Longitudinal changes in glucose during pregnancy in women with gestational diabetes risk factors.
Longitudinal changes in glucose during pregnancy in women with gestational diabetes risk factors.
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DOI：
10.1007/s00125-021-05622-0
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发表时间：
2022-03
期刊：
影响因子：
8.2
通讯作者：
Powe CE
中科院分区：
文献类型：
--
作者：
Bochkur Dratver MA;Arenas J;Thaweethai T;Yu C;James K;Rosenberg EA;Callahan MJ;Cayford M;Tangren JS;Bernstein SN;Hivert MF;Thadhani R;Powe CE
尽管建议在妊娠前三个月对患有糖尿病危险因素的女性进行高血糖筛查，但妊娠早期正常血糖值的标准尚未确定。我们的目的是比较具有糖尿病危险因素的女性妊娠早期、妊娠后期和妊娠外的血糖水平。我们对孕妇 (N=123) 进行了产后期纵向跟踪，并对另一组非孕妇 (N=65) 进行了 75 g 口服葡萄糖耐量试验。所有参与者都有一种或多种糖尿病危险因素。使用线性回归，我们测试了非孕妇和孕妇在妊娠早期（7-15周）和中晚期（24-32周）以及产后的血糖水平差异，并根据母亲年龄、产次、婚姻状况和体重指数进行了调整。在使用混合效应模型的纵向分析中，我们测试了妊娠早期和中晚期与产后的血糖水平的差异。差异表示为 β (95% CI)。与非孕妇相比，孕妇的空腹血糖在妊娠早期低 0.34 (0.18, 0.51) mmol/l (p<0.0001)，在妊娠中晚期低 0.45 (0.29, 0.61) mmol/l (p<0.0001)。在纵向模型中，与相同女性产后相比，妊娠早期空腹血糖降低了 0.13 (0.04, 0.21) mmol/l (p=0.003)，怀孕中后期空腹血糖降低了 0.16 (0.08, 0.25) mmol/l (p=0.0003)。妊娠早期负荷后的血糖水平与非孕妇或同一女性产后的血糖水平没有差异。妊娠中晚期，与非孕妇相比，负荷后1小时血糖水平（0.60 [−0.12, 1.33] mmol/l，p=0.10）和负荷后2小时血糖水平（0.49 [−0.21, 1.19] mmol/l，p=0.17）升高没有统计学意义。然而，在纵向分析中，与产后相比，妊娠中晚期的负荷后 1 小时和 2 小时血糖水平较高（分别增加 0.78 [0.35, 1.21] mmol/l，p=0.0004 和 0.67 [0.30, 1.04] mmol/l，p=0.0005）。对于有糖尿病危险因素的女性，空腹血糖在妊娠前三个月会下降。怀孕后期负荷后血糖会升高。这些发现可能为妊娠早期高血糖的诊断标准提供信息。 –
Despite recommendations to screen women with diabetes risk factors for hyperglycaemia in the first trimester, criteria for normal glucose values in early pregnancy have not been firmly established. We aimed to compare glucose levels in early pregnancy with those later in gestation and outside of pregnancy in women with diabetes risk factors. In pregnant women (N=123) followed longitudinally through the postpartum period, and a separate cohort of non-pregnant women (N=65), we performed 75 g oral glucose tolerance tests. All participants had one or more risk factors for diabetes. Using linear regression, we tested for differences in glucose levels between non-pregnant and pregnant women at early (7–15 weeks) and mid-late (24–32 weeks) gestation as well as postpartum, with adjustment for maternal age, parity, marital status and BMI. In a longitudinal analysis using mixed-effects models, we tested for differences in glucose levels across early and mid-late pregnancy compared with postpartum. Differences are expressed as β (95% CI). Fasting glucose was lower in pregnant compared with non-pregnant women by 0.34 (0.18, 0.51) mmol/l (p<0.0001) in early pregnancy and by 0.45 (0.29, 0.61) mmol/l (p<0.0001) in mid-late pregnancy. In longitudinal models, fasting glucose was lower by 0.13 (0.04, 0.21) mmol/l (p=0.003) in early pregnancy and by 0.16 (0.08, 0.25) mmol/l (p=0.0003) in mid-late pregnancy compared with the same women postpartum. Early pregnancy post-load glucose levels did not differ from those in non-pregnant women or the same women postpartum. In mid-late pregnancy, compared with non-pregnant women, elevations in 1 h post-load glucose level (0.60 [−0.12, 1.33] mmol/l, p=0.10) and 2 h post-load glucose (0.49 [−0.21, 1.19] mmol/l, p=0.17) were not statistically significant. However, in longitudinal analyses, 1 h and 2 h post-load glucose levels were higher in mid-late pregnancy (by 0.78 [0.35, 1.21] mmol/l, p=0.0004, and 0.67 [0.30, 1.04] mmol/l, p=0.0005, respectively) when compared with postpartum. In women with diabetes risk factors, fasting glucose declines in the first trimester. Post-load glucose increases later in pregnancy. These findings may inform criteria for diagnosing hyperglycaemia early in pregnancy. –
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