Unsatisfactory Glucose Management and Adverse Pregnancy Outcomes of Gestational Diabetes Mellitus in the Real World of Clinical Practice: A Retrospective Study.

BACKGROUND: Facing the increasing prevalence of gestational diabetes mellitus (GDM), this study aimed to evaluate the management of GDM and its association with adverse pregnancy outcomes. METHODS: The data of 996 inpatients with GDM who terminated pregnancies in our hospital from January 2011 to December 2015 were collected. Treatments during pregnancy and the last hospital admission before delivery were analyzed. Pregnancy outcomes of the GDM patients were compared with 996 nondiabetic subjects matched by delivery year and gestational age. The association between fasting plasma glucose (FPG) and adverse pregnancy outcomes was examined by logistic regression analyses. RESULTS: The average prevalence of GDM over the 5 years was 4.4% (1330/30,191). Within the GDM patients, 42.8% (426/996) received dietary intervention, whereas 19.1% (190/996) received insulin treatment. Adverse outcomes were more likely to occur in patients with unsatisfactory control of blood glucose such as respiratory distress syndrome (RDS, χ2 = 13.373, P < 0.01). Elevated FPG was identified as an independent risk factor for premature birth (odds ratio [OR] = 1.460, P < 0.001), neonatal care unit admission (OR = 1.284, P < 0.001), RDS (OR = 1.322, P = 0.001), and stillbirth (OR = 1.427, P < 0.001). CONCLUSIONS: Management of GDM in the real world of clinical practice was unsatisfactory, which might have contributed to adverse pregnancy outcomes.

Lifespan Risk Exposure Measurement Instrument: a Feasible and Effective Tool for Life Course Epidemiology Research.

Life course epidemiology should practically illustrate how risk exposures and their dynamic changes influence the occurrence, development and prognosis of chronic diseases from early life to the elderly. This paper develops the lifespan risk exposure measurement instrument (LREMI) in the framework of retrospective study to collect lifestyle, diet, physical activity information across subjects'life courses from 18-years-old to current age. Through a pilot study, the result of the test-retest analysis demonstrated the reliability of LREMI. In Shandong Multicenter Cohort, the LREMI showed its feasibility, for it could measure the exposure spectrum on both individuals and population with different life experiences. Moreover, it had good differentiation ability for identifying cases versus controls in population-based case-control study. However, further studies should be conducted in an already available prospective cohort to ascertain that our results could match prospective data.