Association between neonatal hyperbilirubinemia and hypoglycemia in Chinese women with diabetes during pregnancy and influencing factors
The results of basic maternal characteristics of Chinese women with PID are shown in Table 1. The mean age, height, pregestational BMI, gestational age at delivery, pregnancy, and parity were 31 .24 ((pm)4.36) years, 158.53 ((pm)5.02)cm, 22.37 ((pm)3.17) kg/m238.36 ((pm)1.52) weeks, 2.49 (± 1.56) times and 0.48 ((pm)0.58) times, respectively. The incidence of NH in Chinese women with PID was 5.82% and NHB was 3.65%, with a combined incidence of 0.59% of both.
Univariate analysis of maternal demographic information showed that older, more pregnant pregnant women with heavier prepregnancy weight and higher prepregnancy BMI were more likely to have NH. In clinical variables, NH risk may also be compounded by insulin use, pre-eclampsia, higher 1-h OGTT blood glucose, higher 2-h OGTT blood glucose, and lower gestational age. Among obstetrical factors, cesarean section, pregnancy with scarred uterus, placenta previa, threatened preterm labor (TPTL), fetal distress, abnormal placental morphology, and postpartum hemorrhage were more likely to result in NH. In neonatal outcomes, birth duration, Apgar 1 min ≤ 7, Apgar 10 min ≤ 7, gender (female), macrosomia, neonatal weight, head circumference, asphyxia, neonatal respiratory distress syndrome ( SNDR), pneumonia, hypoxic ischemic encephalopathy (HIE), congenital heart disease, anemia, and hyperbilirubinemia were more likely to develop hypoglycemia in neonates. Data with statistical differences were presented in Table 2.
In the maternal factor, height, parity, age > 35 years, family history of diabetes, BMI greater than 30 kg/m2, pregnancy weight gain, and OGTT fasting glucose had no significant effect on NH. Other complications during pregnancy (PCI, thalassemia during pregnancy, hysteromyoma, anemia during pregnancy, hypothyroidism during pregnancy, viral hepatitis type B, thrombocytopenia during pregnancy, group B streptococcal infection (GBS), gestational hypertension, chorioamnionitis had no significant effect on neonatal hypoglycemia.Of obstetric factors and neonatal outcome, premature rupture of membranes (PROM), Apgar 5 min ≤ 7, oligohydramnios, polyhydramnios, abruption placental, umbilical cord around the neck and fetal growth retardation had no significant difference in the influence of NH (Table S1).
Longer weeks of gestation (OR 0.76, 95% CI 0.68-0.85), 2-h high blood glucose (OR 1.09, 95% CI 1.02-1.16), caesarean section ( OR 2.01, 95% CI 1.58–2.54), fetal distress (OR 1.52, 95% CI 1.13–2.03), abnormal placental morphology (OR 1.55, CI 95% 1.16–2.08), neonatal sex (female) (OR 1.28, 95% CI 1.05–1.57), head circumference (OR 1.25, 95% CI 1.13– 1.39), hypoxic ischemic encephalopathy (OR 7.66, 95% CI 2.20–26.68), congenital heart disease (OR 2.16, 95% CI 1.25–3.73), macrosomia (OR 1 .54, 95% CI 1.05–2.26), and hyperbilirubinemia (OR 1.93, 95% 1.27–2.92) were statistically significant and associated with NH in multivariate analysis. These factors increased the risk of NH (Fig. 1).
The univariate analysis of the independent variables we included, parity, was associated with NHB. Additionally, gestational hypertension, higher OGTT fasting blood glucose, higher 1-h OGTT blood glucose, and higher 2-h OGTT blood glucose were more likely to develop NHB. We performed continuous variable analysis for gestational age, and there were differences in the incidence of NHB between the two (P
In neonatal outcomes, lower neonatal weight, shorter birth duration, Apgar 1 min ≤ 7, and Apgar 10 min ≤ 7 impacted the development of NHB. Newborns with fetal growth restriction, asphyxia, neonatal respiratory distress, sepsis, pneumonia, hypoxic ischemic encephalopathy, congenital heart disease, anemia, or hypoglycemia were more likely to develop BNH. All significant data results have been presented in Tables 2 and S1.
A new risk assessment regression model for NHB was established. Our results showed that 1-h OGTT blood glucose (OR 1.09, 95% CI 1.01-1.86), pregnancy with thalassemia (OR 1.96, 95% CI 1.12-3.42 ), abnormal placental morphology (OR 1.64, 95% CI 1.10-2.45), chorioamnionitis (OR 4.93, 95% CI 2.47–9.85), fetal growth retardation (OR 4.52, 95% CI 2.30–8.45), neonatal pneumonia (OR 2.99, 95% CI 1.65–5.42), congenital heart disease (OR 10.14, 95% CI 6.47 -15.90), asphyxia (OR 2.78, 95% CI 1.21-6.39), sepsis (OR 2.92, 95% CI 1.20-7.09) and hypoglycemia (OR 1.81, 95% CI 1.19-2.76) increased the risk of NHB. Longer weeks of gestation (OR 0.80, 95% CI 0.69-0.92) and increased parities (OR 0.61, 95% CI 0.46-0.81) decreased the incidence of bilirubinemia in newborns (Fig. 2).