Secular trend of gestational diabetes mellitus and its interaction effect with advance d maternal age on adverse maternal-perinatal outcomes among primiparous singleton and twin pregnancies in Hubei, China (2011-2019)

Nawsherwan ----^1*Hui Li²Yanmei Sun³Ijaz Haq⁴Shafaq Naeem⁵Xiaoqiu Ni⁶

• ¹Xiamen University Affiliated Cardiovascular Hospital, Xiamen, Fujian Province, China
• ²Taixing People's Hospital, Taixing, China
• ³Renmin Hospital of Wuhan University, Wuhan, Hubei Province, China
• ⁴Department of Nursing, Children's Hospital, Fudan University, Shanghai, Shanghai Municipality, China
• ⁵Department of Preventive Medicine, School of Health Sciences, Wuhan University, Wuhan, Hubei Province, China
• ⁶First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang Province, China

Background: Gestational diabetes mellitus (GDM) is a metabolic disorder of pregnancy associated with multiple adverse maternal-perinatal outcomes among singleton and twin pregnancies and its incidence is increasing across the globe. We aimed to find the secular trend of GDM and its interaction effect with advanced maternal age (AMA) on adverse maternal-perinatal outcomes among primiparous singleton and twin pregnancies in Hubei, China. Results: The secular trend of GDM [average annual percentage change (AAPC) 51.3% (95% confidence interval (95%CI): 3.9, 120.5)] significantly increased among singleton pregnant women. Based on age groups, the secular trend of GDM significantly increased in younger women with singleton [AAPC, 53.2% (95%CI: 2.0, 130.0)] and twin gestations [AAPC, 83.7% (95%CI: 36.0, 148.1)] between 2011 and 2019. Among younger women with singleton gestation, GDM showed a higher risk of hypertensive disorders of pregnancy (HDP), C-section, and macrosomia compared with non-GDM. Among younger women with twin gestations, GDM increased the risk of nuchal cord, polyhydramnios, and preterm births. GDM was associated with an increased risk of HDP, nuchal cord, macrosomia, and congenital defects among older women with singleton gestation. The interaction effect between GDM and AMA significantly increased the risk of HDP (adjusted odds ratio (aOR), 2.5; 95% CI: 1.8, 3.6), C-section (aOR, 2.5; 95% CI: 1.9, 3.4), and preterm birth (aOR, 1.5; 95% CI: 1.1, 1.9) among singleton pregnancies. Conclusion: Among younger women with singleton and twin gestations, the secular trend of GDM significantly increased between 2011 and 2019. Among singleton pregnancies, GDM is associated with an increased risk of several adverse maternal-perinatal outcomes in both younger and older women. The interaction effect between GDM and AMA significantly increased the risk of HDP, C-section, and preterm birth among singleton pregnancies.