Original research
Maternal hemoglobin and risk of gestational diabetes mellitus in Chinese women

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Abstract

OBJECTIVE:

To examine the relationship between high maternal hemoglobin concentration at the initial antenatal visit and occurrence of gestational diabetes mellitus (GDM) in the third trimester in nonanemic women.

METHODS:

In a prospective observational study, 762 nondiabetic Chinese women with singleton pregnancies, whose initial visit hemoglobin concentration and mean cell volume were 10 g/dL or more and 80 fL or more, respectively, recruited at 28–30 weeks, had blood drawn for repeat measurement of hemoglobin concentration and iron parameters. These women were categorized by their initial visit hemoglobin concentration into quartiles, and the incidence of GDM was analyzed together with the maternal characteristics and iron status.

RESULTS:

The final study sample comprised 730 women. Compared with the rest, the group in the highest hemoglobin quartile (more than 13 g/dL) had a significantly higher incidence of GDM (18.7% versus 10.9%, P = .007), as well as greater age, weight, and serum ferritin and iron concentrations. Logistic regression was used to examine the effects of high body mass index (more than 25 kg/m2), advanced age (older than 34 years), parity of 1 or more, and hemoglobin in the highest quartile, on the incidence of GDM. Only advanced age (odds ratio 3.79, 95% confidence interval 2.33, 6.17) and hemoglobin in the highest quartile (odds ratio 1.73, 95% confidence interval 1.08, 2.78) emerged to be significant factors.

CONCLUSION:

A high maternal hemoglobin (more than 13 g/dL) at the initial prenatal visit in Chinese women is an independent risk factor for GDM. This may reflect a better nutritional status in these women, as suggested by the increased iron status.

Section snippets

Materials and methods

Our hospital is a government-funded regional hospital with about 5000 deliveries per annum, and caters mainly to residents of Hong Kong who do not have to pay for antenatal care. The majority of our patients (more than 95%) is ethnic Chinese. A multivitamin preparation containing 29 mg of elemental iron is offered to all patients from 20 weeks’ gestation, but patients’ compliance is not monitored. At the first antenatal visit, maternal hemoglobin concentration, mean corpuscular volume, and

Results

The records of 865 women attending the clinic consecutively were screened, and 780 women who fulfilled the inclusion criteria were approached for recruitment, of whom 762 consented to be studied. However, the results of the serum ferritin and iron concentrations were not available in 32 women, leaving only 730 women in the final analysis. The 75th, 50th, and 25th percentile values of the initial visit hemoglobin concentration were 13.0 g/dL, 12.4 g/dL, and 11.5 g/dL, respectively, and the

Discussion

The measurement of hemoglobin at the first antenatal visit has become a standard investigation in the pregnant woman. This result could be useful for the identification of women who are at risk not only for complications, such as fetal growth restriction and preterm birth, but also for GDM if the association between high hemoglobin concentration and diabetes mellitus found in the nonpregnant woman can also be demonstrated during pregnancy.

In nonpregnant subjects, the association between high

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  • Cited by (0)

    1

    Present address for Louis Y. Chan, MBBS: Department of Obstetrics and Gynecology, Princess Margaret Hospital, Kowloon, Hong Kong, China.

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