Popova Polina, Tkachuk Alexandra, Dronova Alexandra, Gerasimov Andrey, Kravchuk Ekaterina, Bolshakova Maria, Rozdestvenskaya Olga, Demidova Ksenia, Nikolaeva Alla, Grineva Elena
Institute of Endocrinology, Almazov Federal North-West Medical Research Centre, Saint Petersburg, Russia -
Minerva Endocrinol. 2016 Dec;41(4):477-85.
The aim of this study was to evaluate the associations between fasting glycemia (FG) at the first prenatal visit and adverse pregnancy outcomes.
Medical records of 1584 pregnant women with a recorded level of FG <7 mmol/L before 24 weeks of gestation and delivery after 24 weeks were examined 823 of them underwent oral glucose tolerance test (OGTT) at 24-32 weeks of pregnancy. FG values were devided into five groups starting with <4.1 mmol/L as the first group, with subsequent increases of 0.5 mmol/L between groups and >5.6 mmol/L as the last group. The main outcomes were gestational diabetes mellitus (GDM) development, macrosomia, primary cesarean delivery, shoulder dystocia or birth injury.
With increasing FG levels at first prenatal visit, the frequency of GDM (among women who underwent OGTT) increased from 18.3% in the lowest category to 44.4% in the highest (odds ratio (OR) 2.94; 95% confidence interval [CI]: 1.39-6.19) and the frequency of hyperbilirubinemia increased from 4.5 to 18% respectively (OR 4.7; 95% CI: 1.8-12.5). After adjustment for maternal age and BMI, only the highest glucose category (5.6<FG<7 mmol/L) was significantly associated with the increased risk of the above mentioned outcomes. The frequency of shoulder dystocia/birth injury (OR 24.5; 95% CI: 2.8-214.8) and preeclampsia (OR 2.7; 95% CI: 1.2-5.9) was increased in the highest glucose category compared to the intermediary categories.
Only the highest glucose category (5.6<FG<7 mmol/L) at the first prenatal visit was strongly associated with some adverse pregnancy outcomes.
本研究旨在评估首次产前检查时的空腹血糖（FG）与不良妊娠结局之间的关联。
检查了1584名孕妇的病历，这些孕妇在妊娠24周前记录的FG水平<7 mmol/L且在24周后分娩，其中823人在妊娠24 - 32周时进行了口服葡萄糖耐量试验（OGTT）。FG值分为五组，以<4.1 mmol/L为第一组，随后每组增加0.5 mmol/L，最后一组>5.6 mmol/L。主要结局为妊娠期糖尿病（GDM）的发生、巨大儿、初次剖宫产、肩难产或产伤。
随着首次产前检查时FG水平的升高，GDM（在进行OGTT的女性中）的发生率从最低类别中的18.3%增加到最高类别中的44.4%（优势比（OR）2.94；95%置信区间[CI]：1.39 - 6.19），高胆红素血症的发生率分别从4.5%增加到18%（OR 4.7；95% CI：1.8 - 12.5）。在调整了产妇年龄和BMI后，只有最高血糖类别（5.6<FG<7 mmol/L）与上述结局风险增加显著相关。与中间类别相比，最高血糖类别中肩难产/产伤（OR 24.5；95% CI：2.8 - 214.8）和先兆子痫（OR 2.7；95% CI：1.2 - 5.9）的发生率增加。
只有首次产前检查时最高血糖类别（5.6<FG<7 mmol/L）与一些不良妊娠结局密切相关。
