Preconception hypoglycemia and adverse pregnancy outcomes in Chinese women aged 20–49 years: A retrospective cohort study in China

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Abstract
Background: In addition to hyperglycemia, women with hypoglycemia identified during pregnancy have a higher risk of adverse pregnancy outcomes. However, there is limited evidence of the association between prepregnant hypoglycemia and adverse pregnancy outcomes in women without pre-existing diabetes. This study aims to explore the association between maternal preconception hypoglycemia and adverse pregnancy outcomes among childbearing-aged women in China. Methods and findings: This was a retrospective cohort study of the National Free Preconception Checkup Project (NFPCP), including women who were aged 20–49, successfully conceived within one year without multiple gestations, and had complete information on pregnancy outcomes. Maternal fasting plasma glucose (FPG) concentrations were analyzed in the preconception examination stage, and women were divided into normal (FPG 3.9 to P < 0.001), LBW by 8% (95% CI [1.03, 1.12], P = 0.001), SGA by 7% (95% CI [1.05, 1.08], P < 0.001), and birth defects by 21% (95% CI [1.06, 1.37], P = 0.004), while the ORs of medical abortion decreased by 6% (95% CI [0.91, 0.98], P = 0.002), miscarriage or early stillbirth by 5% (95% CI [0.92, 0.97], P < 0.001), macrosomia by 12% (95% CI [0.86, 0.90], P < 0.001), and LGA by 12% (95% CI [0.86, 0.89], P < 0.001) if mothers had a preconception hypoglycemia. The associations of maternal preconception hypoglycemia and adverse pregnancy outcomes varied among BMI groups. Among underweight women, preconception hypoglycemia was associated with a lower risk of medical abortion, miscarriage or early stillbirth, LGA, and PID, while overweight women had a lower risk of macrosomia and LGA. Moreover, a higher risk of miscarriage or early stillbirth and PTB was observed in obesity and underweight, respectively, in association with preconception hypoglycemia. Main limitations in the current study included the limited generalizability in other countries with varying disparities in healthcare and the lack of information on certain potential confounders (such as gestational complications and whether they received any related intervention after preconception examination). Conclusion: Preconception hypoglycemia was significantly associated with adverse pregnancy outcomes, and maternal preconception BMI could modify the association. In addition to paying attention to women with preconception hyperglycemia, our findings call for increased concern for women with hypoglycemia in preconception glycemic screening, with consideration of modified effects by preconception BMI, which might be worth exploring as a means to reduce adverse pregnancy outcomes.
Funding Information
  • University Grants Committee Areas of Excellence Scheme (AoE/M-401/24R)
  • University Grants Committee Areas of Excellence Scheme (AoE/M-401/24R)
  • National Key Research and Development Program of China (2021YFC2700705)
  • National Key Research and Development Program of China (2016YFC100307)

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