Maternal Glycemic Spectrum and Adverse Pregnancy and Perinatal Outcomes in a Multiracial US Cohort

Yaa Adoma Kwapong, Ellen Boakye, Guoying Wang, Xiumei Hong, Jennifer Lewey, Mamas Andreas Mamas, Pensee Wu, Michael Joseph Blaha, Khurram Nasir, Allison Gamboa Hays, Roger Scott Blumenthal, Xiaobin Wang, Garima Sharma

Research output: Contribution to journalArticlepeer-review


Diabetes mellitus (pregestational (PDM) and gestational (GDM)) is associated with adverse pregnancy outcomes (APOs). However, studies exploring the association of APOs with maternal glycemia among women without PDM/GDM are limited. We utilized data from 4119 women (307—PDM; 582—GDM; 3230—non‐PDM/GDM) in the Boston Birth Cohort (1998–2016). Women in the non‐PDM/GDM group were subdivided by tertiles of 1 h, 50 g oral glucose load test at 24–32 weeks: T1: 50–95 mg/dL (n = 1166), T2: 96–116 mg/dL (n = 1151), T3: 117–201 mg/dL (n = 913). Using multivariable logistic regression, we examined the association of maternal glycemia with APOs— preterm birth (PTB) and hypertensive disorders of pregnancy (HDP)—and adverse perinatal out-comes—high birth weight (HBW), cesarean section (CS), and sub‐analyses by race‐ethnicity. Compared to women in T1, women in T2 and T3 had a higher prevalence of pre‐existing hypertension (T1: 2.8% vs. T2: 5.2% vs. T3: 6.3%) and obesity (T1: 13.3% vs. T2: 18.1% vs. T3: 22.9%). Women in T2 and T3 had higher odds of HBW (adjusted odds ratio aOR T2: 1.47 [1.01–2.19] T3: 1.68[1.13–2.50]) compared to women in T1. Additionally, women in T2, compared to T1, had higher odds of HDP (aOR 1.44 [1.10–1.88]). Among non‐Hispanic Black (NHB) women, those in T2 and T3 had higher odds of HDP compared to T1 (aOR T2 1.67[1.13–2.51]; T3: 1.68[1.07–2.62]). GDM and PDM were associated with higher odds of HBW, CS, PTB, and HDP, compared to women in T1. In this pre-dominantly NHB and Hispanic cohort, moderate maternal glycemia without PDM/GDM was associated with higher odds of HBW and HDP, even more strongly among NHB women. If confirmed, a review of current guidelines of glucose screening and risk stratification in pregnancy may be war-ranted.

Original languageEnglish (US)
Article number179
JournalJournal of Cardiovascular Development and Disease
Issue number6
StatePublished - Jun 2022


  • adverse pregnancy outcomes
  • cardiovascular risk
  • gestational diabetes
  • glycemia

ASJC Scopus subject areas

  • Pharmacology (medical)
  • Pharmacology, Toxicology and Pharmaceutics(all)


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