Quantitative assessment of the effect of pre-gestational diabetes and risk of adverse maternal, perinatal and neonatal outcomes

// Lei Yu 1, * , Xiao-Ling Zeng 1, 2, * , Ming-Liang Cheng 3 , Guo-Zhen Yang 1 , Bi Wang 1, 4 , Zi-Wen Xiao 1 , Xin Luo 2 , Bao-Fang Zhang 3 , De-Wei Xiao 4 , Shuai Zhang 5 , Hua-Juan Liu 3 , Ya-Xin Hu 3 , Hou-Kang Lei 1 , Qin-Fen Li 1 and Zheng-Rong Wang 1 1 Prenatal Diagnosis Center, Hospital Affiliated to Guizhou Medical University, Guiyang 550004, Guizhou, China 2 The First Affiliated Hospital of Jinan University, Guangdong 510632, Guangzhou, China 3 Department of Infectious Diseases, Hospital Affiliated to Guizhou Medical University, Guiyang 550004, Guizhou, China 4 Department of Eugenics and Genetics, Guiyang Maternal and Child Health-Care Hospital, Guiyang 550003, Guizhou, China 5 Department of Interventional Radiology, Cancer Hospital of Guizhou Medical University, Guiyang 550004, Guizhou, China * These authors have contributed equally to this work Correspondence to: Ming-Liang Cheng, email: gmcmingliang_cheng@163.com Guo-Zhen Yang, email: gmcguozhen_yang@163.com Keywords: pre-gestational diabetes, adverse pregnancy outcomes, risk, meta-analysis Received: February 21, 2017      Accepted: April 05, 2017      Published: May 11, 2017 ABSTRACT Pregnancies complicated by pre-gestational diabetes (PGD) are associated with a higher rate of adverse outcomes, including an increased rage of preterm delivery, pregnancy-induced hypertension, pre-eclampsia, caesarean section, perinatal mortality, stillbirth, shoulder dystocia, macrosomia, small for gestational age, large for gestational age, low birth weight, neonatal hypoglycemia, neonatal death, low Apgar score, NICU admission, jaundice and respiratory distress. In the past two decades, numerous reports have been published regarding associations between PGD and risk of adverse outcomes. However, study results are inconsistent. To provide a synopsis of the current understanding of PGD for risk of adverse pregnancy outcomes, a random-effects meta-analysis over 40 million subjects from 100 studies was performed to calculate the pooled ORs. Potential sources of heterogeneity were systematically explored by multiple strata analyses and meta-regression. Overall, PGD were significantly associated with increased risk of preterm delivery (OR=3.48), LGA (OR=3.90), perinatal mortality (OR=3.39), stillbirth (OR=3.52), pre-eclampsia (OR=3.48), caesarean section (OR=3.52), NICU admission (OR=3.92), and neonatal hypoglycemia (OR=26.62). Significant results were also observed for 7 adverse outcomes with OR range from 1.54 to 2.82, while no association was found for SGA and respiratory distress after Bonferroni correction. We found that women with T1DM had higher risks for most of adverse pregnancy outcomes compared with women with T2DM. When stratified by study design, sample size, type of diabetes, geographic region, and study quality, significant associations remains. Our findings demonstrated that PGD is a strong risk-conferring factor for adverse maternal, perinatal and neonatal outcomes.