Wahlberg Jeanette, Ekman Bertil, Nyström Lennarth, Hanson Ulf, Persson Bengt, Arnqvist Hans J
Department of Endocrinology and Department of Medical and Health Sciences, Linköping University, Linköping, Sweden; Department of Endocrinology and Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden.
Department of Endocrinology and Department of Medical and Health Sciences, Linköping University, Linköping, Sweden.
Diabetes Res Clin Pract. 2016 Apr;114:99-105. doi: 10.1016/j.diabres.2015.12.017. Epub 2016 Jan 12.
To investigate how glucose levels at diagnosis of gestational diabetes (GDM) are associated with infant birth weight and long-term risk of manifest diabetes mellitus in the mother.
In a case control study GDM pregnancies (n=2085) were compared with non-GDM pregnancies matched for day of delivery and obstetric unit (n=3792). GDM was defined as capillary blood glucose (cB-glucose) ≥9.0mmol/l (plasma glucose ≥10.0mmol/l) after a 75g oral glucose tolerance test (OGTT). The GDM cohort were followed up 8.5-13.5yrs after initial diagnosis with a questionnaire, answered by 1324 GDM women (65%).
GDM women had higher mean infant birth-weight compared with controls (3682g vs. 3541g, P<0.001). In multiple linear regression analysis, birth weight was positively correlated to fasting cB-glucose at GDM diagnosis (P<0.001), increased week of gestation (P<0.001) and BMI before pregnancy (P<0.003), while 2h OGTT cB-glucose values ≥9.0mmol/l were not related. Infants born to mothers with fasting cB-glucose ≤4.5mmol/l had no increased mean birth-weight or macrosomia (≥4500g) compared to controls. In the follow up 334/1324 women (25%) of the GDM women had developed diabetes, 215 type 2 diabetes, 46 type 1 diabetes and 72 unclassified diabetes. In logistic regression fasting cB-glucose and 2h OGTT cB-glucose at diagnosis of GDM as well as BMI >25 and origin outside Europe were risk factors for manifest diabetes.
Fasting blood glucose at diagnosis of GDM gives important information besides 2h OGTT glucose about pregnancy outcome and future risk for maternal diabetes.
研究妊娠期糖尿病（GDM）诊断时的血糖水平与婴儿出生体重以及母亲患显性糖尿病的长期风险之间的关系。
在一项病例对照研究中，将2085例GDM妊娠与3792例在分娩日期和产科单位相匹配的非GDM妊娠进行比较。GDM定义为口服75g葡萄糖耐量试验（OGTT）后毛细血管血糖（cB-葡萄糖）≥9.0mmol/l（血浆葡萄糖≥10.0mmol/l）。对GDM队列在初次诊断后8.5 - 13.5年进行随访，通过问卷调查进行，1324例GDM女性（65%）进行了回答。
与对照组相比，GDM女性的婴儿平均出生体重更高（3682g对3541g，P<0.001）。在多元线性回归分析中，出生体重与GDM诊断时的空腹cB-葡萄糖呈正相关（P<0.001），与妊娠周数增加（P<0.001）和孕前BMI呈正相关（P<0.003），而2小时OGTT cB-葡萄糖值≥9.0mmol/l则无相关性。空腹cB-葡萄糖≤4.5mmol/l的母亲所生婴儿与对照组相比，平均出生体重或巨大儿（≥4500g）并无增加。在随访中，1324例GDM女性中有334例（25%）患糖尿病，其中215例为2型糖尿病，46例为1型糖尿病，72例为未分类糖尿病。在逻辑回归中，GDM诊断时的空腹cB-葡萄糖和2小时OGTT cB-葡萄糖以及BMI>25和非欧洲血统是患显性糖尿病的危险因素。
GDM诊断时的空腹血糖除了2小时OGTT血糖外，还能为妊娠结局和母亲未来患糖尿病的风险提供重要信息。
