Long-term Evaluation of Gestational Endocrine & Metabolic Dynamics

Subjects who meet either criterion 1 or 2 will be considered to have type 2 diabetes：

• With classical symptoms of diabetes: if any one of the following is met:

Random plasma glucose ≥ 11.1 mmol/L, or Fasting plasma glucose (FPG) ≥ 7.0 mmol/L, or 2-hour plasma glucose during an oral glucose tolerance test (OGTT) ≥ 11.1 mmol/L, or HbA1c (glycated hemoglobin) ≥ 6.5%.

• Without classical symptoms of diabetes: either two glucose indicators measured at the same time point reaching or exceeding diagnostic thresholds, or Glucose indicators measured at two different time points reaching or exceeding diagnostic thresholds (excluding random plasma glucose).

Individuals meeting 3 or more of the following 5 components will be considered to have metabolic syndrome:

• Waist circumference ≥ 85 cm in women;
• FPG ≥ 6.1 mmol/L and/or 2hPG ≥ 7.8 mmol/L, and/or previously diagnosed diabetes;
• Blood pressure ≥ 130/85 mmHg, and/or previously diagnosed hypertension and treated;
• Fasting TG ≥ 1.7 mmol/L;
• Fasting HDL-C < 1.04 mmol/L.

The presence of any of the following items is considered indicative of cardiovascular disease:

• Inquire about history(definitively diagnosed by a qualified physician) of cardiovascular diseases, including coronary heart disease, hypertension and arrhythmia.
• Quantify coronary artery calcium score via non-contrast CT scan, > 100 indicates elevated risk for coronary heart disease.
• With Framingham Cardiovascular Risk Score calculated for non-diseased individuals(men ≥15 and women ≥18 are classified as high cardiovascular risk).
• Perform an electrocardiogram for diagnose of arrhythmia.
• ABI, TBI, and baPWV are utilized to assess arteriosclerosis in the extremities, ABI < 0.9 or TBI < 0.7 or baPWV > 1400 cm/s is diagnostic of peripheral arterial disease.
• Carotid ultrasonography is performed to assess carotid plaque.

Inquire about history of cognitive function(definitively diagnosed by a qualified physician).

Subjects who meet criterion 1 or 2 will be considered to have renal disease:

• Serum creatinine>133μmol/L.
• Urinary microalbumin/urinary creatinine>30mg/g.

Assessed by standardized depression and anxiety scales [Zung Self-rating Anxiety Scale(SAS)].

Anxiety Severity Classification:

Normal: <50, Mild Anxiety: 50-59, Moderate Anxiety: 60-69, Severe Anxiety: ≥70

Assessed via measurement of thyroid hormone levels

Assessed via quantitative ultrasound (QUS) measurement of T-scores and Z-scores at the bilateral distal radius.

Growth curve values persistently below the 3rd percentile (P3) or above the 97th percentile (P97), as defined by the *China Height and Weight Percentile Curves for Children and Adolescents Aged 2-18 Years* developed by the Growth and Development Research Laboratory, Capital Institute of Pediatrics, were considered indicative of abnormal growth

With CAIDE Dementia Risk Score calculated for individuals without history of cognitive function.

>12U/L is considered early-stage renal tubule injury.

Assessed by standardized depression and anxiety scales [Zung Self-Rating Depression Scale(SDS)].

Depression Severity Classification: Normal: <53, Mild Depression: 53-62, Moderate Depression: 63-72, Severe Depression: ≥73

Serum uric acid levels exceed 420 μmol/L.

Serum homocysteine >15 μmol/L

Liver Transient Elastography (CAP) Fat Attenuation Grading:

Normal: <244 dB/m Mild Hepatic Steatosis: 244-269 dB/m Moderate Hepatic Steatosis: 269-296 dB/m Severe Hepatic Steatosis: >296 dB/m

18%-28% is considered normal.

Range: 0-33; Higher scores indicate worse status. A total score ≥9 suggests a depressive state.

Items 1-9 constitute the Attention Deficit subscale (range: 0-27, ≤13: Normal); Items 10-18 constitute the Hyperactivity-Impulsivity subscale (range: 0-27, ≤13: Normal); Items 19-26 constitute the Oppositional Defiant subscale: Abnormality is defined as ≥4 items scored as 2 or 3.

Range: 0-82; Higher scores indicate worse condition; a total score ≥25 suggests anxiety.

Range: 0-20; Higher scores indicate worse condition; no standardized cutoff.