Population health: modest glycaemic improvements in a pregnant cohort with mild glucose intolerance decreased adverse outcomes.
Population health: modest glycaemic improvements in a pregnant cohort with mild glucose intolerance decreased adverse outcomes.
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DOI：
10.1111/ppe.12124
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发表时间：
2014-07
影响因子：
2.8
通讯作者：
Jonsson Funk M
中科院分区：
文献类型：
--
作者：
Berggren EK;Boggess KA;Jonsson Funk M
不良围产期结局是常见的妊娠相关轻度葡萄糖耐受不良。改善人口健康而不是个人健康对围产期的影响尚未量化。我们估计了1996年4月至2010年5月在北卡罗来纳大学妇女医院分娩的轻度葡萄糖耐受不良妇女的影响。在模拟每组血糖值降低一个标准差的队列后，我们比较了观察到的和预测的围产期结局风险。我们用泊松回归和自举95%置信区间[CI]估计绝对和调整风险、相对风险和风险差异。在3217名女性中，平均（SD） 1小时筛查结果为157 (16)mg/dL；空腹、1小时、2小时和3小时的3小时诊断结果分别为81（10）、154（28）、130（25）和104 (26)mg/dL。与观察结果相比，子痫前期（9.1%比6.6%，风险比[RR] 0.73 [95% CI 0.60, 0.88]）、剖宫产（30.1%比26.4%,RR 0.88 [95% CI 0.81, 0.96]）、早产（13.0%比9.8%,RR 0.75 [95% CI 0.64, 0.87]）、出生体重>4000 g（13.4%比10.5%,RR 0.78 [95% CI 0.67, 0.90]）和肩难产（3.5%比2.2%,RR 0.61 [95% CI 0.46, 0.83]）的预测风险降低。轻度葡萄糖耐受不良孕妇中葡萄糖耐量人群分布的适度改善转化为围产期结局的有意义的改善。
Adverse perinatal outcomes are common with pregnancy-related mild glucose intolerance. The perinatal impact of improving this population’s health, instead of individual health, has not been quantified. We estimated this impact among women with mild glucose intolerance, delivered at The University of North Carolina Women’s Hospital from April 1996 to May 2010. We compared observed with predicted risks of perinatal outcomes after simulating a cohort with a one standard deviation decrease in each glucose value. We estimated absolute and adjusted risks, relative risks, and risk differences with Poisson regression and bootstrapped 95% confidence intervals [CI]. Among 3217 women, mean (SD) 1-h screening result was 157 (16) mg/dL; 3-h diagnostic results were 81 (10), 154 (28), 130 (25), and 104 (26) mg/dL for fasting, 1-h, 2-h, and 3-h, respectively. Compared with observed, predicted risks decreased for preeclampsia (9.1% vs. 6.6%, risk ratio [RR] 0.73 [95% CI 0.60, 0.88]), caesarean delivery (30.1% vs. 26.4%, RR 0.88 [95% CI 0.81, 0.96]), preterm birth (13.0% vs. 9.8%, RR 0.75 [95% CI 0.64, 0.87]), birthweight >4000 g (13.4% vs. 10.5%, RR 0.78 [95% CI 0.67, 0.90]), and shoulder dystocia (3.5% vs. 2.2%, RR 0.61 [95% CI 0.46, 0.83]). Modestly improved population distribution of glucose tolerance in pregnancies affected by mild glucose intolerance translated to meaningful improvements in perinatal outcomes.