distribution were expressed as median (interquartile range) (M, IQR). Qualitative data were expressed as a frequency (n, %). The Student's t test was used to compare normally distributed quantitative data, the Mann–Whitney U test was used for non-normally distributed quantitative data, and the chi-square test was applied to qualitative data. A P value of less than 0.05 was considered statistically significant.
Results
Pregnant women diagnosed with PGDM
The research personnel flow is illustrated in Fig. 1. Between June 1, 2016, and December 31, 2023, a total of 467 women with PGDM who were hospitalized for delivery or pregnancy termination at Dongguan People's Hospital were identified. After applying the inclusion criteria, 415 women were enrolled in the study. Among them, 242 (58.31%) were diagnosed before pregnancy, and 173 (41.69%) were diagnosed during pregnancy. Specifically, the cohort consisted of 162 women diagnosed with type 2 diabetes, 26 with type 1 diabetes, and 227 who met the diagnostic criteria for diabetes during clinical assessment but had not been further classified by diabetes type.
Fig. 1.
Flowchart of the study population
Among the women diagnosed before pregnancy, 225 (92.98%) had a diabetes history of less than 10 years, while 17 (7.02%) had a history exceeding 10 years.
For those diagnosed during pregnancy, 54.34% were identified between 14 and 27 + 6 weeks of gestation. The majority of these cases were diagnosed based on FPG ≥ 7.0 mmol/L (n = 78), HbA1c ≥ 6.5% (n = 10), or both criteria (n = 4). One case was diagnosed based on the random plasma glucose ≥ 11.1 mmol/L with classic hyperglycemic symptoms. Another 24.85% were diagnosed after 28 weeks of gestation, including 28 women with FPG ≥ 7.0 mmol/L, 12 with HbA1c ≥ 6.5%, and 3 who met both criteria. The remaining 20.81% were diagnosed before 14 weeks of gestation, consisting of 21 women with FPG ≥ 7.0 mmol/L, 8 with HbA1c ≥ 6.5%, 6 who met both criteria, and 1 case diagnosed based on both HbA1c ≥ 6.5% and random plasma glucose ≥ 11.1 mmol/L with typical hyperglycemic symptoms.
Comparison of general clinical information
The baseline characteristics of the two groups of women were presented in Table 1. The results indicated no significant differences in baseline characteristics, such as age, occupation, or obstetric history between the two groups. However, the proportion of pregnant women with a college degree or higher was significantly higher in the diagnosed before pregnancy group when compared with the diagnosed during pregnancy group (51.65% vs. 36.42%, P < 0.01). In addition, the median number of hospitalizations was 1 (1–2) in the diagnosed before pregnancy group and 2 (1–2) in the diagnosed during pregnancy group, with a statistically significant difference between the two groups (P < 0.01).
Table 1.
Comparison of general clinical data between the two groups of women
| Diagnosed before pregnancy group (n = 242 cases) | Diagnosed during pregnancy group (n = 173 cases) | t value/z value/χ2 value | P value | |
|---|---|---|---|---|
| Age (years) | 33.37 ± 0.30 | 32.77 ± 0.41 | 1.176 | 0.241 |
| Occupation (n, %) | 2.735 | 0.098 | ||
| Incumbency | 147 (60.74%) | 91 (52.60%) | ||
| Unemployment | 95 (39.26%) | 82 (47.40%) | ||
| Educational level (n, %) | 9.452 | 0.002 | ||
| College degree or above | 125 (51.65%) | 63 (36.42%) | ||
| Below junior college | 117 (48.35%) | 110 (63.58%) | ||
| Number of pregnancies (times) | 2 (2, 3) | 2 (2, 4) | − 0.699 | 0.484 |
| Number of births (times) | 1 (0, 1) | 1 (0, 1) | − 1.566 | 0.117 |
| Weight gain during pregnancy (kg) | 10.25 (7.00, 14.00) | 10.00 (7.00, 14.00) | − 0.781 | 0.435 |
| Prepregnancy, BMI (kg/m2) | 25.10 (22.40, 28.50) | 25.40 (22.60, 29.00) | − 0.823 | 0.862 |
| Prenatal BMI (kg/m2) | 29.10 (26.10, 32.90) | 29.40 (26.60, 32.70) | − 0.173 | 0.862 |
| Advanced age of pregnancy (n, %) | 93 (38.43%) | 67 (38.73%) | 0.004 | 0.951 |
| Chronic hypertension (n, %) | 30 (12.40%) | 20 (11.56%) | 0.067 | 0.796 |
| Hyperlipidemia (n, %) | 102 (42.15%) | 85 (49.13%) | 1.988 | 0.159 |
| Obesity (n, %) | 70 (28.93%) | 57 (32.95%) | 0.769 | 0.381 |
| Assisted reproductive technology (n, %) | 25 (10.33%) | 11 (6.36%) | 2.009 | 0.156 |
| Number of hospitalizations (times) | 1 (1, 2) | 2 (1, 2) | − 2.889 | 0.004 |
| Hospitalization costs (¥) | 7140.23 (4232.41, 9646.40) | 7069.87 (4402.86, 8692.21) | − 0.492 | 0.623 |
Comparison of glycemic control
Further analysis of glycemic management during pregnancy between the two groups of women was presented in Table 2. Owing to 18 pregnant women having only recorded fasting and preprandial blood glucose levels without HbA1c measurements, the comparison of prenatal HbA1c was limited to 397 women. The results showed that the median prenatal HbA1c for women diagnosed during pregnancy was 6.70% (6.10%–7.10%), significantly higher than the 6.20% (5.70%–6.80%) for those diagnosed before pregnancy, with a statistically significant difference (P < 0.001). The risk of hospitalization due to abnormal blood glucose during pregnancy was 22.73% for women diagnosed before pregnancy and 42.77% for those diagnosed during pregnancy, with the difference being statistically significant (P < 0.001). In terms of glycemic management strategies, 80.17% of pregnant women in the diagnosed before pregnancy group used insulin, which was higher than the 69.36% in the diagnosed during pregnancy group. This difference was statistically significant (P < 0.05). However, there were no significant differences in the incidence of diabetes-related complications between the two groups (P > 0.05).
Table 2.
Glycemic control of women in the two groups
| Diagnosed before pregnancy group (n = 242 cases) | Diagnosed during pregnancy group (n = 173 cases) | z value/χ2 value | P value | |
|---|---|---|---|---|
| Prenatal HbA1c (%) |
6.20 (5.70, 6.80) (n = 229) |
6.70 (6.10, 7.10) (n = 168) |
− 4.169 | < 0.001 |
| Insulin utilization (n, %) | 194 (80.17%) | 120 (69.36%) | 6.391 | 0.011 |
| Hospitalization due to abnormal blood glucose | 55(22.73%) | 74(42.77%) | 15.368 | < 0.001 |
| DKA (n, %) | 5 (2.07%) | 6 (3.7%) | 0.755 | 0.385 |
| Diabetic microangiopathy (n, %) | 4 (1.65%) | 1 (0.59%) | 0.284 | 0.594 |
Comparison of maternal outcomes
Further analysis of the impact of the timing of diabetes diagnosis on maternal outcomes was presented in Table 3. The median gestational age at delivery for women diagnosed before pregnancy was 38 weeks (36 + 4 weeks to 38 + 6 weeks), while for those diagnosed during pregnancy, it was 38 + 1 weeks (36 + 3 weeks to 38 + 6 weeks). The difference between the two groups was not statistically significant (P > 0.05). Regarding the risk of spontaneous abortion, the incidence was 4.13% in the women diagnosed before pregnancy, higher than the 1.16% in those diagnosed during pregnancy; however, this difference also did not reach statistical significance. Other adverse outcomes, including preterm birth, stillbirth, and preeclampsia, exhibited similar incidence rates between the two groups, with no statistically significant differences observed (P > 0.05 for all).
Table 3.
Comparison of maternal outcomes of women in the two groups
| Diagnosed before pregnancy group (n = 242 cases) | Diagnosed during pregnancy group (n = 173 cases) | χ2 value | P value | |
|---|---|---|---|---|
| Gestational weeks (w) |
38 + 0 (36 + 4, 38 + 6) (n = 223) |
38 + 1 (36 + 3, 38 + 6) (n = 163) |
− 0.171 | 0.864 |
| Spontaneous abortion (n, %) | 10 (4.13%) | 2 (1.16%) | 3.182 | 0.074 |
| Induced labor (n, %) | 7 (2.89%) | 6 (3.47%) | 0.110 | 0.740 |
| Stillbirth (n, %) | 2 (0.83%) | 2 (1.16%) | 0.115 | 0.735 |
| Vaginal delivery (n, %) |
57 (25.56%) (n = 223) |
45 (27.61%) (n = 163) |
0.329 | 0.566 |
| Cesarean delivery (n, %) |
166 (74.44%) (n = 223) |
118 (72.39%) (n = 163) |
0.007 | 0.933 |
| Premature labor (n, %) | 58 (23.97%) | 44 (25.43%) | 0.117 | 0.732 |
| Gestational hypertension (n, %) | 8 (3.31%) | 8 (4.62%) | 0.473 | 0.492 |
| Preeclampsia (n, %) | 68 (28.10%) | 37 (21.39%) | 2.405 | 0.121 |
| Premature rupture of membranes (n, %) | 51 (21.07%) | 35 (20.23%) | 0.044 | 0.834 |
| Polyhydramnios (n, %) | 7 (2.89%) | 4 (2.31%) | 0.132 | 0.717 |
Comparison of fetal outcomes
Fetal outcomes were detailed in Table 4. Owing to only 386 women having successful deliveries, the analysis of newborn birth weight focused solely on these infants. The median birth weight for newborns of women diagnosed during pregnancy was 3210.0 g (2735.0–3625.0), whereas for those diagnosed before pregnancy, it was 3350.0 g (2750.0–3915.0). Regarding the risk of macrosomia, the incidence among women diagnosed during pregnancy was 20.23%, significantly higher than the 10.74% observed in the group diagnosed before pregnancy, with a statistically significant difference (P = 0.007). However, no statistically significant differences were noted for other fetal outcomes (P > 0.05 for all).
Table 4.
Comparison of fetal outcomes of women in the two groups
| Diagnosed before pregnancy group (n = 242 cases) | Diagnosed during pregnancy group (n = 173 cases) | χ2 value | P value | |
|---|---|---|---|---|
| Birth weight (kg) |
3210.0 (2735.0, 3625.0) (n = 223) |
3350.0 (2750.0, 3915.0) (n = 163) |
− 1.837 | 0.066 |
| Macrosomia (n, %) | 26 (10.74%) | 35 (20.23%) | 7.242 | 0.007 |
| Fetal malformation (n, %) | 35 (14.46%) | 27 (15.61%) | 0.104 | 0.747 |
| Neonatal respiratory distress syndrome (n, %) | 24 (9.92%) | 18 (10.40%) | 0.009 | 0.923 |
| Neonatal transfer (n, %) | 110 (45.45%) | 86 (49.71%) | 0.733 | 0.392 |
| Neonatal hyperbilirubinemia (n, %) | 115 (47.52%) | 88 (50.87%) | 0.452 | 0.501 |
| Neonatal hypoglycemia (n, %) | 13 (5.37%) | 13 (7.51%) | 0.789 | 0.375 |
Discussion
PGDM was a common complication during pregnancy, strongly linked to various adverse maternal and fetal outcomes, posing significant risks to the health and lives of both mothers and infants [3]. Based on the awareness of diabetes before pregnancy, pregnant women were divided into those diagnosed before pregnancy and those diagnosed during pregnancy [12]. However, in China, due to relatively low health awareness among most women of childbearing age, only 1.2% of pregnant women were diagnosed with diabetes before pregnancy [7]. Moreover, the most existing studies had focused on the overall impact of PGDM on outcomes, with fewer examining the specific influence of the timing of diabetes diagnosis on maternal and fetal outcomes. Therefore, this study aimed to focus on the timing of diabetes diagnosis and analyze its potential impact on maternal and fetal outcomes.
This study found that approximately 41.69% of women were not diagnosed with diabetes in a timely manner before pregnancy. Among those diagnosed during pregnancy, the majority (54.34%) were diagnosed between 14 and 27 + 6 weeks of gestation. These women were diagnosed relatively late, which delayed their access to specialized diabetes care and, as a result, negatively impacted their blood glucose management during the preconception and early pregnancy periods. Therefore, there was an urgent need to strengthen diabetes screening and management for women of childbearing age. With China’s rapid economic development, it had become the country with the highest number of diabetes patients globally[24]. The relaxation of national fertility policies had led more women with high-risk factors for diabetes—such as advanced maternal age and obesity—to opt for childbearing, which further increased the risk of PGDM[25]. This study revealed that 38.55%, 15.06%, and 30.60% of women had advanced age, hyperlipidemia, and obesity, respectively. Unhealthy lifestyles, advanced age, and being overweight or obese exacerbated the threat of hyperglycemia to both maternal and fetal health [26–28]. Therefore, preconception diabetes screening for high-risk women should have been prioritized to improve the early diagnosis of diabetes.
This study further revealed that the number of hospitalizations during pregnancy was significantly higher in the group diagnosed during pregnancy compared to the group diagnosed before pregnancy (2 vs. 1, P = 0.004). Further analysis indicated that approximately 42.77% of women in the diagnosed during pregnancy group required hospitalization due to poor glycemic control—a significantly higher proportion than that observed in the diagnosed before pregnancy group (74/173 vs. 55/242, P < 0.001). In addition, the prenatal HbA1c level was significantly higher in the diagnosed during pregnancy group as compared to the diagnosed before pregnancy group (6.70% vs. 6.20%, P < 0.001). These findings suggested that women diagnosed during pregnancy may have suboptimal perinatal glycemic control and an increased risk of metabolic disturbances, which could have contributed to a higher frequency of hospitalizations and elevated healthcare costs. Moreover, approximately 71.33% of PGDM patients had HbA1c levels exceeding the recommended target of < 6.0%, as outlined in national guidelines for the management of hyperglycemia during pregnancy [15], indicating that further improvements in perinatal diabetes management were needed.
The risk of macrosomia was significantly higher in women diagnosed during pregnancy compared to those diagnosed before pregnancy (20.23% vs. 10.74%, P = 0.007). Previous studies showed that inadequate perinatal management (AOR = 8.8, 95% CI: 4.5–13.0) and abnormal perinatal blood glucose levels (AOR = 10.5, 95% CI: 5.9–15.1) were independent predictive factors for the occurrence of macrosomia in pregnant women with PGDM [29]. Women who had undiagnosed diabetes before pregnancy were less able to effectively manage their blood glucose levels during early pregnancy, which increased the risk of adverse maternal and fetal outcomes, such as preterm birth, macrosomia, and other perinatal complications [30–32]. Moreover, previous research found that both preconception diabetes diagnosis and educational attainment were significant factors influencing the implementation of preconception management [33]. A study by Zheng Xueying demonstrated that the educational level of women of childbearing age (OR = 2.282, 95% CI: 1.203–4.331, P = 0.024) and advanced diabetes education (OR = 25.378, 95% CI: 24.887–26.705, P < 0.001) were independent factors associated with the awareness of preconception management among women with T1DM[33, 34]. In the present study, the educational level of women diagnosed before pregnancy was significantly higher than that of women diagnosed during pregnancy (P = 0.002). Women with higher educational levels tended to have a more comprehensive understanding of diabetes, better treatment adherence, and were more likely to achieve optimal perinatal glycemic control [35, 36]. Therefore, underscoring the need for strengthened perinatal diabetes education and management strategies.
However, the study by Shen Lixia reached a contrary conclusion, suggesting that pregnant women diagnosed before pregnancy exhibited more severe glucose metabolism disorders as compared to those diagnosed during pregnancy [37]. This result might have been related to the misdiagnosis of some cases of gestational hyperglycemia as PGDM. A 2022 study found that, due to significant ethnic differences in glucose metabolism, in China, among pregnant women who were diagnosed with PGDM based solely on an OGTT with a 2-h blood glucose value ≥ 11.1 mmol/L, only 10.7% were later confirmed to have diabetes postpartum [38]. Therefore, the 2022 Gestational Hyperglycemia Diagnosis and Treatment Guidelines clarified for the first time that an abnormal OGTT 2-h blood glucose value should no longer be used as a diagnostic criterion for PGDM [12]. The study by Wei Yumei showed that among the women diagnosed based only on an abnormal 2-h OGTT blood glucose value, the rates of adverse maternal and fetal outcomes (such as macrosomia, cesarean section, gestational hypertension, and insulin requirements) were significantly lower as compared to PGDM pregnant women [39]. Therefore, to more accurately assess the impact of PGDM on maternal and fetal outcomes, it was crucial to conduct more in-depth and systematic studies.
This study had several limitations. First, it was a retrospective analysis examining the impact of the timing of diabetes diagnosis on maternal and fetal outcomes. However, 227 cases lacked definitive classification of diabetes type, and some women diagnosed before pregnancy did not receive preconception care or follow-up at our hospital, resulting in missing data on disease duration and treatment history. These issues limited our ability to account for potential sources of bias, such as diabetes type, disease course, and preconception management, which might have affected the accuracy of certain findings. Second, as a single-center retrospective study with a relatively small sample size, the results were not supported by large-scale, multicenter data, which limited their external validity and generalizability.
Conclusion
In summary, approximately half of the women in this study were diagnosed during pregnancy, which emphasized the critical need for improved early detection of diabetes in women of reproductive age. Strengthening preconception diabetes education and expanding screening efforts helped reduce the occurrence of undiagnosed diabetes before pregnancy. Furthermore, when compared with women diagnosed before pregnancy, those diagnosed during pregnancy experienced more severe perinatal glucose metabolism disorders and a higher rate of macrosomia. Early diagnosis and management of diabetes—especially before conception—helped improve perinatal glycemic control, potentially reducing healthcare burdens and the incidence of macrosomia.
Author contributions
All authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by Shuzhen Wu, Lin Li, Wenting Chen, Yuting Xiang, Zhongjun Li and Kaiyan Zhou. The first draft of the manuscript was written by Kaiyan Zhou and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.
Funding
This work was supported by the Guangdong Provincial Basic and Applied Basic Research Fund Project (2022 A1515140168), the Dongguan Science and Technology of Social Development Program (20221800906392), the Research Project of Guangdong Provincial Bureau of Traditional Chinese Medicine (20241342) and the Guangdong Provincial Medical Science and Technology Research Fund Project (C2023114).
Data availability
No datasets were generated or analysed during the current study.
Declarations
Conflict of interests
The authors declare no competing interests.
Ethical statement
This study has received approval from the Medical Ethics Committee of Dongguan People's Hospital (Approval No. KYKT2024-006).
Footnotes
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Kaiyan Zhou and Wenting Chen contributed equally to this work and share first authorship.
Contributor Information
Yuting Xiang, Email: xiangyt@pku.org.cn.
Zhongjun Li, Email: Zhongjun@gdmu.edu.cn.
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Associated Data
This section collects any data citations, data availability statements, or supplementary materials included in this article.
Data Availability Statement
No datasets were generated or analysed during the current study.