Department of Diabetes and Endocrinology, Bankstown-Lidcombe Hospital, NSW, Australia.
Diabet Med. 2013 Sep;30(9):1040-6. doi: 10.1111/dme.12207. Epub 2013 May 15.
To identify predictors of large and small for gestational age in women with gestational diabetes mellitus.
A retrospective audit of clinical data analysed for singleton births in women diagnosed with gestational diabetes by Australasian Diabetes in Pregnancy Society guidelines from 1994 to 2009. Exclusions were: incomplete data, delivered at < 36 weeks gestation and/or last recorded weight > 4 weeks pre-delivery. We assessed: pre-pregnancy BMI, ethnicity, total maternal weight gain, weight gain before and after treatment initiation for gestational diabetes, HbA(1c) at gestational diabetes presentation and treatment modality (diet or insulin) and smoking. Birthweight was assessed using customized percentile charts (large for gestational age > 90th; small for gestational age < 10th percentile). Multiple regression analyses were undertaken; statistical significance was p < 0.05.
There were 1695 women first seen at (mean ± sd) 28.1 ± 5.3 weeks gestation (range 6-39). Ethnic mix was South-East Asian 36.7%, Middle Eastern 27.6%, European 22.4%, Indian/Pakistani 8.6%, Samoan 1.9%, African 1.5% and Maori 1.1%. Therapy was diet 69.1% and insulin 30.9%. Mean total weight gain was 12.3 ± 6.1 kg, the majority (10.6 ± 6.0 kg), gained before dietary intervention. There were 7.9% small for gestational age and 15.2% large for gestational age births. Significant independent large for gestational age predictors were: weight gain before intervention, pre-pregnancy BMI, weight gain after intervention and treatment type, but not HbA1c or smoking. Significant small for gestational age predictors were: weight gain before intervention, weight gain after intervention, but not pre-pregnancy BMI, HbA(1c) or smoking.
Conventional treatment for gestational diabetes mellitus concentrates on management of blood glucose levels. The trends identified here emphasize the need to also address pregnancy weight gain stratified by pre-pregnancy BMI.
确定符合澳大利亚妊娠糖尿病学会指南诊断标准的妊娠期糖尿病女性中，胎儿大小与胎龄不相符的预测因素。
对 1994 年至 2009 年期间，根据澳大利亚妊娠糖尿病学会指南，对诊断为妊娠期糖尿病的单胎分娩女性的临床数据进行回顾性分析。排除标准为：数据不完整、分娩孕周<36 周、最后一次记录体重距分娩时间>4 周。评估内容包括：孕前 BMI、种族、产妇总体重增加、妊娠期糖尿病治疗开始前后的体重增加、妊娠期糖尿病时的糖化血红蛋白（HbA1c）值、治疗方式（饮食或胰岛素）和吸烟情况。通过定制的百分位图表评估出生体重（大于胎龄儿>第 90 百分位；小于胎龄儿<第 10 百分位）。进行多变量回归分析；p<0.05 具有统计学意义。
共有 1695 名女性在（平均±标准差）28.1±5.3 孕周时首次就诊（范围 6-39 周）。种族混合为：东南亚裔 36.7%、中东裔 27.6%、欧洲裔 22.4%、印度/巴基斯坦裔 8.6%、萨摩亚裔 1.9%、非洲裔 1.5%和毛利裔 1.1%。治疗方法为饮食治疗 69.1%，胰岛素治疗 30.9%。总体重增加平均值为 12.3±6.1kg，其中大部分（10.6±6.0kg）在饮食干预前增加。小于胎龄儿发生率为 7.9%，大于胎龄儿发生率为 15.2%。大于胎龄儿的独立预测因素有：干预前体重增加、孕前 BMI、干预后体重增加和治疗类型，但与 HbA1c 或吸烟无关。小于胎龄儿的独立预测因素有：干预前体重增加、干预后体重增加，但与孕前 BMI、HbA1c 或吸烟无关。
妊娠期糖尿病的常规治疗侧重于血糖水平的管理。这里确定的趋势强调，需要根据孕前 BMI 对妊娠体重增加进行分层管理。
