Herranz Lucrecia, Pallardo Luis F, Hillman Natalia, Martin-Vaquero Pilar, Villarroel Africa, Fernandez Alberto
Division of Diabetes, Department of Endocrinology, Hospital Universitario La Paz, Madrid, Spain.
Diabetes Res Clin Pract. 2007 Jan;75(1):42-6. doi: 10.1016/j.diabres.2006.05.019. Epub 2006 Jul 11.
To determine which maternal glycaemic parameters in type 1 diabetes better predict large-for-gestational-age (LGA) infants.
Maternal glycaemic parameters (mean overall, preprandial, and postprandial glucose; the percentage of glucose readings above and below target and HbA1c levels) of LGA (n=37) and appropriate-for-gestational-age (n=36) infants were compared during preconception and each trimester of pregnancy. Logistic regression was used to select predictive variables.
Preconception glycaemic parameters were not different. Mean glucose and the percentage of glucose readings above target were higher in mothers of LGA infants in every trimester of pregnancy. Second and third trimesters mean postprandial glucose, third trimester mean preprandial glucose and third trimester HbA1c were also higher. Only third trimester glycaemic variables were risk indicators of LGA infants: mean glucose (OR: 3.45; 95% CI: 1.52-7.80), mean preprandial glucose (OR: 2.97; 95% CI: 1.34-6.60), mean postprandial glucose (OR: 2.09; 95% CI: 1.19-3.67) and the percentage of glucose readings above target (OR: 1.08; 95% CI: 1.03-1.14). The percentage of glucose readings above target was the best risk indicator.
Third trimester glycaemic parameters are more powerful predictors of foetal growth than glycaemic parameters earlier in pregnancy or during preconception. Hyperglycaemic excursions are the strongest predictor of LGA infants.
确定1型糖尿病患者的哪些母体血糖参数能更好地预测大于胎龄（LGA）儿。
比较了LGA儿（n = 37）和适于胎龄儿（n = 36）母亲在孕前及孕期各阶段的母体血糖参数（总体平均、餐前和餐后血糖；高于和低于目标值的血糖读数百分比以及糖化血红蛋白水平）。采用逻辑回归选择预测变量。
孕前血糖参数无差异。在孕期的每个阶段，LGA儿母亲的平均血糖及高于目标值的血糖读数百分比均较高。孕中期和孕晚期的平均餐后血糖、孕晚期的平均餐前血糖以及孕晚期的糖化血红蛋白也较高。只有孕晚期血糖变量是LGA儿的风险指标：平均血糖（比值比：3.45；95%置信区间：1.52 - 7.80）、平均餐前血糖（比值比：2.97；95%置信区间：1.34 - 6.60）、平均餐后血糖（比值比：2.09；95%置信区间：1.19 - 3.67）以及高于目标值的血糖读数百分比（比值比：1.08；95%置信区间：1.03 - 1.14）。高于目标值的血糖读数百分比是最佳风险指标。
孕晚期血糖参数比孕期早期或孕前的血糖参数更能有力地预测胎儿生长。血糖波动是LGA儿最强的预测指标。
