Discussion
obesity, obese, fasting blood glucose, hypertension/preeclampsia, macrosomia, prediabetes, Overweight, weight gain, GDM, overweight, Diabetes, overweight or obese, Weight gain, hypertension, diabetes
OBESITY, DIABETES DURING PREGNANCY, INSULIN RESISTANCE, HYPERTENSIVE DISORDER, PRE-DIABETES, FETAL DISTRESS, RECRUITMENT, EARLY PREGNANCY, GDM, DIABETES, OBESE, ANEMIA DURING PREGNANCY, PREMATURE MEMBRANE RUPTURE, COMPLICATIONS, NEONATAL JAUNDICE, CHORIOAMNIONITIS, NEONATAL HYPOGLYCEMIA, PREDIABETES, PREMATURE DELIVERY, DIABETES, HYPERTENSION, PREMATURE RUPTURE OF MEMBRANES, FETAL GROWTH RESTRICTION
Weight gain and obesity are critical risk factors for the development of diabetes. A cross-sectional study including 31 provinces and cities in Mainland China showed that the prevalence rates of diabetes and prediabetes in women of childbearing age in China between 2010 and 2012 were 1.4 and 12.9%, respectively. Meanwhile, incidences of being overweight (BMI 25.0–29.9 kg/mThe one-day outpatient service was implemented to manage patients' weight gain using a science-based diet and proper exercise, to empower patients to effectively control their blood glucose levels, and to reduce maternal and infant-related complications. This study observed the therapeutic effects of attending the one-day outpatient service on participants with GDM who had different pre-pregnancy BMIs. The study also assessed the impacts of different weight-gain levels during gestation on pregnancy-related outcomes.The study findings demonstrated that fasting blood glucose was lowest in the low weight group at enrollment and before delivery but was slightly higher in the normal weight group and highest in the overweight and obesity group. This difference was statistically significant among the three groups, indicating that pre-pregnancy BMI had a crucial impact on the blood glucose of pregnant women, with blood glucose increasing proportionately with an increase in BMI. By implementing the comprehensive management strategies during the one-day outpatient service, fasting blood glucose in all three groups was decreased, suggesting that the outpatient service had a vital impact on controlling blood glucose and protecting patients with GDM and different pre-pregnancy BMIs from pre-diabetes progressing to diabetes.According to the 2020 ADA guidelines for the diagnosis and treatment of diabetes during pregnancy, it is appropriate to set the HbA1C target to < 6%. Following a GDM diagnosis, HbA1C in the three groups was in the normal range; however, the low weight group showed the lowest HbA1C level compared with the normal weight and overweight and obesity groups. The data also showed that changes in blood glucose proportionally increased along with BMI. However, this study found that from enrollment to delivery, the average level of HbA1C increased in all three groups, with no significant difference in the degree of increase among the three groups, and HbA1C was within the normal range. In this case, however, HbA1C reflected only the average blood glucose levels of the previous 2–3 months. Additionally, insulin resistance in pregnant women with GDM was mild during early pregnancy but gradually increased at 24–28 weeks of pregnancy. Following a diagnosis, insulin resistance was steadily aggravated. Furthermore, the 2017 China Diabetes Society guidelines note that HbA1c was often underestimated and had limited value in GDM diagnosis because of increased red blood cell conversion in the second and third trimesters, and because of the effects of anemia during pregnancy.The insulin utilization rate was different among the three groups; the overweight and obesity group showed the highest insulin utilization rates. Among the three groups, the overweight and obesity group presented with the highest blood glucose levels. As a result of the comprehensive management presented in the one-day outpatient service, the blood glucose levels of these participants decreased compared with their initial levels; however, the overweight and obesity group still reported the highest levels of insulin utilization. These findings highlight that an increased BMI corresponds to greater perturbations in blood glucose and subsequently increases the likelihood that insulin will be used as a treatment for controlling blood glucose during pregnancy. Moreover, studies have shown that a pre-pregnancy BMI has a greater impact on insulin resistance than weight gain during pregnancy, with a higher BMI before pregnancy correlating with more severe insulin resistance (In this study, the overweight and obesity group had the highest incidence of gestational hypertension/preeclampsia and neonatal jaundice, indicating that being overweight or obese prior to becoming pregnant may increase the incidence of hypertension and neonatal jaundice in patients with GDM. No significant difference was observed in the rates of premature membrane rupture, premature delivery, polyhydramnios/oligohydramnios, neonatal hypoglycemia, fetal distress, macrosomia, fetal growth restriction, or cesarean section. These findings may have resulted from = improved blood glucose and weight control as a result of attending the one-day outpatient service.In addition, the study results showed that positive (but not excessive) weight gain and normal weight gain were predominant among the three groups, and the differences were not statistically significant. However, the overweight and obesity group had the highest rate of excessive weight gain, and the differences among the three groups were statistically significant. The highest negative weight-gain rate and the no weight-gain rate were observed in the overweight and obesity group, followed by the normal weight group, with the lowest rates found in the low-weight group. These data indicated that excessive weight gain in the overweight and obesity group occurred prior to enrollment, but the weight gain had been well-controlled after comprehensive diabetes outpatient management. Excessive weight gain might occur during pregnancy because of excessive weight gain that occurred prior to enrollment. Excessive weight gain during pregnancy is associated with an increased risk of medication use, hypertensive disorders, cesarean section, gestational age, and macrosomia, compared with normal or no excessive weight gain. Furthermore, low weight gain during pregnancy was shown to have a protective function against macrosomia and did not increase the risk of low birth weight. In pregnant women with GDM, less weight gain than what is recommended is beneficial, but the effective prevention of excessive weight gain is paramount (After recruitment to the one-day outpatient service, some pregnant women evidenced no weight gain, as well as negative weight gain, but only three pregnant women showed negative weight gain during the entire pregnancy period, which was considered to have been related to a high pre-pregnancy BMI and excessive weight gain before a GDM diagnosis. After delivery of the outpatient service, no statistically significant difference was observed in the incidence of hypertension/preeclampsia, premature rupture of membranes, chorioamnionitis, premature delivery, polyhydramnios/oligohydramnios, neonatal jaundice, neonatal hypoglycemia, fetal distress, macrosomia, fetal growth restriction, and cesarean section rate among the participants with a negative, zero, and positive weight gain (Collectively, the current study results showed that the comprehensive one-day outpatient management of DM may control blood glucose and body weight in GDM patients with different pre-pregnancy BMIs. Overweight or obese patients reflected a higher risk of developing gestational hypertension/preeclampsia and neonatal jaundice. Furthermore, these patients had a higher use rate of insulin for controlling blood glucose. Some pregnant women showed negative weight gain, no weight gain, or insufficient weight gain, but these outcomes did not increase the risk of adverse pregnancy outcomes; this may have been due to inappropriate weight gain before or during early pregnancy. Therefore, women of childbearing age should control their weight to ensure they remain within a reasonable weight range before becoming pregnant to reduce the risk of GDM.The current study includes several limitations. First, all of the participants were recruited from the authors' hospital, thus limiting the patient representation. Second, all patient information was collected through the electronic medical records system of the authors' hospital, but, some important measurements were not included. Third, since this had been a cohort study, the authors lost some test information from participants in the mid-phase of the study. Nevertheless, despite these limitations, the authors can confidently assert that the one-day outpatient service presents a promising and effective strategy for improving the current management of women with GDM.