Early Diagnosed Gestational Diabetes Mellitus Is Associated With Adverse Pregnancy Outcomes: A Prospective Cohort Study
Early Diagnosed Gestational Diabetes Mellitus Is Associated With Adverse Pregnancy Outcomes: A Prospective Cohort Study
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早期诊断的妊娠糖尿病与不良妊娠结局相关：一项前瞻性队列研究
DOI：
10.1210/clinem/dgaa633
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发表时间：
2020-12-01
影响因子：
5.8
通讯作者：
Wang, Zilian
中科院分区：
文献类型：
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作者：
Liu, Bin;Cai, Jian;Wang, Zilian
内容：口服葡萄糖耐量试验（OGTT）的早期诊断妊娠期糖尿病（GDM）的意义还没有determined.Objective：这项工作的目的是探讨早期和标准OGTT诊断GDM，并确定不良孕产妇和新生儿的结果与早期GDMdiagnosis.Research Design and Methods：早期诊断妊娠期糖尿病研究是一项前瞻性队列研究。研究中的每个参与者都经历了2次OGTT，在18至20孕周（gws）进行早期OGTT，在24至28 gws进行标准OGTT。分析早期OGTT与标准OGTT的重复性。产妇和新生儿的代谢紊乱和妊娠结局进行了比较groups.Results：共有522名参与者完成了早期和标准OGTT。早期OGTT的血糖值与标准OGTT无显著差异（空腹：4.31 +/- 0.41 mmol/L vs 4.29 +/- 0.37 mmol/L，P= 0.360; 1小时：7.68 +/- 1.71 mmol/L vs 7.66 +/- 1.59 mmol/L，P= 0.826; 2小时：6.69 +/- 1.47 mmol/L vs 6.71 +/- 1.39 mmol/L，P = 0.800）。早期和标准OGTT结果的重复性为74.9%。GDM组孕妇在妊娠晚期有较高的糖化血红蛋白、C肽和稳态模型评估的胰岛素抵抗。GDM组母亲所生的新生儿有较高的风险大于胎龄（比值比（OR）：3.665; 95%CI：1.006-11.91），也更容易发生新生儿高胰岛素血症结论：经OGTT确诊为18 ~ 20 gw的早发GDM与母儿代谢紊乱及不良妊娠结局有关。对早发GDM治疗效果的进一步随机对照试验将证实GDM早期筛查的重要性。
Context: The significance of an early diagnosis of gestational diabetes mellitus (GDM) with oral glucose tolerance test (OGTT) has not been determined.Objective: The objective of this work is to investigate GDM diagnosed by early and standard OGTTs and determine adverse maternal and neonatal outcomes associated with early GDM diagnosis.Research Design and Methods: The Early Diagnosis of Gestational Diabetes Mellitus study is a prospective cohort study. Each participant in the study underwent 2 OGTTs, an early OGTT at 18 to 20 gestational weeks (gws) and a standard OGTT at 24 to 28 gws. The reproduciblity between early and standard OGTT were analyzed. Maternal and neonatal metabolic disorders and pregnancy outcomes were compared across groups.Results: A total of 522 participants completed both the early and standard OGTTs. The glucose values in the early OGTT were not significantly different from those in the standard OGTT (fasting: 4.31 +/- 0.41 mmol/L vs 4.29 +/- 0.37 mmol/L, P= .360; 1-hour: 7.68 +/- 1.71 mmol/L vs 7.66 +/- 1.59 mmol/L, P= .826; 2-hour: 6.69 +/- 1.47 mmol/L vs 6.71 +/- 1.39 mmol/L, P = .800). The reproducibility of early and standard OGTT results was 74.9%. Pregnant women in the GDM group had higher glycated hemoglobin, C-peptide, and homeostasis model assessment of insulin resistance in the late gestational period. Neonates born to mothers in the GDM group were at a higher risk of being large for gestational age (odds ratio (OR): 3.665; 95% CI, 1.006-11.91) and were also more prone to neonatal hyperinsulinemia (OR: 3.652; 95% CI, 1.152-10.533).Conclusion: Early-onset GDM diagnosed by OGTT at 18 to 20 gws is associated with maternal and neonatal metabolic disorders and adverse pregnancy outcomes. Further randomized controlled trials on the therapeutic efficacy for early-onset GDM will confirm the significance of early screening for GDM.