Hyperglycemia and adverse pregnancy outcomes
Hyperglycemia and adverse pregnancy outcomes
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DOI：
10.1056/nejmoa0707943
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发表时间：
2008-05-08
影响因子：
158.5
通讯作者：
Sacks, David A.
中科院分区：
文献类型：
--
作者：
Metzger, Boyd E.;Lowe, Lynn P.;Sacks, David A.
背景：与糖尿病相比，母体低血糖是否与妊娠不良结局风险增加有关，目前存在争议。方法：来自9个国家15个中心的25505名孕妇在妊娠24至32周接受了75克口服葡萄糖耐量试验。如果空腹血糖水平为105毫克/分升（5.8毫摩尔/升）或更低，2小时血糖水平为200毫克/分升（11.1毫摩尔/升）或更低，则数据保持盲法。主要结局为出生体重高于胎龄第90百分位、初次剖宫产、临床诊断的新生儿低血糖和脐带血血清c肽水平高于第90百分位。次要结局为妊娠37周前分娩、肩难产或分娩损伤、需要新生儿重症监护、高胆红素血症和先兆子痫。结果：对于23,316名参与者的盲法数据，我们计算了与空腹血糖升高1 SD （6.9 mg / dl [0.4 mmol / l]）、1小时血糖升高1 SD （30.9 mg / dl [1.7 mmol / l]）和2小时血糖升高1 SD （23.5 mg / dl [1.3 mmol / l]）相关的不良妊娠结局的校正优势比。出生体重高于第90百分位，比值比分别为1.38（95%可信区间[CI]， 1.32 ~ 1.44）、1.46（1.39 ~ 1.53）和1.38 (1.32 ~ 1.44)；脐带血血清c肽水平高于第90百分位，分别为1.55 （95% CI, 1.47 ~ 1.64）、1.46（1.38 ~ 1.54）和1.37 (1.30 ~ 1.44)；初次剖宫产为1.11 （95% CI, 1.06 ~ 1.15）、1.10（1.06 ~ 1.15）和1.08 (1.03 ~ 1.12)；新生儿低血糖为1.08 （95% CI, 0.98 ~ 1.19）、1.13（1.03 ~ 1.26）和1.10（1.00 ~ 1.12）。没有明显的阈值表明风险增加。次要结果也观察到显著的关联，尽管这些关联往往较弱。结论：我们的研究结果表明，孕妇血糖水平低于糖尿病诊断水平与出生体重增加和脐带血血清c肽水平升高存在强烈的、持续的关联。
Background: It is controversial whether maternal hyperglycemia less severe than that in diabetes mellitus is associated with increased risks of adverse pregnancy outcomes.Methods: A total of 25,505 pregnant women at 15 centers in nine countries underwent 75-g oral glucose-tolerance testing at 24 to 32 weeks of gestation. Data remained blinded if the fasting plasma glucose level was 105 mg per deciliter (5.8 mmol per liter) or less and the 2-hour plasma glucose level was 200 mg per deciliter (11.1 mmol per liter) or less. Primary outcomes were birth weight above the 90th percentile for gestational age, primary cesarean delivery, clinically diagnosed neonatal hypoglycemia, and cord-blood serum C-peptide level above the 90th percentile. Secondary outcomes were delivery before 37 weeks of gestation, shoulder dystocia or birth injury, need for intensive neonatal care, hyperbilirubinemia, and preeclampsia.Results: For the 23,316 participants with blinded data, we calculated adjusted odds ratios for adverse pregnancy outcomes associated with an increase in the fasting plasma glucose level of 1 SD (6.9 mg per deciliter [0.4 mmol per liter]), an increase in the 1-hour plasma glucose level of 1 SD (30.9 mg per deciliter [1.7 mmol per liter]), and an increase in the 2-hour plasma glucose level of 1 SD (23.5 mg per deciliter [1.3 mmol per liter]). For birth weight above the 90th percentile, the odds ratios were 1.38 (95% confidence interval [CI], 1.32 to 1.44), 1.46 (1.39 to 1.53), and 1.38 (1.32 to 1.44), respectively; for cord-blood serum C-peptide level above the 90th percentile, 1.55 (95% CI, 1.47 to 1.64), 1.46 (1.38 to 1.54), and 1.37 (1.30 to 1.44); for primary cesarean delivery, 1.11 (95% CI, 1.06 to 1.15), 1.10 (1.06 to 1.15), and 1.08 (1.03 to 1.12); and for neonatal hypoglycemia, 1.08 (95% CI, 0.98 to 1.19), 1.13 (1.03 to 1.26), and 1.10 (1.00 to 1.12). There were no obvious thresholds at which risks increased. Significant associations were also observed for secondary outcomes, although these tended to be weaker.Conclusions: Our results indicate strong, continuous associations of maternal glucose levels below those diagnostic of diabetes with increased birth weight and increased cord-blood serum C-peptide levels.