Table 2.
Relationship between maternal GDM status (no GDM, GDM diagnosed based on IADPSG criteria, and GDM based on CC criteria) and outcomes in the HAPO North American cohort
| Outcome | Participants in category, n | Participants in category with the outcome | Model I |
Model II |
|||
|---|---|---|---|---|---|---|---|
| n | % | OR | 95% CI | OR | 95% CI | ||
| Birth weight >90th percentile* | |||||||
| No GDM | 5,303 | 394 | (7.9) | 1.00 | 1.00 | ||
| GDM diagnosed based on IADPSG criteria | 877 | 134 | (15.3) | 2.11 | 1.71–2.60 | 1.87 | 1.50–2.34 |
| GDM based on CC | 260 | 50 | (19.2) | 2.79 | 2.01–3.86 | 2.56 | 1.82–3.61 |
| Total | 6,140 | 578 | (9.4) | ||||
| Cord C-peptide >90th percentile† | |||||||
| No GDM | 4,204 | 252 | (6.0) | 1.00 | 1.00 | ||
| GDM diagnosed based on IADPSG | 758 | 110 | (14.5) | 2.57 | 2.02–3.27 | 2.00 | 1.54–2.58 |
| GDM based on CC | 221 | 48 | (11.0) | 4.30 | 3.04–6.07 | 2.93 | 2.01–4.27 |
| Total | 5,183 | 410 | (21.7) | ||||
| Newborn percentage body fat >90th percentile‡ | |||||||
| No GDM | 3,775 | 306 | (8.1) | 1.00 | |||
| GDM diagnosed based on IADPSG | 659 | 101 | (15.3) | 2.05 | 1.61–2.60 | 1.73 | 1.35–2.23 |
| GDM based on CC | 189 | 34 | (18.0) | 2.49 | 1.69–3.67 | 2.08 | 1.39–3.12 |
| Total | 4,623 | 441 | (9.5) | ||||
| Primary cesarean delivery§ | |||||||
| No GDM | 4,441 | 764 | (17.2) | 1.00 | 1.00 | ||
| GDM diagnosed based on IADPSG | 728 | 174 | (23.9) | 1.65 | 1.36–1.99 | 1.31 | 1.07–1.60 |
| GDM based on CC | 224 | 68 | (30.4) | 2.21 | 1.64–2.98 | 1.59 | 1.17–2.18 |
| Total | 5,393 | 1,006 | (18.7) | ||||
| Neonatal hypoglycemia‖ | |||||||
| No GDM | 5,006 | 67 | (1.3) | 1.00 | 1.00 | ||
| GDM diagnosed based on IADPSG | 875 | 25 | (2.9) | 2.66 | 1.66–4.27 | 2.11 | 1.28–3.49 |
| GDM based on CC | 260 | 8 | (3.1) | 2.81 | 1.32–5.99 | 1.90 | 0.86–4.19 |
| Total | 6,141 | 100 | (1.6) | ||||
| Newborn sum of skinfolds >90th percentile‡ | |||||||
| No GDM | 3,832 | 291 | (7.6) | 1.00 | |||
| GDM diagnosed based on IADPSG | 673 | 109 | (16.2) | 2.35 | 1.85–2.98 | 2.00 | 1.56–2.57 |
| GDM based on CC | 193 | 38 | (19.7) | 2.98 | 2.05–4.34 | 2.53 | 1.71–3.74 |
| Total | 4,698 | 438 | (9.3) | ||||
| Preeclampsia¶ | |||||||
| No GDM | 4,420 | 285 | (6.4) | 1.00 | |||
| GDM diagnosed based on IADPSG | 732 | 109 | (14.9) | 2.24 | 1.75–2.86 | 1.73 | 1.32–2.27 |
| GDM based on CC | 200 | 28 | (14.0) | 2.27 | 1.47–3.49 | 1.79 | 1.12–2.87 |
| Total | 5,352 | 422 | (7.9) | ||||
| Preterm delivery (<37 weeks)# | |||||||
| No GDM | 5,020 | 301 | (6.0) | 1.00 | |||
| GDM diagnosed based on IADPSG | 878 | 68 | (7.7) | 1.32 | 1.00–1.74 | 1.22 | 0.91–1.64 |
| GDM based on CC | 261 | 36 | (13.8) | 2.51 | 1.73–3.65 | 2.37 | 1.60–3.52 |
| Total | 6,159 | 405 | (6.6) | ||||
| Shoulder dystocia or birth injury# | |||||||
| No GDM | 5,006 | 92 | (1.8) | 1.00 | 1.00 | ||
| GDM diagnosed based on IADPSG | 875 | 26 | (3.0) | 1.50 | 0.96–2.34 | 1.38 | 0.87–2.19 |
| GDM based on CC | 260 | 6 | (2.3) | 1.19 | 0.52–2.76 | 1.15 | 0.49–2.70 |
| Total | 6,141 | 124 | (2.0) | ||||
| NICU admission** | |||||||
| No GDM | 5,006 | 313 | (6.3) | 1.00 | |||
| GDM diagnosed based on IADPSG | 875 | 71 | (8.1) | 1.22 | 0.93–1.60 | 1.07 | 0.81–1.43 |
| GDM based on CC | 260 | 25 | (9.6) | 1.49 | 0.97–2.29 | 1.32 | 0.84–2.06 |
| Total | 6,141 | 409 | (6.7) | ||||
| Hyperbilirubinemia†† | |||||||
| No GDM | 5,006 | 249 | (5.0) | 1.00 | |||
| GDM diagnosed based on IADPSG | 875 | 57 | (6.5) | 1.47 | 1.09–1.98 | 1.31 | 0.95–1.79 |
| GDM based on CC | 260 | 22 | (8.5) | 1.88 | 1.19–2.98 | 1.67 | 1.03–2.69 |
| Total | 6,141 | 328 | (5.3) | ||||
*The 90th percentile for gestational age (30–44 weeks only) was determined using quantile regression analyses for each of eight newborn sex-ethnic groups (Caucasian or other, black, Hispanic, Asian), with adjustment for gestational age, field center, and parity (0, 1, ≥2). A newborn was considered to have a birth weight above the 90th percentile if the birth weight was greater than the estimated 90th percentile for the baby’s sex, gestational age, ethnicity, field center, and maternal parity. Otherwise the newborn was considered to have a birth weight at or below the 90th percentile. Model I: Adjusted for the variables used in estimating 90th percentiles. Model II: Model I adjustment plus age, height, BMI, and gestational age at the OGTT; smoking; alcohol use; hospitalization before delivery; family history of diabetes; and mean arterial pressure.
†The 90th percentile of the values for the total HAPO sample. Model I: Adjusted for field center. Model II: Model I adjustment plus age, height, BMI, and gestational age at OGTT; smoking; alcohol use; hospitalization before delivery; family history of diabetes; parity; and baby’s sex, mean arterial pressure, and cord glucose.
‡Defined based on sex, ethnicity, field center, gestational age (36–44 weeks), and parity using quantile regression analysis. Model I: Adjusted for the variables used in estimating 90th percentiles. Model II: Model I adjustment plus age, height, BMI, and gestational age at OGTT; smoking; alcohol use; hospitalization before delivery; family history of diabetes; and mean arterial pressure.
§Model I: Adjusted for field center. Model II: Model I adjustment plus age, height, BMI, and gestational age at the OGTT; smoking; alcohol use; hospitalization before delivery; family history of diabetes; baby’s sex, and mean arterial pressure.
‖Clinical neonatal hypoglycemia was defined as present if there was a notation of neonatal hypoglycemia in the medical record and there were symptoms and/or treatment with a glucose infusion or a local laboratory report of a glucose value ≤1.7 mmol/L in the first 24 h and/or ≤2.5 mmol/L after the first 24 h after birth. Models I and II adjusted for the same variables as cord C-peptide >90th percentile, except for cord glucose in Model II.
¶Preeclampsia was defined as systolic blood pressure ≥140 mmHG or diastolic blood pressure ≥90 mmHG on two or more occasions a minimum of 6 h apart and proteinuria of ≥1+ on a dipstick test or a protein level in the urine ≥300 mg within a 24-h period. If the criteria for elevated blood pressure were met but those for proteinuria were not, the hypertension was classified as gestational hypertension. Model I: Adjusted for field center. Model II: Model I adjustment plus age, height, BMI, and gestational age at the OGTT; smoking; alcohol use; family history of diabetes; family history of high blood pressure; parity; baby’s sex; and maternal urinary tract infection.
#Models I and II adjusted for the same variables as the models for neonatal hypoglycemia.
**Intensive neonatal care was defined by admission to any type of unit for care more intensive than normal newborn care and lasting more than 24 h or by death of the baby or transfer to another hospital. Data were excluded for admissions that were only for possible sepsis or sepsis, observation, or feeding problems. Models I and II adjusted for the same variables as neonatal hypoglycemia.
††Hyperbilirubinemia was defined by treatment with phototherapy after birth, at least one laboratory report of a bilirubin level ≥20 mg/dL (342 μmol/L), or readmission for hyperbilirubinemia. Models I and II adjusted for the same variables as neonatal hypoglycemia.
OR, odds ratio.