Effect of continuous positive urine ketone body on clinical outcomes of pregnant women with gestational diabetes mellitus and newborn

doi:10.3969/j.issn.1674-8115.2023.03.007

Abstract

Abstract:

Objective ·To explore the effect of continuous positive urine ketone body in pregnant women with gestational diabetes mellitus (GDM) on the maternal and infant outcomes. Methods ·A total of 168 GDM pregnant women who attended the Nutrition Clinic of the International Peace Maternal & Child Health Hospital, Shanghai Jiao Tong University School of Medicine from January 2021 to January 2022 and gave birth in the hospital were selected as the study subjects. According to the difference of urine ketone body test results in prenatal examination, they were divided into ketone body-positive group (56 cases, the pregnant women had ketone body test positive for three times or more after the diagnosis of GDM) and ketone body-negative group (112 cases, the ketone body test was continuously negative after the diagnosis of GDM). The general information included clinical data and laboratory indicators of pregnant women and clinical outcomes of pregnant women and their newborns were collected and compared. Results ·There were no statistically significant differences in clinical data and laboratory indicators of pregnant women between the two groups, among which the body mass index before pregnancy, weight change before diagnosis of GDM, family history of diabetes mellitus, history of GDM, total cholesterol and triacylglycerol levels in the early pregnancy, fasting blood glucose and insulin levels in the middle pregnancy had no significant correlation with the production of urine ketone body. The results of clinical outcome indicators of pregnant women showed that there were statistically significant differences in weight change (P=0.000; RR=6.000, 95% CI 1.251?28.777) and rate of weight gain (P=0.000; RR=1.829, 95% CI 1.132?2.953) after diagnosis of GDM between the two groups. The results of neonatal clinical outcome indicators showed that there was statistically significant difference in the neonatal hospitalization rate (P=0.023; RR=2.167, 95% CI 1.059?4.434) between the two groups; among them, there were 4 adverse events in the ketone body positive group and no such adverse events in the ketone body negative group. Conclusion ·The continuous positive urine ketone body of pregnant women with GDM may increase the risk of insufficient weight gain in pregnant women and neonatal hospitalization. It is recommended to timely detect and intervene in clinical practice.

Key words: gestational diabetes mellitus (GDM), ketone body, neonatal outcome, pregnant women's outcome

CLC Number:

R459.3

ZHANG Yue, QU Lei, GU Qin, ZHU Yiqing, MA Liying, SUN Wenguang. Effect of continuous positive urine ketone body on clinical outcomes of pregnant women with gestational diabetes mellitus and newborn[J]. Journal of Shanghai Jiao Tong University (Medical Science), 2023, 43(3): 314-319.

Figures/Tables 4

TrendMD

References 17

1	LAFFEL L. Ketone bodies: a review of physiology, pathophysiology and application of monitoring to diabetes[J]. Diabetes Metab Res Rev, 1999, 15(6): 412-426.
2	American Diabetes Association. 14. management of diabetes in pregnancy: Standards of Medical Care in Diabetes-2021[J]. Diabetes Care, 2021, 44(Suppl 1): S200-S210.
3	BAZ B, RIVELINE J P, GAUTIER J F. Endocrinology of Pregnancy: gestational diabetes mellitus: definition, aetiological and clinical aspects[J]. Eur J Endocrinol, 2016, 174(2): R43-R51.
4	QIAN M C, WU N, LI L, et al. Effect of elevated ketone body on maternal and infant outcome of pregnant women with abnormal glucose metabolism during pregnancy[J]. Diabetes Metab Syndr Obes, 2020, 13: 4581-4588.
5	中华医学会妇产科学分会产科学组, 中华医学会围产医学分会, 中国妇幼保健协会妊娠合并糖尿病专业委员会. 妊娠期高血糖诊治指南(2022)[第一部分][J]. 中华妇产科杂志, 2022, 57(1): 3-12.
	Obstetrics Group on Society of Gynaecology and Obstetrics of Chinese Medical Association, Society of Perinatal Medicine of Chinese Medical Association, Professional Committee of Diabetes in Pregnancy of China Meternal and Child Health Association. Guidelines for diagnosis and treatment of hyperglycemia in pregnancy (2022) [Part 1][J]. Chin J Obstet Gynecol, 2022, 57(1): 3-12.
6	中华医学会妇产科学分会产科学组, 中华医学会围产医学分会妊娠合并糖尿病协作组. 妊娠合并糖尿病诊治指南(2014)[J]. 中华妇产科杂志, 2014, 49(8): 561-569.
	Obstetrics Group on Society of Gynaecology and Obstetrics of Chinese Medical Association, Collaborative Group of Diabetes in Pregnancy on Society of Perinatal Medicine of Chinese Medical Association. Guidelines for diagnosis and treatment of diabetes in pregnancy(2014)[J]. Chin J Obstet Gynecol, 2014, 49(8): 561-569.
7	HUANG S Y, YU B, HE X, et al. Intrapartum results on differing degrees of ketonuria in nulliparous women with gestational diabetes mellitus during spontaneous labor[J]. Int J Endocrinol, 2019, 2019: 7207012.
8	VASILE F C, PREDA A, ȘTEFAN A G, et al. An update of medical nutrition therapy in gestational diabetes mellitus[J]. J Diabetes Res, 2021, 2021: 5266919.
9	BARBOUR L A, HERNANDEZ T L. Maternal lipids and fetal overgrowth: making fat from fat[J]. Clin Ther, 2018, 40(10): 1638-1647.
10	KAPUR K, KAPUR A, HOD M. Nutrition management of gestational diabetes mellitus[J]. Ann Nutr Metab, 2021: 1-13.
11	中国营养学会. 中国妇女妊娠期体重监测与评价[EB/OL]. (2021-9-1)[2022-10-25]. https://www.cnsoc.org/otherNotice/39210 0200.html.
	Chinese Nutrition Society. Weight monitoring and evaluation during pregnancy period of Chinese women[EB/OL]. (2021-09-01) [2022-10-25]. https://www.cnsoc.org/otherNotice/392100200.html.
12	SPANOU L, DALAKLEIDI K, ZARKOGIANNI K, et al. Ketonemia and ketonuria in gestational diabetes mellitus[J]. Hormones (Athens), 2015, 14(4): 644-650.
13	GOLDSTEIN R F, ABELL S K, RANASINHA S, et al. Association of gestational weight gain with maternal and infant outcomes: a systematic review and meta-analysis[J]. JAMA, 2017, 317(21): 2207-2225.
14	MALIN G L, MORRIS R K, KHAN K S. Strength of association between umbilical cord pH and perinatal and long term outcomes: systematic review and meta-analysis[J]. BMJ, 2010, 340: c1471.
15	GERNAND A D, SCHULZE K J, STEWART C P, et al. Micronutrient deficiencies in pregnancy worldwide: health effects and prevention[J]. Nat Rev Endocrinol, 2016, 12(5): 274-289.
16	毛郑霞, 张红飞, 包正荣, 等. 妊娠期糖尿病孕妇分娩前糖化血红蛋白与新生儿血糖及出生体重的相关性分析[J]. 中华糖尿病杂志, 2022, 14(1): 38-42.
	MAO Z X, ZHANG H F, BAO Z R, et al. Association between maternal glycated hemoglobin A1c before delivery in gestational diabetes mellitus pregnancies and neonatal blood glucose and birth weight[J]. Chin J Diabetes Mellitus, 2022, 14(1): 38-42.
17	SHARMA A, DAVIS A, SHEKHAWAT P S. Hypoglycemia in the preterm neonate: etiopathogenesis, diagnosis, management and long-term outcomes[J]. Transl Pediatr, 2017, 6(4): 335-348.

Item	Ketone body-positive group (n=56)	Ketone body-negative group (n=112)	χ² /t/U value	P value
Height/cm	160 (158, 163)	162 (159, 166)	3 690.500	0.061
Pro-gestational weight/kg	55 (51, 61)	57 (51, 61)	3 208.000	0.808
Pro-gestational BMI/(kg·cm^-2)	21.5 (20.0, 23.4)	21.1 (19.6, 23.2)	3 044.000	0.757
Weight change before diagnosis of GDM/kg	8.53±3.36	7.89±2.95	1.223	0.224
Family history of DM/n (%)	9 (16.1)	19 (17.0)	0.021	0.884
History of GDM/n (%)	3 (5.4)	4 (3.6)	0.019	0.891
Early pregnancy/(mmol·L^-1)
TC	4.45±0.75	4.46±0.70	0.048	0.962
TAG	1.34 (1.00, 1.63)	1.32 (1.02, 1.71)	3 203.000	0.822
HDL-C	1.80 (1.54, 2.15)	1.84 (1.63, 2.12)	3 320.000	0.536
LDL-C	2.49±0.60	2.46±0.57	0.343	0.732
Middle pregnancy
HbA1c/%	5.29±0.26	5.32±0.25	0.959	0.339
0 h OGTT/(mmol·L^-1)	4.81±0.52	4.70±0.50	1.256	0.211
1 h OGTT/(mmol·L^-1)	9.97±1.32	9.90±1.28	0.325	0.745
2 h OGTT/(mmol·L^-1)	8.32±1.35	8.32±1.26	0.002	0.998
0 h INS/(mU·L^-1)	6.85 (4.90, 10.30)	6.80 (4.83, 9.50)	3 006.500	0.663
1 h INS/(mU·L^-1)	56.55 (40.20, 73.70)	64.85 (48.05, 87.83)	3 706.000	0.055
2 h INS/(mU·L^-1)	59.85 (42.93, 88.75)	58.10 (40.80, 87.15)	3 128.500	0.980

Item	Ketone body-positive group (n=56)	Ketone body-negative group (n=112)	χ² /t/U value	P value
Height/cm	160 (158, 163)	162 (159, 166)	3 690.500	0.061
Pro-gestational weight/kg	55 (51, 61)	57 (51, 61)	3 208.000	0.808
Pro-gestational BMI/(kg·cm^-2)	21.5 (20.0, 23.4)	21.1 (19.6, 23.2)	3 044.000	0.757
Weight change before diagnosis of GDM/kg	8.53±3.36	7.89±2.95	1.223	0.224
Family history of DM/n (%)	9 (16.1)	19 (17.0)	0.021	0.884
History of GDM/n (%)	3 (5.4)	4 (3.6)	0.019	0.891
Early pregnancy/(mmol·L^-1)
TC	4.45±0.75	4.46±0.70	0.048	0.962
TAG	1.34 (1.00, 1.63)	1.32 (1.02, 1.71)	3 203.000	0.822
HDL-C	1.80 (1.54, 2.15)	1.84 (1.63, 2.12)	3 320.000	0.536
LDL-C	2.49±0.60	2.46±0.57	0.343	0.732
Middle pregnancy
HbA1c/%	5.29±0.26	5.32±0.25	0.959	0.339
0 h OGTT/(mmol·L^-1)	4.81±0.52	4.70±0.50	1.256	0.211
1 h OGTT/(mmol·L^-1)	9.97±1.32	9.90±1.28	0.325	0.745
2 h OGTT/(mmol·L^-1)	8.32±1.35	8.32±1.26	0.002	0.998
0 h INS/(mU·L^-1)	6.85 (4.90, 10.30)	6.80 (4.83, 9.50)	3 006.500	0.663
1 h INS/(mU·L^-1)	56.55 (40.20, 73.70)	64.85 (48.05, 87.83)	3 706.000	0.055
2 h INS/(mU·L^-1)	59.85 (42.93, 88.75)	58.10 (40.80, 87.15)	3 128.500	0.980

Item	Ketone body-positive group (n=56)	Ketone body-negative group (n=112)	χ² /t/U value	P value
Late pregnancy
TC/(mmol·L^-1)	6.13±1.07	6.14±1.15	0.054	0.957
TAG/(mmol·L^-1)	3.53 (2.75, 4.76)	3.33 (2.60, 4.20)	2 816.000	0.282
HDL-C/(mmol·L^-1)	1.88±0.38	1.92±0.38	0.573	0.494
LDL-C/(mmol·L^-1)	3.21 (2.55, 3.93)	3.35 (2.71, 4.15)	3 425.500	0.330
GA/%	12.35±0.87	12.60±0.98	1.581	0.116
Pregnancy outcome
Week of delivery/week	39 (38, 39)	39 (38, 39)	2 862.000	0.335
Vaginal delivery/n (%)	33 (58.9)	66 (58.9)	0.000	1.000
Weight change after diagnosis of GDM/kg	2.77±3.03	4.39±2.18	3.977	0.000
Rate of weight gain after diagnosis of GDM /(kg·week^-1)	0.22±0.24	0.35±0.32	3.720	0.000

Item	Ketone body-positive group (n=56)	Ketone body-negative group (n=112)	χ² /t/U value	P value
Late pregnancy
TC/(mmol·L^-1)	6.13±1.07	6.14±1.15	0.054	0.957
TAG/(mmol·L^-1)	3.53 (2.75, 4.76)	3.33 (2.60, 4.20)	2 816.000	0.282
HDL-C/(mmol·L^-1)	1.88±0.38	1.92±0.38	0.573	0.494
LDL-C/(mmol·L^-1)	3.21 (2.55, 3.93)	3.35 (2.71, 4.15)	3 425.500	0.330
GA/%	12.35±0.87	12.60±0.98	1.581	0.116
Pregnancy outcome
Week of delivery/week	39 (38, 39)	39 (38, 39)	2 862.000	0.335
Vaginal delivery/n (%)	33 (58.9)	66 (58.9)	0.000	1.000
Weight change after diagnosis of GDM/kg	2.77±3.03	4.39±2.18	3.977	0.000
Rate of weight gain after diagnosis of GDM /(kg·week^-1)	0.22±0.24	0.35±0.32	3.720	0.000

Item	Ketone body-positive group (n=56)	Ketone body-negative group (n=112)	χ² /t value	P value
Newborn birth weight/g	3 356.25±352.54	3 281.70±404.68	1.173	0.242
Low body weight infant/n (%)	1 (1.8)	2 (1.8)	0.000	1.000
Macrosomia/n (%)	2 (3.6)	5 (4.5)	0.000	1.000
Neonatal hospitalization/n (%)	13 (23.2)	12 (10.7)	4.605	0.023