Excessive Weight Gain Before and During Gestational Diabetes Mellitus Management: What Is the Impact?
Excessive Weight Gain Before and During Gestational Diabetes Mellitus Management: What Is the Impact?
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DOI：
10.2337/dc19-0800
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发表时间：
2020-01-01
期刊：
影响因子：
16.2
通讯作者：
Flack, Jeff R.
中科院分区：
文献类型：
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作者：
Barnes, Robyn A.;Wong, Tang;Flack, Jeff R.
目的：传统的妊娠期糖尿病（GDM）管理主要集中在控制血糖，以防止不良结局。我们假设，在GDM首次出现时体重过度增加（妊娠期体重过度增加[EGWG]）和开始GDM管理后继续EGWG（cEGWG）将增加不良结局的风险，尽管治疗以优化妊娠结局。研究设计和方法：对在一个机构前瞻性收集的妊娠期糖尿病孕妇的数据进行分析。GDM是根据澳大利亚妊娠糖尿病学会1998年指南（1992-2015）诊断的。EGWG是指超过了医学研究所推荐的整个妊娠的目标范围的上限，通过GDM表现。评估了EGWG与产前75 g口服葡萄糖耐量试验（oGTT）值和不良结局之间的关系。研究cEGWG、胰岛素需求和大于胎龄儿（LGA）之间的关系。结果在3,281例孕妇中，776例（23.6%）有EGWG。在oGTT中，EGWG女性的平均空腹血糖（FPG）较高（5.2 mmol/L [95% CI 5.1-5.3] vs. 5.0 mmol/L [95% CI 4.9-5.0]; P < 0.01），校正混杂因素后，更常接受胰岛素治疗（47.0% vs. 33.6%; P < 0.0001），调整后比值比（aOR）为1.4（95%CI 1.1-1.7; P < 0.01）。cEGWG每增加2 kg的aOR是胰岛素治疗的1.3倍（95% CI 1.1-1.5; P < 0.001），最终每日胰岛素剂量增加8个单位（95%CI 5.4-11.0; P < 0.0001），LGA婴儿的分娩率增加1.4倍（95%CI 1.2-1.7; P < 0.0001）。结论：GDM患者缺乏EGWG和限制cEGWG对基于oGTT的FPG、LGA婴儿的风险和胰岛素需求具有缓解作用。
OBJECTIVE Conventional gestational diabetes mellitus (GDM) management focuses on managing blood glucose in order to prevent adverse outcomes. We hypothesized that excessive weight gain at first presentation with GDM (excessive gestational weight gain [EGWG]) and continued EGWG (cEGWG) after commencing GDM management would increase the risk of adverse outcomes, despite treatment to optimize glycemia. RESEARCH DESIGN AND METHODS Data collected prospectively from pregnant women with GDM at a single institution were analyzed. GDM was diagnosed on the basis of Australasian Diabetes in Pregnancy Society 1998 guidelines (1992-2015). EGWG means having exceeded the upper limit of the Institute of Medicine-recommended target ranges for the entire pregnancy, by GDM presentation. The relationship between EGWG and antenatal 75-g oral glucose tolerance test (oGTT) values and adverse outcomes was evaluated. Relationships were examined between cEGWG, insulin requirements, and large-for-gestational-age (LGA) infants. RESULTS Of 3,281 pregnant women, 776 (23.6%) had EGWG. Women with EGWG had higher mean fasting plasma glucose (FPG) on oGTT (5.2 mmol/L [95% CI 5.1-5.3] vs. 5.0 mmol/L [95% CI 4.9-5.0]; P < 0.01), after adjusting for confounders, and more often received insulin therapy (47.0% vs. 33.6%; P < 0.0001), with an adjusted odds ratio (aOR) of 1.4 (95% CI 1.1-1.7; P < 0.01). aORs for each 2-kg increment of cEGWG were a 1.3-fold higher use of insulin therapy (95% CI 1.1-1.5; P < 0.001), an 8-unit increase in final daily insulin dose (95% CI 5.4-11.0; P < 0.0001), and a 1.4-fold increase in the rate of delivery of LGA infants (95% CI 1.2-1.7; P < 0.0001). CONCLUSIONS The absence of EGWG and restricting cEGWG in GDM have a mitigating effect on oGTT-based FPG, the risk of having an LGA infant, and insulin requirements.