Interpretation
Over the past decades, the prevalence of obesity and diabetes mellitus
has increased robustly, and both have become serious health problems
worldwide. 3 According to the International Diabetes
Federation, 1 in 6 live births, approximately 20 million, is affected by
hyperglycemia during pregnancy, with 84% of mothers having gestational
diabetes. 22 Compared to general diabetes, GDM has
more significant clinical implications in that it can influence both
neonates and mothers. Although numerous studies have been conducted on
diagnostic criteria, treatment targets, and prognostic factors, many of
these findings remain controversial.
Several previous reports have investigated the association between the
AUC of the OGTT and pregnancy outcomes. Kim et al. reported that the AUC
for the 100-g OGTT was associated with an increased risk of LGA in GDM.23 Another study from China demonstrated that a higher
AUC for the 75-g OGTT was related to adverse pregnancy outcomes, such as
hypertensive disease and macrosomia. 24 Our study
findings are consistent with these results, demonstrating that
hyperglycemia itself is an important pitfall for adverse perinatal
outcomes though a more meticulous analysis of the OGTT results. It is
also necessary to explain why primary cesarean section (CS) was not
included as an adverse pregnancy outcome in our study. Most of the GDM
patients (85.2%, 219/257) had undergone primary CS because of the
unique situation in Korea, where CS is generally preferred by pregnant
women, and health service accessibility is very high.
We clustered all subjects based on the LPA, presenting specific patterns
such as impaired fasting glucose-like pattern, impaired glucose
tolerance-like pattern, and combined patterns (Fig. 1 ), since
we initially expected the OGTT patterns reflecting the individual
insulin response to play an important role in adverse pregnancy
outcomes. However, we did not find significant associations between OGTT
patterns and pregnancy outcomes. We postulate that hyperglycemia itself
is a matter of substance because the number of abnormal values and AUCs
during the 100-g OGTTs were independent risk factors for adverse
pregnancy outcomes. Moreover, the ORs for three and four abnormal values
in Table 3 slightly decreased after additional adjustment for
treatment-related factors in Model 2, underpinning the importance of
hyperglycemic control and related risk factor management.