Osmundson Sarah S, Norton Mary E, El-Sayed Yasser Y, Carter Susan, Faig Jeffrey C, Kitzmiller John L
Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, California.
Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, California.
Am J Perinatol. 2016 Jan;33(2):172-9. doi: 10.1055/s-0035-1563715. Epub 2015 Sep 7.
To examine whether women with prediabetes benefit from early treatment for gestational diabetes mellitus (GDM).
Women with a glycosylated hemoglobin A1C (A1C) of 5.7 to 6.4% at <14 weeks were recruited. Participants were randomized to usual care or treatment for GDM with diet, blood glucose monitoring, and insulin as needed. The primary outcome was a 75-g oral glucose tolerance test at 26 to 28 weeks. Secondary outcomes included cesarean delivery, birthweight, weight gain, and A1C change.
Between May 2012 and June 2014, 95 women were enrolled and 83 had data for analysis; 42 were randomized to treatment and 41 to usual care. The groups were similar in baseline characteristics with 40% obese. There was no difference in the primary outcome (treatment 45.2% vs. control 56.1%; relative risk [RR] 0.80; 95% confidence interval [CI] 0.53-1.24) except that women in the treatment group had a significantly lower A1C over time than women in the control group (p = 0.04). Nonobese women (n = 50) treated for GDM experienced a 50% reduction in GDM compared with controls (29.6 vs. 60.9%; RR 0.49; 95% CI 0.25-0.95).
Early treatment for women with a first-trimester A1C of 5.7 to 6.4% did not significantly reduce the risk of GDM except in nonobese women.
探讨糖尿病前期女性是否能从妊娠期糖尿病（GDM）的早期治疗中获益。
招募孕14周前糖化血红蛋白A1C（A1C）为5.7%至6.4%的女性。参与者被随机分为接受常规护理或接受GDM治疗，治疗方式包括饮食、血糖监测以及必要时使用胰岛素。主要结局是孕26至28周时的75克口服葡萄糖耐量试验。次要结局包括剖宫产、出生体重、体重增加以及A1C变化。
2012年5月至2014年6月期间，95名女性入组，83名有数据可供分析；42名被随机分配至治疗组，41名被分配至常规护理组。两组基线特征相似，肥胖者占40%。主要结局无差异（治疗组45.2% vs. 对照组56.1%；相对危险度[RR] 0.80；95%置信区间[CI] 0.53 - 1.24），但治疗组女性随时间推移的A1C显著低于对照组女性（p = 0.04）。接受GDM治疗的非肥胖女性（n = 50）与对照组相比，GDM发生率降低了50%（29.6% vs. 60.9%；RR 0.49；95% CI 0.25 - 0.95）。
孕早期A1C为5.7%至6.4%的女性进行早期治疗，除非肥胖女性外，并未显著降低GDM风险。
