The Area under the Curve (AUC) of Oral Glucose Tolerance Test (OGTT) Could Be a Measure Method of Hyperglycemia in All Pregnant Women

Objective: We adopted the area under the curve (AUC) of oral glucose tolerance test (OGTT) as a measure method of the severity of maternal hyperglycemia and investigated its relationship with adverse perinatal outcomes among women with and without gestational diabetes mellitus (GDM). Research design and methods: This is a retrospective cohort study. Our study group collected the medical records of 15,296 women who received perinatal care in 15 hospitals in Beijing and who delivered from July 1, 2013, to December 31, 2013. And several original articles on this cohort have been published. In this study, we analyze the relationship between AUC and adverse perinatal outcomes, so that in multiple pregnant cases, patients with pre-pregnancy diabetes, hypertension, and abnormal kidney function and those who did not receive a 75-g OGTT were excluded. A Chi-squared test and logistic regression analysis were used to determine the associations. Results: In total, 13,561 women were included. As the AUC of OGTT increased, the prevalence of macrosomia (odds ratio [OR] 1.059, 95% confidence interval [95% CI] 1.029 - 1.090, p < 0.001) and hypertensive diseases (OR 1.106, 95% CI 1.064 - 1.149, p < 0.001) also increased. For patients with same levels of AUC values, no significant differences in the risk of macrosomia, preterm birth and neonatal complications were observed between the GDM and non-GDM groups. Women with an AUC higher than 14.20 (mmol * h/L) had a higher risk of adverse outcomes regardless of the presence of GDM. Conclusions: The AUC could be a measure method of the severity of maternal hyperglycemia, and women with a high AUC should undergo aggressive management to avoid adverse outcomes regardless of the presence of GDM.

Clinical Management Guidelines for Intrahepatic Cholestasis of Pregnancy

Intrahepatic cholestasis of pregnancy(ICP)is a significant gestational complication in late pregnancy,potentially leading to severe perinatal complications such as intrauterine fetal demise and preterm birth.The Obstetrics Group of the Gynecology and Obstetrics Branch and the Perinatal Medicine Branch of the Chinese Medical Association organized a panel of domestic experts to deliberate and propose recommendations based on domestic and international guidelines,recent evidence-based medical evidence about key clinical issues including risk factors,clinical manifestations,perinatal outcomes,diagnosis,severity grading,maternal and fetal monitoring,treatment methods,timing,and methods of pregnancy termination,and postpartum follow-up for ICP,with the aim to guide its clinical diagnosis,treatment,and management.

Atomic tracking of thermally-driven structural evolution in 2D crystals:Case of NbSe_(2)

Advanced atomic tracking techniques play a critical role in characterizing structural evolution,elucidating fundamental mechanisms of exotic phenomena and tailoring delicate properties.Thermally driven structural modulation in 2D crystals,such as the charge density wave(CDW),often leads to intriguing quantum properties,making them a valuable platform for exploring fundamental physics and potential device applications.However,despite their significance,experimental studies addressing atomic tracking of thermally-driven structural evolution in 2D crystals have been limited.Herein,we utilize high-accuracy variable-temperature atomic tracking measurements with scanning tunneling microscopy(STM)to directly observe a series of structural transitions in a model 2D crystal,namely NbSe_(2).With the atomic tracking technique,we confirm the existence of the universal thermally-driven CDW transition hysteresis between the heating and cooling cycles.This transition hysteresis,characterized by a constant temperature offset,represents a new phenomenon of structural evolution.Our findings provide a feasible method to track CDW transitions at the atomic scale in 2D crystals,significantly contributing to a better understanding and the potential modulation of these materials'functions in nanodevices.

妇产科手术后盆腹腔粘连预防中国指南(2023年版)

粘连是最常见的手术并发症,术后粘连在妇产科手术后也较为常见,术后粘连可能引起病理性的并发症,严重者甚至可危及生命。为了在临床上更好地预防粘连,在2015年的《预防妇产科手术后盆腹腔粘连的中国专家共识》基础上,根据新的研究结果,专家组遴选了与临床密切相关的12项问题进行了文献检索,并根据国际通用的标准进行了严谨评级和严格推荐。在兼顾严肃性、严谨性、严格性、实用性、科学性、权威性、政策性和安全性的前提下,最终制定了本指南,以规范临床工作,指导选择防粘连材料,加强防粘连意识,最终使患者获益。

Maternal circulating biomarkers associated with placenta accreta spectrum disorders

To the Editor:Placenta accreta spectrum(PAS)disorders refer to a spectrum of abnormal placentation.PAS subtypes include placenta accreta(creta or adherenta,PA),placenta increta(PI),and placenta percreta(PP).The incidence of PAS has dramatically increased over the past four decades.A study using a nationally representative sample in the United States showed that the prevalence of PAS was 0.29%among women who underwent cesarean delivery with live birth.[1]Women with PAS are at a considerably higher risk of concurrent hemorrhage,bladder and urinary tract injury,and hysterectomy during delivery.[1]

Advance in two-dimensional twisted moirématerials:Fabrication,properties,and applications

Two-dimensional(2D)twisted moirématerials,a new class of van der Waals(vdW)layered heterostructures with different twist angles between neighboring layers,have attracted tremendous attention due to their rich emerging properties.In this review,we systematically summarize the recent progress of 2D twisted moirématerials.Firstly,we introduce several representative fabrication methods and the fascinating topographies of the twisted moirématerials.Specifically,we discuss various remarkable physical properties related to twisted angles,including flat bands,unconventional superconductivity,ferromagnetism,and ferroelectricity.We also analyze the potential applications in various twisted moirésystems.Finally,the challenges and future perspectives of the twisted moirématerials are discussed.This work would spur edge-cutting ideas and related achievements in the scientific and technological frontiers of 2D twisted moirématerials.

Risk Factors for Gestational Diabetes Mellitus(GDM)in Subsequent Pregnancy Among Women Without GDM History in China:A Multicenter Retrospective Study

Objective:This study aimed to determine the likelihood of gestational diabetes mellitus(GDM)in subsequent pregnancy among women without GDM history and to identify risk factors for GDM in subsequent pregnancy.Methods:This retrospective cohort study involved participants who delivered twice in same hospital of 18 research centers when delivered the second baby from January 2018 to December 2018.Finally 6204 women were enrolled and 5180 women without GDM history were analyzed further.Women were categorized as non-GDM or GDM based on the blood glucose values of the subsequent pregnancy,and the characteristics and GDM risk of these groups were compared.A univariate analysis of potential risk factors was performed using the Chi-squared test and/ort-test for qualitative or quantitative variables,respectively.Associations withP values<0.1 were chosen to be included in the multivariate binary logistic regression model.Results:In primary analysis of 6204 women,the incidence of GDM in subsequent pregnancy is 48.9%(490/1002)in women with GDM history and 16.1%(835/5202)in women without GDM history.In a further analysis for 5180 women without GDM at index pregnancy,compared with the non-GDM group,the GDM group had a significantly higher age,prepregnancy body mass index,and blood glucose value at each oral glucose tolerance test(OGTT)timepoint(fasting,1 h and 2 h)during the index and subsequent pregnancies,as well as higher weight retention during the interval between the two pregnancies(P<0.001).Age above 35 years in subsequent pregnancy(odds ratio(OR)=1.540,95%confidence interval(CI)=1.257-1.886,P<0.001),macrosomia in index pregnancy(OR=1.749,95%CI=1.277-2.395,P=0.001),OGTT blood glucose values in index pregnancy(fasting,OR=2.487,95%CI=1.883-3.285,P<0.001;1 h,OR=1.142,95%CI=1.051-1.241,P=0.002;2 h,OR=1.290,95%CI=1.162-1.432,P<0.001)and weight retention(OR=1.052,95%CI=1.035-1.068,P<0.001)were independent risk factors for GDM in subsequent pregnancy.Conclusion:For women without GDM history,GDM risk factors including age,macrosomia history,OGTT value,and weight retention,these can be evaluated before a subsequent pregnancy.Early warning and interventions are needed for women at high risk.

Vertical Transmission of Severe Acute Respiratory Syndrome Coronavirus 2:Current Evidence and Perspectives

With the widespread transmission of severe acute respiratory syndrome coronavirus 2(SARS-CoV-2),the medical community has organized efforts to determine a series of clinical questions about the virus.Critical questions have also arisen in the field of maternal-fetal medicine and have received increasing attention,as physiological and immunologic changes in pregnancy might potentially increase the susceptibility to SARS-CoV-2 infection and complications of the virus.1 Many early reports indicated that pregnant women with SARS-CoV-2 infection were not prone to experiencing severe disease.

Low-dose aspirin in the prevention of pre-eclampsia in China: postpartum hemorrhage in subgroups of women according to their characteristics and potential bleeding risk

Background:The APPEC study is a large-population randomized controlled trial in China evaluating the role of low-dose aspirin prophylactic treatment for pre-eclampsia.There was no statistically significant difference in postpartum hemorrhage(PPH)incidence between the aspirin and control groups.This study aimed to evaluate the potential bleeding risk of 100 mg aspirin in high-risk pregnant women and the difference in the incidence of PPH according to maternal characteristics.Methods:This is a secondary data analysis of the APPEC study.Platelet counts and coagulation test results were collected at five follow-up visits.Subgroups defined by maternal age(<35 years and≥35 years),pre-pregnancy body mass index(pre-BMI,<28 kg/m 2 and≥28 kg/m 2),parity,gestational age at enrollment,and medical history,including pre-eclampsia,chronic hypertension,and diabetes mellitus,were analyzed.Logistic regression analysis was used to determine the statistical significance of the difference in the incidence of PPH after aspirin administration in pregnant women in each subgroup.Adjustment using multiple logistic regression models followed these analyses.Binary logistic regression was used to determine the relationship between pre-BMI and PPH.Results:There was no significant difference between the aspirin and control groups in bleeding risk(3.4%[16/464]vs.3.0%[13/434],T=0.147,P=0.701).No significant difference was found in the incidence of PPH in total(relative risk=1.220,95%confidence interval[CI]=0.720–2.067,P=0.459;aspirin group vs.control group,6.5%[30/464]vs.5.3%[23/434],P=0.459)or in subgroup analysis.A significant correlation between pre-BMI and PPH was found in the aspirin group,while in the control group there was no significant correlation(aspirin group,odds ratio[OR]=1.086,95%CI=1.004–1.175,P=0.040;control group,OR=1.060,95%CI=0.968–1.161,P=0.209).Conclusions:A dosage of 100 mg of aspirin per day,initiated from 12 to 20 gestational weeks until 34 weeks of gestation,did not increase the risk of potential bleeding and PPH regardless of the maternal characteristic.In the aspirin group,the positive correlation between BMI and PPH was significant.Trial Registration:ClinicalTrials.gov,NCT01979627.

Recommendations for the Diagnosis and Treatment of Maternal SARS-CoV-2 Infection

The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection has spread worldwide and threatened human’s health.With the passing of time,the epidemiology of coronavirus disease 2019 evolves and the knowledge of SARS-CoV-2 infection accumulates.To further improve the scientific and standardized diagnosis and treatment of maternal SARS-CoV-2 infection in China,the Chinese Society of Perinatal Medicine of Chinese Medical Association commissioned leading experts to develop the Recommendations for the Diagnosis and Treatment of Maternal SARS-CoV-2 Infection under the guidance of the Maternal and Child Health Department of the National Health Commission.This recommendations includes the epidemiology,diagnosis,management,maternal care,medication treatment,care of birth and newborns,and psychological support associated with maternal SARS-CoV-2 infection.It is hoped that the recommendations will effectively help the clinical management of maternal SARS-CoV-2 infection.

High Risk Factors for Placenta Accreta Other than Pregnancy and Their Impact on Patient Prognosis

Objective This study aimed to determine the most pertinent factors responsible for placenta accreta spectrum disorders in patients without any history of pregnancy and evaluate their prognostic implications.Methods This retrospective cohort study included 1009 patients diagnosed with placenta accreta spectrum disorders based on standardized diagnostic criteria across 10 tertiary hospitals in China between January 1,2018,and December 31,2018;45 patients without a history of pregnancy were selected.The collected data mainly included demographic characteristics(including age,operative history,and ultrasound findings)and maternal-fetal outcomes(including any history of intraoperative bleeding,blood transfusion details,maternal-fetal complications,and fetal Apgar scores).SPSS 24.0 was used for statistical analyses.The Mann-Whitney U test and logistic regression were performed;a two-tailed P<0.050 was considered statistically significant.Results Ultrasound-based detection of placenta previa(χ^(2)=9.911,P=0.003)showed a strong association with placenta accreta spectrum types.The severity of placenta accreta spectrum was directly proportional to the likelihood of having coexistent complete placenta previa(χ^(2)=11.626,P=0.009)and being diagnosed by ultrasound(χ^(2)=5.449,P=0.047).Blood transfusion also impacted placenta accreta spectrum types in relation to maternal prognosis(χ^(2)=8.785,P=0.004).On univariate analysis,older age led to more complications(U=82.000,P=0.011),and in vitro fertilization-embryo transfer caused more intraoperative bleeding(U=91.500,P=0.007).Although the 1-and 5-minute Apgar scores were statistically significant,the rates of neonatal asphyxia did not differ(P>0.050).Endometrial damage led to lower Apgar scores on both univariate(1 minute:U=29.500,P=0.027;and 5 minutes:U=33.500,P=0.031)and multivariate(1 minute:β=−1.510,95%confidence interval,−2.639 to 0.381,P=0.010;and 5 minutes:β=−0.968,95%confidence interval,−1.779 to 0.157,P=0.021)analyses.Conclusion In patients who had no history of pregnancy,placenta previa was a strong risk factor for severe placenta accreta spectrum disorders.Endometrial damage led to lower Apgar scores;this warrants greater consideration in the clinic.

A Summary of Chinese Guidelines on Diagnosis and Management of Hyperglycemia in Pregnancy(2022)

Hyperglycemia is one of the most common complications women encounter during pregnancy,and is associated with a higher incidence of short-and long-term health risks for both the mother and offspring.In 2022,the Maternal-Fetal Medicine Committee of the Chinese Society of Obstetrics and Gynecology,Chinese Medicine Association,worked with the Chinese Society of Perinatal Medicine and the Professional Committee of Gestational Diabetes Mellitus of the Chinese Maternal and Child Health Association to update the Guidelines for the diagnosis and management of hyperglycemia in pregnancy in China.The aim was to further standardize the management of hyperglycemia in pregnancy from the aspects of screening,diagnosis,monitoring,treatment,and prevention of gestational diabetes mellitus,and consequently to further improve the health of mother and child.

Using the Delphi Technique to Achieve Consensus on Prevention and Treatment of Preterm Single Birth in China

Objective::This study aimed to reach a consensus among obstetric experts on the prevention and treatment of preterm single births in China.Methods::Based on the scoping literature review and the 2014 edition of preterm birth of Clinical Diagnosis and Treatment guidelines,we generated the Delphi survey statements with five evaluation dimensions,including the definition of preterm birth,exclusion of risk factors for preterm birth,prevention,and prediction of preterm birth,treatment of preterm birth,and evaluation of intervention outcomes of preterm birth.Obstetric experts from the Obstetrics and Gynecology Branch of the Chinese Medical Association formed the expert group for this survey.All the obstetric experts participated two-round modified Delphi survey via an anonymous online survey and an online panel.Mean scores,rank sum,full score ratio,and the lowest score ratio were calculated to reflect the concentration of expert opinions.The coefficient of variation and Kendall W coefficient were used to reflect the expert opinion coordination degree of the survey statement.Results::The expert response rate for both rounds of surveys was 100%(41/41).Experts reached an agreement on 36 statements in five dimensions of preterm birth prevention and treatment in the first round of the survey and reached a consensus on the remaining 13 statements in the second round.A total of 49 statements(mean scores≥3,full score ratio≥20%,coefficient of variation≤0.3)were explicitly included in this guideline to form recommendations,while the remaining three clinical issues that did not reach a consensus require further determination based on evidence quality.The Kendall W coefficient in the two rounds of the Delphi survey were 0.20(P<0.001)and 0.29(P<0.001).Conclusion::The five dimensions and 49 statements,agreed upon through a two-round Delphi study,determined the recommended statements to be included in the updated guidelines for the prevention and treatment of preterm birth in China.The defined lower limit is set at≥28 gestational weeks;however,an update has been made to the definition of premature birth,specifying that"with the consent of the mother and her family,treatment is not abandoned for viable infants≥26 gestational weeks."

Exercise intervention during pregnancy induces DNA methylation alterations in maternal blood and cord blood

To the Editor:Obesity characterized with excess accumulation of white adipose tissue increases the prevalence of gestational diabetes mellitus(GDM).Exposure to intrauterine hyperglycemia increases the long-term sequelae including cardiovascular abnormalities and metabolic syndrome in adult offspring.[1]As early as two decades ago,Dr.David Barker provided evidence that nutritional exposures in utero has a lasting impact on offspring’s health status in adulthood.[2]This emphasizes the critical role of early intrauterine environmental exposures and highlights the potential origins of adult metabolic diseases.

SARS-CoV-2 infection and pregnancy:clinical update and perspective

Since the emergence of severe acute respiratory syndrome coronavirus 2(SARS-CoV-2)in December 2019,the virus has overwhelmed the world’s health.Pregnant women as a vulnerable group,the broad implications of SARS-CoV-2 for obstetrical care and perinatal outcomes have raised concern and promoted the rapid development of research.Chinese clinicians and scientists working in obstetrics rapidly reported globally the clinical characteristics,pregnancy outcomes,and vertical transmission potential of SARS-CoV-2 infection in pregnancy on February 12,2020[1]and published clinical management consensus specific for SARS-CoV-2 infection in pregnancy at the earliest time,[2]which were valuable for preventive and clinical practice in China and elsewhere in the early stages of the pandemic.With the passing of time and updating of information,developments have been achieved in our understanding of obstetric outcomes,vertical transmission,and therapeutics for the treatment and prevention of SARS-CoV-2 infection;furthermore,the progress shed light on the gaps in current knowledge for future work.

Conservative Treatment of Fetal Goitrous Hypothyroidism Due to Thyroglobulin Mutations:A Case Report and Literature Review

With the advances in fetal medicine,there will be more cases of congenital hypothyroidism(CH)diagnosed in the fetal period.However,there is no consensus on the management protocol.We present a successful case of conservatively managed fetal goitrous hypothyroidism due to compound heterozygous TG mutations.Goiter was observed in a fetus at 23 weeks of gestation.Because there was no evidence of transplacental passage of antithyroid antibody and drugs,iodine overload,and iodine deficiency,the fetus was highly suspected to have CH.Considering the potential risks of amniocentesis/cordocentesis,and lack of available parenteral levothyroxine in China,the fetus was closely monitored thereafter.A male neonate was delivered vaginally without complications at 39 weeks of gestation.We verified severe hypothyroidism in the infant and immediately initiated levothyroxine therapy.His growth and mental development were normal at the age of 8 month.Whole-exome sequencing showed that the neonate had two compound heterozygous mutations in the TG gene.We also performed a literature review of the prognosis of postnatal treatment of CH due to TG mutations and the result showed that postnatal treatment of CH due to TG mutations has a favorable prognosis.However,further prospective studies are warranted to verify this conclusion.

Exploring the Optimal Diagnostic Thresholds of Hyperglycemia During Pregnancy

Gestational diabetes mellitus(GDM)is a specific disease during pregnancy that is characterized by the onset of abnormal maternal glucose tolerance,1 which was first discovered by O’Sullivan and Mahan2 in 1964.Since then,the gradual understanding of the impact of GDM on the long-term risk of maternal diabetes and other metabolic diseases has led to modifications in the diagnostic criteria of GDM by different associations and organizations.

Advances in probing single biomolecules: From DNA bases to glycans

Imaging biomolecules in real space is crucial for gaining a comprehensive understanding of the properties and functions of biological systems at the most fundamental level.Among the various imaging techniques available for biomolecules and their assembled nanostructures,scanning probe microscopy(SPM)provides a powerful and nondestructive imaging option.SPM is unique in visualizing intrinsically disordered biomolecules at the nanometer scale(e.g.,glycans).This review highlights recent achievements in studying biomolecules using SPM technique,focusing on DNA bases,amino acids,proteins,and glycans.The atomic-level analysis of biomolecules made possible by SPM allows for a more accurate definition of the local structure–property relationship.High-resolution SPM imaging of single biomolecules offers a new way to study basic processes of life at the molecular level.

Comparing the Diagnostic Criteria for Gestational Diabetes Mellitus of World Health Organization 2013 with 1999 in Chinese Population

INTRODUCTION Gestational diabetes mellitus (GDM) was earlier defined as "hyperglycemia first recognized during pregnancy" and has more recently been described by American Diabetes Association (ADA) (2012) as diabetes diagnosed during pregnancy that is not clearly overt diabetes.[1] The hyperglycemia and adverse pregnancy outcomes study (HAPO) demonstrated that the risk of adverse maternal,fetal,and neonatal outcomes continuously increase as a function of maternal glycemia at 24-28 weeks,even within ranges previously considered normal for pregnancy.[2] After reviewing the results of the HAPO study,many international diabetes study groups,including the International Association of Diabetes and Pregnancy Study Groups and ADA have adopted the 75 g oral glucose tolerance test (OGTT) at 24-28 weeks as a screening and diagnostic test and defined new cut-off values for GDM diagnosis.The Ministry of Health of China published the criteria for GDM,that is the same as the ADA criteria on July 1,2011.World Health Organization (WHO) has recommended the 75 g OGTT with different cut-offvalues as a diagnostic test since 1999,changed its recommendation on 2013.In Hongkong and Yunnan province in China,most hospital adopted the WHO 1999 criteria,nevertheless,there is no evidence of multicenter and large sample to show that the GDM population within the same ethnic group diagnosed by the new WHO criteria matches those diagnosed by the old one and consistency between the two criteria has not been reported.Thus,we conducted this study to analyze the two criteria in Chinese pregnant women.

Risk of gestational diabetes recurrence and the development of type 2 diabetes among women with a history of gestational diabetes and risk factors: a study among 18 clinical centers in China

Background:Gestational diabetes mellitus(GDM)brings health issues for both mothers and offspring,and GDM prevention is as important as GDM management.It was shown that a history of GDM was significantly associated with a higher maternal risk for GDM recurrence.The incidence of GDM recurrence was unclear because of the incidence of second-child was low before 2016 in China.We aim to investigate the prevalence of GDM recurrence and its associated high-risk factors which may be useful for the prediction of GDM recurrence in China.Methods:A retrospective study was conducted which enrolled participants who underwent regular prenatal examination and delivered twice in the same hospital of 18 research centers.All participants were enrolled from January 2018 to October 2018,where they delivered the second baby during this period.A total of 6204 women were enrolled in this study,and 1002 women with a history of GDM were analyzed further.All participants enrolled in the study had an oral glucose tolerance test(OGTT)result at 24 to 28 weeks and were diagnosed as GDM in the first pregnancy according to the OGTT value(when any one of the following values is met or exceeded to the 75-g OGTT:0 h[fasting],≥5.10 mmol/L;1 h,≥10.00 mmol/L;and 2 h,≥8.50 mmol/L).The prevalence of GDM recurrence and development of type 2 diabetes mellitus were calculated,and its related risk factors were analyzed.Results:In 6204 participants,there are 1002 women(1002/6204,16.15%)with a history of GDM and 5202 women(5202/6204,83.85%)without a history of GDM.There are significant differences in age(32.43±4.03 years vs.33.00±3.34 years vs.32.19±3.37 years,P<0.001),pregnancy interval(4.06±1.44 years vs.3.52±1.43 years vs.3.38±1.35 years,P=0.004),prepregnancy body mass index(BMI)(27.40±4.62 kg/m^(2)vs.23.50±3.52 kg/m^(2)vs.22.55±3.47 kg/m^(2),P<0.001),history of delivered macrosomia(22.7%vs.11.0%vs.6.2%,P<0.001)among the development of diabetes mellitus(DM),recurrence of GDM,and normal women.Moreover,it seems so important in the degree of abnormal glucose metabolism in the first pregnancy to the recurrence of GDM and the development of DM.There are significant differences in OGTT levels of the first pregnancy such as area under the curve of OGTT value(18.31±1.90 mmol/L vs.16.27±1.93 mmol/L vs.15.55±1.92 mmol/L,P<0.001),OGTT fasting value(5.43±0.48 mmol/L vs.5.16±0.49 mmol/L vs.5.02±0.47 mmol/L,P<0.001),OGTT 1-hour value(10.93±1.34 mmol/L vs.9.69±1.53 mmol/L vs.9.15±1.58 mmol/L,P<0.001),OGTT 2-hour value(9.30±1.66 mmol/L vs.8.01±1.32 mmol/L vs.7.79±1.38 mmol/L,P<0.001),incidence of impaired fasting glucose(IFG)(fasting plasma glucose≥5.6 mmol/L)(31.3%vs.14.6%vs.8.8%,P<0.001),and incidence of two or more abnormal OGTT values(68.8%vs.39.7%vs.23.9%,P<0.001)among the three groups.Using multivariate analysis,the factors,such as age(1.07[1.02-1.12],P=0.006),prepregnancy BMI(1.07[1.02,1.12],P=0.003),and area under the curve of OGTT in the first pregnancy(1.14[1.02,1.26],P=0.02),have an effect on maternal GDM recurrence;the factors,such as age(1.28[1.01-1.61],P=0.04),pre-pregnancy BMI(1.26[1.04,1.53],P=0.02),and area under the curve of OGTT in the first pregnancy(1.65[1.04,2.62],P=0.03),have an effect on maternal DM developed further.Conclusions:The history of GDM was significantly associated with a higher maternal risk for GDM recurrence during follow-up after the first pregnancy.The associated risk factors for GDM recurrence or development of DM include age,high pre-pregnancy BMI,history of delivered macrosomia,the OGTT level in the first pregnancy,such as the high area under the curve of OGTT,IFG,and two or more abnormal OGTT values.To prevent GDM recurrence,women with a history of GDM should do the preconception counseling before preparing next pregnancy.