妊娠期糖尿病后的产后微量白蛋白尿：当前糖耐量状态的影响
Postpartum microalbuminuria after gestational diabetes: the impact of current glucose tolerance status.
作者信息
Kew Simone, Swaminathan Balakumar, Hanley Anthony J, Connelly Philip W, Sermer Mathew, Zinman Bernard, Retnakaran Ravi
机构信息
Leadership Sinai Centre for Diabetes (S.K., B.S., A.J.H., B.Z., R.R.), Division of Obstetrics and Gynecology (M.S.), and Lunenfeld-Tanenbaum Research Institute (B.Z., R.R.), Mount Sinai Hospital, Toronto, Ontario M5T 3L9, Canada; Division of Endocrinology (A.J.H., P.W.C., B.Z., R.R.) and Department of Nutritional Sciences (A.J.H.), University of Toronto, Toronto, Ontario M5S, Canada; and Keenan Research Centre for Biomedical Science of St. Michael's Hospital (P.W.C.), Toronto, Ontario M5B 1W8, Canada.
出版信息
J Clin Endocrinol Metab. 2015 Mar;100(3):1130-6. doi: 10.1210/jc.2014-3814. Epub 2015 Jan 5.
CONTEXT
It has been reported that women with a history of gestational diabetes mellitus (GDM) have an increased risk of microalbuminuria compared with that of their peers. Because previous GDM predicts an increased risk of prediabetes, which itself is associated with microalbuminuria, we hypothesized that current glucose intolerance may confound any association between GDM and microalbuminuria.
OBJECTIVE
The purpose of this study was to evaluate the relative impact of gestational and current dysglycemia on postpartum microalbuminuria in a cohort of women reflecting the full spectrum of gestational glucose tolerance from normal to mildly abnormal to GDM.
DESIGN/SETTING/PARTICIPANTS: In this prospective observational cohort study, 320 women underwent a glucose challenge test (GCT) and an oral glucose tolerance test (OGTT) in pregnancy, which identified 100 women with GDM, 58 with gestational impaired glucose tolerance, 90 with an abnormal GCT but a normal OGTT, and 72 with a normal GCT and OGTT. At 3 years postpartum, they underwent measurement of urine microalbumin and a repeat OGTT that identified 63 women with glucose intolerance (prediabetes/diabetes).
RESULTS
The postpartum urine microalbumin to creatinine ratio did not differ among the 4 gestational glucose tolerance groups (P = .23). Furthermore, on logistic regression analysis, GDM did not independently predict an elevated urine microalbumin to creatinine ratio of ≥1.5 g/mol of creatinine (odds ratio, 0.43; 95% confidence interval, 0.17-1.11), after adjustment for age, ethnicity, family history of diabetes, body mass index, blood pressure, estimated glomerular filtration rate, and current glucose intolerance. In contrast, current glucose intolerance independently predicted a urine microalbumin to creatinine ratio of ≥1.5 (odds ratio, 3.4; 95% confidence interval, 1.4-8.2, P = .005).
CONCLUSION
Current glucose intolerance, rather than previous GDM, may be associated with an increased risk of microalbuminuria in the early postpartum years.
背景
据报道，有妊娠期糖尿病（GDM）病史的女性与同龄人相比，微量白蛋白尿风险增加。由于既往GDM预示着糖尿病前期风险增加，而糖尿病前期本身与微量白蛋白尿相关，我们推测当前的糖耐量异常可能会混淆GDM与微量白蛋白尿之间的任何关联。
目的
本研究旨在评估在一组涵盖从正常到轻度异常再到GDM的全谱妊娠期糖耐量的女性队列中，妊娠期和当前血糖异常对产后微量白蛋白尿的相对影响。
设计/地点/参与者：在这项前瞻性观察性队列研究中，320名女性在孕期接受了葡萄糖耐量试验（GCT）和口服葡萄糖耐量试验（OGTT），其中100名女性患有GDM，58名患有妊娠期糖耐量受损，90名GCT异常但OGTT正常，72名GCT和OGTT均正常。产后3年，她们接受了尿微量白蛋白测量和重复的OGTT，其中63名女性被诊断为糖耐量异常（糖尿病前期/糖尿病）。
结果
4个妊娠期糖耐量组之间的产后尿微量白蛋白与肌酐比值无差异（P = 0.23）。此外，在逻辑回归分析中，在调整年龄、种族、糖尿病家族史、体重指数、血压、估计肾小球滤过率和当前糖耐量异常后，GDM并不能独立预测尿微量白蛋白与肌酐比值≥1.5 g/mol肌酐升高（比值比，0.43；95%置信区间，0.17 - 1.11）。相比之下，当前糖耐量异常可独立预测尿微量白蛋白与肌酐比值≥1.5（比值比，3.4；95%置信区间，1.4 - 8.2，P = 0.005）。
结论
在产后早期，可能是当前的糖耐量异常而非既往的GDM与微量白蛋白尿风险增加有关。
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