Application of glycemic qualification rate based on fingerstick glucose monitoring in women with gestational diabetes mellitus

Figures & data

Table 1. Basic characteristics of patients with GDM.

	Total (n = 311)	Tertile 1 (GQR < 56.25%, n = 101)	Tertile 2 (56.25 ≤ GQR < 75%, n = 92)	Tertile 3 (GQR ≥ 75%, n = 118)	p
Age (years), median (IQR)	34.0 (31.0–37.0)	34.0 (32.0–37.0)	34.5 (30.0–37.0)	33.0 (30.0–38.0)	.233
Age ≥ 35, n (%)	143/311 (45.8%)	50/101 (49.5%)	46/92 (50.0%)	47/118 (39.8%)	.250
Gestational age at data collection (weeks), median (IQR)	32.86 (30–35.14)	32.86 (30–34.14)	31.93 (29.39–34.29)	33.86 (30.46–36.29)	.077
Primiparous, n (%)	147/311 (47.3%)	37/101 (36.6%)	39/92 (42.4%)	72/118 (60.2%)	.001*
FPG (mmol/L), mean (SD)	4.77 ± 0.62	4.99 ± 0.73	4.76 ± 0.52	4.56 ± 0.50	.000*
OGTT 1 h (mmol/L), mean (SD)	9.95 ± 1.37	9.84 ± 1.52	9.92 ± 1.40	10.09 ± 1.19	.366
OGTT 2 h (mmol/L), mean (SD)	8.82 ± 1.19	8.68 ± 1.26	8.89 ± 1.16	8.86 ± 1.16	.522
HbA1c (%), median (IQR)	5.1 (4.9–5.3)	5.2 (5.0–5.4)	5.1 (4.9–5.4)	5.1 (4.9–5.3)	.207
Pre-pregnancy BMI (kg/m^2), median (IQR)	22.34 (20.04–24.60)	22.49 (20.28–24.65)	22.44 (20.61–24.59)	22.21 (19.66–24.59)	.670
Pre-pregnancy BMI category, n (%)					.580
˂18.5	32/311 (10.3%)	6/101 (5.9%)	10/92 (10.9%)	16 (13.6%)
18.5–24	179/311 (57.6%)	63 (61.8%)	52 (56.5%)	59 (54.2%)
24–28	82/311 (26.4%)	28 (27.5%)	25 (27.2%)	29 (24.6%)
≥28	19/311 (6.1%)	5 (4.9%)	5 (5.4%)	9 (7.6%)
Smoking habits of spouse, n (%)	35/311 (11.3%)	10/101 (9.8%)	12/92 (13.0%)	13/118 (11.0%)	.772
History of GDM	34/311 (10.9%)	13/101 (12.7%)	14/92 (15.2%)	7/118 (5.9%)	.078
Family history of diabetes, n (%)	59/311 (19.0%)	18/101 (17.6%)	18/92 (19.6%)	23/118 (19.5%)	.924
Systolic blood pressure (mmHg), mean (SD)	113.3 ± 11.34	114.7 ± 12.0	112.3 ± 10.6	113.0 ± 11.3	.302
Diastolic blood pressure (mmHg), mean (SD)	70.7 ± 8.28	70.3 ± 8.6	70.4 ± 7.6	71.2 ± 8.6	.671
Insulin use, n (%)	31/311 (10.0%)	21/101 (20.8%)	7/92 (7.6%)	3/115 (2.5%)	.000*

^* p < .05.

Table 2. Maternal and neonatal outcomes of patients.

	Tertile 1 (GQR < 56.25%, n = 101)	Tertile 2 (56.25 ≤ GQR < 75%, n = 92)	Tertile 3 (GQR ≥ 75%, n = 118)	p
Maternal outcomes
Cesarean section, n (%)	62/101 (61.4%)	54/92 (58.7%)	53/118 (44.9%)	.031*
Polyhydramnios, n (%)	5/101 (5.0%)	6/92 (6.5%)	2/118 (1.7%)	.221
Gestational hypertension, n (%)	7/101 (6.9%)	4/92 (4.3%)	8/118 (6.8%)	.702
Pre-eclampsia, n (%)	7/101 (6.9%)	4/92 (4.3%)	1/118 (0.8%)	.055
Maternal composite outcomes	66/101(65.3%)	56/92(60.9%)	55/118 (46.6%)	.013*
Neonatal outcomes
Miscarriage and intrauterine fetal death, n (%)	5/101 (5.0%)	6/92 (6.5%)	3/118 (2.5%)	.404
Gestational age at delivery (weeks), median (IQR)	38.43 (37.29–39.14)	38.43 (36.86–39.00)	38.64 (37.96–39.43)	.363
Preterm birth, n (%)	16/96 (16.7%)	18/86 (20.9%)	11/115 (9.6%)	.074
Birthweight (kg)	3.08 ± 0.55	3.01 ± 0.48	3.02 ± 0.42	.567
Low birth weight, n (%)	12/96 (12.5%)	11/86 (12.8%)	11/115 (9.6%)	.719
SGA, n (%)	8/96 (8.3%)	9/86 (10.5%)	21/115 (18.3%)	.074
LGA, n (%)	4/96 (4.2%)	3/86 (3.5%)	1/115 (0.9%)	.278
Macrosomia, n (%)	4/96 (4.2%)	2/86 (2.3%)	1/115 (0.9%)	.343
Neonatal hypoglycemia, n (%)	19/96 (19.8%)	16/86 (18.6%)	10/115 (8.7%)	.047*
Fetal distress, n (%)	18/96 (18.8%)	12/86 (14.0%)	23/115 (20.0%)	.520
Fetal growth restriction, n (%)	10/101 (9.9%)	5/92 (5.4%)	6/118 (5.1%)	.322
ARDS, n (%)	8/96 (8.2%)	6/86 (7.0%)	4/115 (3.5%)	.325
Abnormal Apgar 1 min (<8), n (%)	6/96 (6.3%)	5/86 (5.8%)	5/115 (4.3%)	.813
Apgar 1 min (<10), n (%)	21/96 (21.9%)	11/86 (12.8%)	13/115 (11.3%)	.079
Transfer treatment to neonate department, n (%)	34/96 (35.4%)	21/86 (24.4%)	28/115 (24.3%)	.140
Neonatal composite outcomes	54/101 (53.5%)	45/92 (48.9%)	39/118 (33.1%)	.006*

ARDS: acute respiratory distress syndrome.

The data are presented as the mean (SD) or median (IQR) as appropriate. The maternal composite outcome comprised of at least one of the following outcomes: pre-eclampsia, cesarean section, and polyhydramnios. The neonatal composite outcome comprised of at least one of the following outcomes: preterm birth, LGA infant, macrosomia, neonatal hypoglycemia, transfer treatment to neonate department, miscarriage and intrauterine death.

* p < .05.

Table 3. Odds ratios from different levels of glycemic qualification rate for adverse pregnancy outcomes.

		Tertile 1 (GQR < 56.25%)		Tertile 2 (56.25 ≤ GQR < 75%)		Tertile 3 (GQR ≥ 75%)
		OR (95% CI)	p Value	OR (95% CI)	p Value	OR (reference)
Cesarean section	Crude	2.050 (1.195–3.518)	.009*	1.804 (1.039–3.131)	.036*	1.00
	Model 1	2.029 (1.128–3.648)	.018*	1.858 (1.024–3.372)	.041*	1.00
	Model 2	1.882 (0.999–3.544)	.049*	1.631 (0.897–2.966)	.055	1.00
	Model 3	2.141 (1.223–3.748)	.008*	1.850 (1.049–3.262)	.034*	1.00
Neonatal hypoglycemia	Crude	2.558 (1.127–5.806)	.025*	2.400 (1.030–5.593)	.043*	1.00
	Model 1	2.498 (1.082–5.766)	.032*	2.382 (1.012–5.604)	.047*	1.00
	Model 2	2.919 (1.249–6.826)	.013*	2.487 (1.058–5.848)	.037*	1.00
	Model 3	2.556 (1.104–5.920)	.029*	2.425 (1.028–5.720)	.043*	1.00
APGAR 1 min < 10	Crude	2.372 (1.100–5.116)	.028*	1.392 (0.592–3.270)	.448	1.00
	Model 1	2.657 (1.201–5.878)	.016*	1.500 (0.632–3.557)	.358	1.00
	Model 2	2.412 (1.072–5.424)	.033*	1.427 (0.601–3.386)	.420	1.00
	Model 3	2.286 (1.035–5.050)	.041*	1.396 (0.565–3.204)	.502	1.00
Maternal composite outcomes	Crude	2.160 (1.250–3.731)	.006*	1.782 (1.025–3.099)	.041*	1.00
	Model 1	2.145 (1.180–3.897)	.012*	1.836 (1.009–3.340)	.046*	1.00
	Model 2	1.819 (1.018–3.250)	.043*	1.710 (0.973–3.004)	.062	1.00
	Model 3	2.179 (1.238–3.835)	.007*	1.795 (1.019–3.163)	.043*	1.00
Neonatal composite outcomes	Crude	2.327 (1.346–4.025)	.003*	1.939 (1.107–3.397)	.021*	1.00
	Model 1	2.389 (1.363–4.186)	.002*	1.975 (1.120–3.481)	.019*	1.00
	Model 2	3.035 (1.676–5.496)	.000*	2.100 (1.187–3.714)	.011*	1.00
	Model 3	2.225 (1.271–3.897)	.005*	1.920 (1.088–3.390)	.024*	1.00

The OR was calculated by logistic regression analysis. Model 1 adjusted for age, BMI before pregnancy and parity (primipara or multipara). Model 2 adjusted for OGTT 0 min, 1 h and 2 h (normal or abnormal) and insulin use. Model 3 adjusted for history of GDM, family history of diabetes and smoking habits of spouse.

* p < .05.

Figure 1. ROC curves. (a) ROC curve of GQR, HbA1c, and fasting BG during the OGTT for predicting the diagnosis of neonatal hypoglycemia. (b) ROC curve of GQR, HbA1c, and fasting BG during the OGTT for predicting the diagnosis of neonatal composite outcomes. AUC: area under the ROC curve.

Data availability statement

All data generated and analyzed in this study are included in this published article. The datasets are available from the corresponding author on reasonable request.