{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,6,5]],"date-time":"2025-06-05T04:10:07Z","timestamp":1749096607717,"version":"3.41.0"},"reference-count":43,"publisher":"PeerJ","license":[{"start":{"date-parts":[[2025,6,4]],"date-time":"2025-06-04T00:00:00Z","timestamp":1748995200000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0"}],"funder":[{"name":"National High Level Hospital Clinical Research Funding","award":["22cz020401-4811009","24cz020204-4803048"],"award-info":[{"award-number":["22cz020401-4811009","24cz020204-4803048"]}]},{"name":"National Key Research and Development Program of China","award":["2021YFC2700700"],"award-info":[{"award-number":["2021YFC2700700"]}]},{"name":"Youth Program of National Natural Science Foundation of China","award":["82003528"],"award-info":[{"award-number":["82003528"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"abstract":"<jats:sec>\n               <jats:title>Purpose<\/jats:title>\n               <jats:p>To investigate the associations between maternal glucose and lipid metabolism and adverse pregnancy outcomes in women with type 2 diabetes mellitus (T2DM).<\/jats:p>\n            <\/jats:sec>\n            <jats:sec>\n               <jats:title>Methods<\/jats:title>\n               <jats:p>A retrospective cohort of pregnant women with T2DM who delivered at Peking University First Hospital was included. Univariate and multivariate logistic regression were used to identify risk factors. ROC curves were applied to determine optimal cut-off points for predicting adverse pregnancy outcomes.<\/jats:p>\n            <\/jats:sec>\n            <jats:sec>\n               <jats:title>Results<\/jats:title>\n               <jats:p>A total of 398 pairs of pregnant women and newborns from 2019 to 2023 were included. The key complications included large-for-gestational-age (LGA, 21.6%), preeclampsia (PE, 14.3%), preterm birth (14.3%) and birth defects (11.6%). The achievement rates for both glycated hemoglobin A1c (HbA1c) and lipid levels in early pregnancy were approximately 50%. HbA1c in the third trimester was significantly associated with increased birth weight (for LGA, aOR = 3.819, 95% CI [1.534\u20139.509]). Elevated triglyceride (TG) in early pregnancy were critical risk factors for LGA, PE, and preterm birth (aOR = 2.627, 2.478, 2.233; all <jats:italic>p<\/jats:italic> &lt; 0.05). The optimal cut-off point for third-trimester HbA1c predicting LGA was \u22645.95%. The optimal cut-off points for first-trimester TG predicting LGA, PE, and preterm birth were separately \u22641.51, \u22641.67, and \u22641.46 mmol\/L.<\/jats:p>\n            <\/jats:sec>\n            <jats:sec>\n               <jats:title>Conclusions<\/jats:title>\n               <jats:p>In Chinese pregnant women with T2DM, elevated plasma glucose and lipid levels at different pregnancy stages were independently linked to adverse outcomes, especially third-trimester HbA1c and first-trimester TG. TG level in early pregnancy lower than currently recommended may be beneficial to improve adverse outcomes.<\/jats:p>\n            <\/jats:sec>","DOI":"10.7717\/peerj.19502","type":"journal-article","created":{"date-parts":[[2025,6,4]],"date-time":"2025-06-04T08:22:27Z","timestamp":1749025347000},"page":"e19502","source":"Crossref","is-referenced-by-count":0,"title":["Associations between maternal glycemic level and lipid profile and adverse pregnancy outcomes in women with type 2 diabetes mellitus: a retrospective study from China"],"prefix":"10.7717","volume":"13","author":[{"given":"Yiwei","family":"Xue","sequence":"first","affiliation":[{"name":"Department of Obstetrics & Gynecology and Reproductive Medicine, Peking University First Hospital,  Beijing, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Juan","family":"Juan","sequence":"additional","affiliation":[{"name":"Department of Obstetrics & Gynecology and Reproductive Medicine, Peking University First Hospital,  Beijing, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Xinyu","family":"Shu","sequence":"additional","affiliation":[{"name":"Department of Obstetrics & Gynecology and Reproductive Medicine, Peking University First Hospital,  Beijing, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yilin","family":"He","sequence":"additional","affiliation":[{"name":"Department of Obstetrics & Gynecology and Reproductive Medicine, Peking University First Hospital,  Beijing, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kefan","family":"Cao","sequence":"additional","affiliation":[{"name":"Department of Obstetrics & Gynecology and Reproductive Medicine, Peking University First Hospital,  Beijing, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Xin","family":"Kang","sequence":"additional","affiliation":[{"name":"Department of Obstetrics & Gynecology and Reproductive Medicine, Peking University First Hospital,  Beijing, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hongli","family":"Huang","sequence":"additional","affiliation":[{"name":"Department of Obstetrics & Gynecology, Shenzhen Luohu Maternity and Child Health Hospital, Shenzhen, Guangdong, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Huixia","family":"Yang","sequence":"additional","affiliation":[{"name":"Department of Obstetrics & Gynecology and Reproductive Medicine, Peking University First Hospital,  Beijing, China"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"4443","published-online":{"date-parts":[[2025,6,4]]},"reference":[{"key":"10.7717\/peerj.19502\/ref-1","doi-asserted-by":"publisher","first-page":"1484","DOI":"10.2337\/dc13-1934","article-title":"Normalizing metabolism in diabetic pregnancy: is it time to target lipids?","volume":"37","author":"Barrett","year":"2014","journal-title":"Diabetes Care"},{"key":"10.7717\/peerj.19502\/ref-2","doi-asserted-by":"publisher","first-page":"e001966","DOI":"10.1136\/bmjdrc-2020-001966","article-title":"Periconception glycemic control and congenital anomalies in women with pregestational diabetes","volume":"9","author":"Dude","year":"2021","journal-title":"BMJ Open Diabetes Research & Care"},{"key":"10.7717\/peerj.19502\/ref-3","doi-asserted-by":"publisher","first-page":"102080","DOI":"10.1016\/j.plefa.2020.102080","article-title":"Maternal dietary fatty acids and their roles in human placental development","volume":"155","author":"Duttaroy","year":"2020","journal-title":"Prostaglandins, Leukotrienes and Essential Fatty Acids"},{"key":"10.7717\/peerj.19502\/ref-4","doi-asserted-by":"publisher","first-page":"S282","DOI":"10.2337\/dc24-S015","article-title":"15. Management of diabetes in pregnancy: standards of care in diabetes\u20142024","volume":"47","author":"ElSayed","year":"2024","journal-title":"Diabetes Care"},{"key":"10.7717\/peerj.19502\/ref-5","doi-asserted-by":"publisher","first-page":"1761","DOI":"10.1111\/jdi.13841","article-title":"Trends in maternal characteristics and perinatal outcomes among Japanese pregnant women with type 1 and type 2 diabetes from 1982 to 2020","volume":"13","author":"Fujikawa Shingu","year":"2022","journal-title":"Journal of Diabetes Investigation"},{"key":"10.7717\/peerj.19502\/ref-6","doi-asserted-by":"publisher","first-page":"420","DOI":"10.1039\/C9MO00117D","article-title":"Altered triglyceride and phospholipid metabolism predates the diagnosis of gestational diabetes in obese pregnancy","volume":"15","author":"Furse","year":"2019","journal-title":"Molecular Omics"},{"key":"10.7717\/peerj.19502\/ref-7","doi-asserted-by":"publisher","first-page":"2071","DOI":"10.2337\/dc10-0484","article-title":"Changes in serum lipid levels during pregnancy in type 1 and type 2 diabetic subjects","volume":"33","author":"G\u00f6bl","year":"2010","journal-title":"Diabetes Care"},{"key":"10.7717\/peerj.19502\/ref-8","doi-asserted-by":"publisher","first-page":"467","DOI":"10.2337\/dc06-1875","article-title":"The impact of glycemic control on neonatal outcome in singleton pregnancies complicated by gestational diabetes","volume":"30","author":"Gonz\u00e1lez-Quintero","year":"2007","journal-title":"Diabetes Care"},{"key":"10.7717\/peerj.19502\/ref-9","doi-asserted-by":"publisher","first-page":"63.e1-63.e14","DOI":"10.1016\/j.ajog.2022.12.006","article-title":"Trends in delivery hospitalizations with pregestational and gestational diabetes mellitus and associated outcomes: 2000\u20132019","volume":"229","author":"Gorsch","year":"2023","journal-title":"American Journal of Obstetrics and Gynecology"},{"key":"10.7717\/peerj.19502\/ref-10","doi-asserted-by":"publisher","first-page":"2198","DOI":"10.2337\/dc11-0723","article-title":"Continuous glucose profiles in obese and normal-weight pregnant women on a controlled diet","volume":"34","author":"Harmon","year":"2011","journal-title":"Diabetes Care"},{"key":"10.7717\/peerj.19502\/ref-11","doi-asserted-by":"publisher","first-page":"1490","DOI":"10.1111\/dme.14350","article-title":"Need for less tight glucose control in early pregnancy after embryogenesis due to high risk of maternal hypoglycaemia in women with pre-existing diabetes can be compensated by good control in late pregnancy","volume":"37","author":"Hauffe","year":"2020","journal-title":"Diabetic Medicine: A Journal of the British Diabetic Association"},{"key":"10.7717\/peerj.19502\/ref-12","doi-asserted-by":"publisher","first-page":"1114","DOI":"10.1038\/s41366-021-00781-x","article-title":"Placental mobilization of free fatty acids contributes to altered materno-fetal transfer in obesity","volume":"45","author":"Hirschmugl","year":"2021","journal-title":"International Journal of Obesity"},{"key":"10.7717\/peerj.19502\/ref-13","doi-asserted-by":"publisher","first-page":"165359","DOI":"10.1016\/j.bbadis.2018.12.010","article-title":"Human placental glucose transport in fetoplacental growth and metabolism","volume":"1866","author":"Illsley","year":"2020","journal-title":"Biochimica et Biophysica Acta (BBA) - Molecular Basis of Disease"},{"key":"10.7717\/peerj.19502\/ref-14","doi-asserted-by":"publisher","first-page":"60","DOI":"10.1186\/s12884-016-0852-9","article-title":"Associations between maternal lipid profile and pregnancy complications and perinatal outcomes: a population-based study from China","volume":"16","author":"Jin","year":"2016","journal-title":"BMC Pregnancy and Childbirth"},{"key":"10.7717\/peerj.19502\/ref-15","doi-asserted-by":"publisher","first-page":"1211","DOI":"10.2337\/dc23-2304","article-title":"Hemoglobin A1c trajectories during pregnancy and adverse outcomes in women with type 2 diabetes: a Danish National population-based cohort study","volume":"47","author":"Koefoed","year":"2024","journal-title":"Diabetes Care"},{"key":"10.7717\/peerj.19502\/ref-16","doi-asserted-by":"publisher","first-page":"S1908","DOI":"10.3945\/ajcn.110.001230","article-title":"Placental transfer of fatty acids and fetal implications","volume":"94","author":"Larqu\u00e9","year":"2011","journal-title":"The American Journal of Clinical Nutrition"},{"key":"10.7717\/peerj.19502\/ref-17","doi-asserted-by":"publisher","first-page":"e1117\u2013e1125","DOI":"10.1210\/clinem\/dgab769","article-title":"Association between HbA1c levels on adverse pregnancy outcomes during pregnancy in patients with type 1 diabetes","volume":"107","author":"Lemaitre","year":"2022","journal-title":"The Journal of Clinical Endocrinology and Metabolism"},{"key":"10.7717\/peerj.19502\/ref-18","doi-asserted-by":"publisher","first-page":"E797","DOI":"10.1152\/ajpendo.00372.2015","article-title":"The peroxisome proliferator-activated receptors under epigenetic control in placental metabolism and fetal development","volume":"310","author":"Lendvai","year":"2016","journal-title":"American Journal of Physiology. Endocrinology and Metabolism"},{"key":"10.7717\/peerj.19502\/ref-19","first-page":"2788","volume-title":"Williams obstetrics","author":"Leveno","year":"2018","edition":"25"},{"key":"10.7717\/peerj.19502\/ref-20","doi-asserted-by":"publisher","first-page":"1249","DOI":"10.1210\/jc.2018-01372","article-title":"Maternal high triglyceride levels during early pregnancy and risk of preterm delivery: a retrospective cohort study","volume":"104","author":"Lin","year":"2019","journal-title":"The Journal of Clinical Endocrinology & Metabolism"},{"key":"10.7717\/peerj.19502\/ref-21","doi-asserted-by":"publisher","first-page":"1081","DOI":"10.1007\/s00125-017-4529-3","article-title":"Diabetes and pregnancy: national trends over a 15 year period","volume":"61","author":"Mackin","year":"2018","journal-title":"Diabetologia"},{"key":"10.7717\/peerj.19502\/ref-22","doi-asserted-by":"publisher","first-page":"47","DOI":"10.1038\/s41572-019-0098-8","article-title":"Gestational diabetes mellitus","volume":"5","author":"McIntyre","year":"2019","journal-title":"Nature Reviews Disease Primers"},{"key":"10.7717\/peerj.19502\/ref-23","doi-asserted-by":"publisher","first-page":"1298","DOI":"10.1038\/s41440-022-00965-6","article-title":"Hypertensive disorders of pregnancy: definition, management, and out-of-office blood pressure measurement","volume":"45","author":"Metoki","year":"2022","journal-title":"Hypertension Research"},{"key":"10.7717\/peerj.19502\/ref-24","doi-asserted-by":"publisher","first-page":"153","DOI":"10.1016\/S2213-8587(20)30406-X","article-title":"Characteristics and outcomes of pregnant women with type 1 and type 2 diabetes: national population based 5-year cohort study","volume":"9","author":"Murphy","year":"2021","journal-title":"The Lancet Diabetes and Endocrinology"},{"key":"10.7717\/peerj.19502\/ref-25","doi-asserted-by":"publisher","first-page":"e0249907","DOI":"10.1371\/journal.pone.0249907","article-title":"Saturated free fatty acids induce placental trophoblast lipoapoptosis","volume":"16","author":"Natarajan","year":"2021","journal-title":"PLOS ONE"},{"key":"10.7717\/peerj.19502\/ref-26","doi-asserted-by":"publisher","first-page":"109947","DOI":"10.1016\/j.diabres.2022.109947","article-title":"Retrospective national cohort study of pregnancy outcomes for women with type 1 and type 2 diabetes mellitus in Republic of Ireland","volume":"189","author":"Newman","year":"2022","journal-title":"Diabetes Research and Clinical Practice"},{"key":"10.7717\/peerj.19502\/ref-27","doi-asserted-by":"publisher","first-page":"1550","DOI":"10.2337\/diacare.18.12.1550","article-title":"Maternal serum triglyceride, glucose tolerance, and neonatal birth weight ratio in pregnancy: a study within a racially heterogenous population","volume":"18","author":"Nolan","year":"1995","journal-title":"Diabetes Care"},{"key":"10.7717\/peerj.19502\/ref-28","doi-asserted-by":"publisher","first-page":"3","DOI":"10.3760\/cma.j.cn112141-20210917-00528","article-title":"Guideline of diagnosis and treatment of hyperglycemia in pregnancy(2022)[Part one]","volume":"57","author":"Obstetrics Subgroup","year":"2022","journal-title":"Chinese Journal of Obstetrics and Gynecology"},{"key":"10.7717\/peerj.19502\/ref-29","doi-asserted-by":"publisher","first-page":"905","DOI":"10.1515\/CCLM.2011.397","article-title":"Trimester-specific reference intervals for haemoglobin A1c (HbA1c) in pregnancy","volume":"50","author":"O\u2019Connor","year":"2011","journal-title":"Clinical Chemistry and Laboratory Medicine"},{"key":"10.7717\/peerj.19502\/ref-30","doi-asserted-by":"publisher","first-page":"373","DOI":"10.1016\/S2213-8587(21)00045-0","article-title":"Epidemiology and determinants of obesity in China","volume":"9","author":"Pan","year":"2021","journal-title":"The Lancet. Diabetes & Endocrinology"},{"key":"10.7717\/peerj.19502\/ref-31","doi-asserted-by":"publisher","first-page":"e13703","DOI":"10.1111\/obr.13703","article-title":"Mechanisms of lipotoxicity-induced dysfunction and death of human pancreatic beta cells under obesity and type 2 diabetes conditions","volume":"25","author":"Pl\u00f6tz","year":"2024","journal-title":"Obesity Reviews"},{"key":"10.7717\/peerj.19502\/ref-32","doi-asserted-by":"publisher","first-page":"490","DOI":"10.1111\/1471-0528.16031","article-title":"Maternal lipids are associated with newborn adiposity, independent of GDM status, obesity and insulin resistance: a prospective observational cohort study","volume":"127","author":"Samsuddin","year":"2020","journal-title":"BJOG: an International Journal of Obstetrics and Gynaecology"},{"key":"10.7717\/peerj.19502\/ref-33","doi-asserted-by":"publisher","first-page":"1575","DOI":"10.1007\/s00018-013-1297-1","article-title":"Developmental and environmental epigenetic programming of the endocrine pancreas: consequences for type 2 diabetes","volume":"70","author":"Sandovici","year":"2013","journal-title":"Cellular and Molecular Life Sciences: CMLS"},{"key":"10.7717\/peerj.19502\/ref-34","doi-asserted-by":"publisher","first-page":"1939","DOI":"10.1007\/s00125-021-05482-8","article-title":"Potentially modifiable risk factors of preterm delivery in women with type 1 and type 2 diabetes","volume":"64","author":"S\u00f8holm","year":"2021","journal-title":"Diabetologia"},{"key":"10.7717\/peerj.19502\/ref-35","doi-asserted-by":"publisher","first-page":"909","DOI":"10.1002\/oby.21821","article-title":"Prenatal high-fat diet alters placental morphology, nutrient transporter expression, and mtorc1 signaling in rat","volume":"25","author":"Song","year":"2017","journal-title":"Obesity"},{"key":"10.7717\/peerj.19502\/ref-36","doi-asserted-by":"publisher","first-page":"108784","DOI":"10.1016\/j.jnutbio.2021.108784","article-title":"Maternal n-3 PUFA deficiency alters uterine artery remodeling and placental epigenome in the mice","volume":"96","author":"Srinivas","year":"2021","journal-title":"The Journal of Nutritional Biochemistry"},{"key":"10.7717\/peerj.19502\/ref-37","doi-asserted-by":"publisher","first-page":"857","DOI":"10.1016\/S0140-6736(14)60932-6","article-title":"International standards for newborn weight, length, and head circumference by gestational age and sex: the newborn cross-sectional study of the INTERGROWTH-21st Project","volume":"384","author":"Villar","year":"2014","journal-title":"The Lancet"},{"key":"10.7717\/peerj.19502\/ref-38","doi-asserted-by":"publisher","first-page":"246","DOI":"10.1186\/s12944-018-0885-3","article-title":"Recommended reference values for serum lipids during early and middle pregnancy: a retrospective study from China","volume":"17","author":"Wang","year":"2018","journal-title":"Lipids in Health and Disease"},{"key":"10.7717\/peerj.19502\/ref-39","doi-asserted-by":"publisher","first-page":"490","DOI":"10.1111\/cen.12742","article-title":"The associations between triglyceride to high-density lipoprotein cholesterol ratios and the risks of gestational diabetes mellitus and large-for-gestational-age infant","volume":"83","author":"Wang","year":"2015","journal-title":"Clinical Endocrinology"},{"key":"10.7717\/peerj.19502\/ref-40","doi-asserted-by":"publisher","first-page":"e1002926","DOI":"10.1371\/journal.pmed.1002926","article-title":"Preconception diabetes mellitus and adverse pregnancy outcomes in over 6.4 million women: a population-based cohort study in China","volume":"16","author":"Wei","year":"2019","journal-title":"PLOS Medicine"},{"key":"10.7717\/peerj.19502\/ref-41","doi-asserted-by":"publisher","first-page":"437","DOI":"10.3109\/14767058.2010.497571","article-title":"The levels of Pdx1\/insulin, Cacna1c and Cacna1d, and \u03b2-cell mass in a rat model of intrauterine undernutrition","volume":"24","author":"Xu","year":"2011","journal-title":"The Journal of Maternal-Fetal & Neonatal Medicine"},{"key":"10.7717\/peerj.19502\/ref-42","doi-asserted-by":"publisher","first-page":"361","DOI":"10.1002\/ijgo.13636","article-title":"Establishing reference ranges of serum lipid level during pregnancy and evaluating its association with perinatal outcomes: a cohort study","volume":"156","author":"Zheng","year":"2022","journal-title":"International Journal of Gynecology & Obstetrics"},{"key":"10.7717\/peerj.19502\/ref-43","doi-asserted-by":"publisher","first-page":"951871","DOI":"10.3389\/fendo.2022.951871","article-title":"Maternal lipid profile during early pregnancy and birth weight: a retrospective study","volume":"13","author":"Zhu","year":"2022","journal-title":"Frontiers in Endocrinology"}],"container-title":["PeerJ"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/peerj.com\/articles\/19502.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/peerj.com\/articles\/19502.xml","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/peerj.com\/articles\/19502.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/peerj.com\/articles\/19502.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,6,4]],"date-time":"2025-06-04T08:22:31Z","timestamp":1749025351000},"score":1,"resource":{"primary":{"URL":"https:\/\/peerj.com\/articles\/19502"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,6,4]]},"references-count":43,"alternative-id":["10.7717\/peerj.19502"],"URL":"https:\/\/doi.org\/10.7717\/peerj.19502","archive":["CLOCKSS","LOCKSS","Portico"],"relation":{},"ISSN":["2167-8359"],"issn-type":[{"value":"2167-8359","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,6,4]]},"article-number":"e19502"}}