Gestational diabetes mellitus and lesser degrees of pregnancy hyperglycemia: Association with increased risk of spontaneous preterm birth
Gestational diabetes mellitus and lesser degrees of pregnancy hyperglycemia: Association with increased risk of spontaneous preterm birth
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DOI：
10.1016/s0029-7844(03)00661-6
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发表时间：
2003-10-01
影响因子：
7.2
通讯作者：
Sacks, DA
中科院分区：
文献类型：
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作者：
Hedderson, MM;Ferrara, A;Sacks, DA
目的：调查不同程度的母亲葡萄糖耐受不良是否与自发性早产风险相关。 方法：我们对北加州 Kaiser Permanente 医疗护理计划的 46,230 名孕妇进行了一项队列研究，这些孕妇在妊娠 24 至 28 周期间通过 50 克、1 小时口服葡萄糖耐量测试进行筛查。自然早产的定义是妊娠周小于 37 周出生且至少存在以下一种情况的婴儿：自然临产、早产胎膜早破或子宫颈机能不全。糖耐量状态分为正常筛查（1小时血浆葡萄糖低于140 mg/dL）、异常筛查（1小时血浆葡萄糖至少140 mg/dL，诊断性100克、3小时口服葡萄糖耐量试验结果正常）、Carpenter-Coustan（诊断性口服葡萄糖耐量试验期间的血浆葡萄糖测量值达到阈值，但低于国家糖尿病数据组阈值）和妊娠期糖尿病(GDM) 按国家糖尿病数据组标准。 结果： 1956 例自发性早产发生。正常筛查中年龄调整后的自发性早产发生率为 4.0%，异常筛查中为 5.0%，Carpenter-Coustan 中为 6.7%，GDM 中为 6.7%。在根据年龄、种族、妊娠前水肿-妊娠诱发的高血压、慢性高血压、羊水过多和出生胎龄体重进行调整的逻辑回归模型中，筛查异常、Carpenter-Coustan和GDM的妊娠自发性早产的风险显着高于筛查正常的妊娠（相对风险[95%置信区间]：1.23[1.08，1.41]，分别为 1.53 [1.16, 2.03] 和 1.42 [1.15-1.77]）。结论：自发性早产的风险随着妊娠血糖水平的增加而增加。这种关联与可能引发早产的围产期并发症无关。 (C) 2003 年，美国妇产科医师学会。
OBJECTIVE: To investigate whether different degrees of maternal glucose intolerance are associated with the risk of spontaneous preterm birth.METHODS: We performed a cohort study of 46,230 pregnancies screened by a 50-g, 1-hour oral glucose tolerance test between 24 and 28 gestation weeks at the Northern California Kaiser Permanente Medical Care Program. Spontaneous preterm birth was defined as an infant born at less than 37 gestation weeks with at least one of the following: spontaneous labor, preterm premature rupture of membranes, or incompetent cervix. Glucose tolerance status was categorized as normal screening (1-hour plasma glucose less than 140 mg/dL), abnormal screening (1-hour plasma glucose of at least 140 mg/dL with a normal diagnostic 100-g, 3-hour oral glucose tolerance test result), Carpenter-Coustan (plasma glucose measurements during the diagnostic oral glucose tolerance test met the thresholds but were lower than the National Diabetes Data Group thresholds), and gestational diabetes mellitus (GDM) by the National Diabetes Data Group criteria.RESULTS: One thousand nine hundred fifty-six spontaneous preterm births occurred. Age-adjusted incidences of spontaneous preterm birth were 4.0% in normal screening, 5.0% in abnormal screening, 6.7% in Carpenter-Coustan, and 6.7% in GDM. In a logistic regression model adjusted for age, race-ethnicity, prcedampsia-edampsia-pregnancy-induced hypertension, chronic hypertension, polyhydramnios, and birth weight for gestational age, pregnancies with abnormal screening, Carpenter-Coustan, and GDM had a significantly higher risk of spontaneous preterm birth than pregnancies with normal screening (relative risk [95% confidence interval]: 1.23 [1.08, 1.41], 1.53 [1.16, 2.03], and 1.42 [1.15-1.77], respectively).CONCLUSION: The risk of spontaneous preterm birth increased with increasing levels of pregnancy glycemia. This association was independent of perinatal complications that could have triggered early delivery. (C) 2003 by The American College of Obstetricians and Gynecologists.