Guillemette L, Durksen A, Rabbani R, Zarychanski R, Abou-Setta A M, Duhamel T A, McGavock J M, Wicklow B
Children's Hospital Research Institute of Manitoba, University of Manitoba, Winnipeg, Manitoba, Canada.
George &Fay Yee Center for Healthcare Innovation, and Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada.
Int J Obes (Lond). 2017 Jul;41(7):999-1004. doi: 10.1038/ijo.2017.65. Epub 2017 Mar 13.
Hyperglycemia in pregnancy is associated with increased risk of offspring childhood obesity. Treatment reduces macrosomia; however, it is unclear if this effect translates into a reduced risk of childhood obesity. We performed a systematic review and meta-analysis of randomized controlled trials to evaluate the efficacy and safety of intensive glycemic management in pregnancy in preventing childhood obesity.
We searched MEDLINE, EMBASE, CENTRAL and ClinicalTrials.gov up to February 2016 and conference abstracts from 2010 to 2015. Two reviewers independently identified randomized controlled trials evaluating intensive glycemic management interventions for hyperglycemia in pregnancy and included four of the 383 citations initially identified. Two reviewers independently extracted study data and evaluated internal validity of the studies using the Cochrane Collaboration's Risk of Bias tool. Data were pooled using random-effects models. Statistical heterogeneity was quantified using the I test. The primary outcome was age- and sex-adjusted childhood obesity. Secondary outcomes included childhood weight and waist circumference and maternal hypoglycemia during the trial (safety outcome).
The four eligible trials (n=767 children) similarly used lifestyle and insulin to manage gestational hyperglycemia, but only two measured offspring obesity and waist circumference and could be pooled for these outcomes. We found no association between intensive gestational glucose management and childhood obesity at 7-10 years of age (relative risk 0.89, 95% confidence interval (CI) 0.65 to 1.22; two trials; n=568 children). Waist circumference also did not differ between treatment and control arms (mean difference, -2.68 cm; 95% CI, -8.17 to 2.81 cm; two trials; n=568 children).
Intensive gestational glycemic management is not associated with reduced childhood obesity in offspring, but randomized data is scarce. Long-term follow-up of trials should be prioritized and comprehensive measures of childhood metabolic risk should be considered as outcomes in future trials.
孕期高血糖与子代儿童期肥胖风险增加相关。治疗可降低巨大儿的发生率；然而，尚不清楚这种效果是否能转化为降低儿童期肥胖的风险。我们进行了一项随机对照试验的系统评价和荟萃分析，以评估孕期强化血糖管理在预防儿童期肥胖方面的疗效和安全性。
我们检索了截至2016年2月的MEDLINE、EMBASE、CENTRAL和ClinicalTrials.gov以及2010年至2015年的会议摘要。两名研究者独立识别评估孕期高血糖强化血糖管理干预措施的随机对照试验，最初识别的383篇文献中纳入了4篇。两名研究者独立提取研究数据，并使用Cochrane协作网的偏倚风险工具评估研究的内部效度。采用随机效应模型合并数据。使用I²检验对统计异质性进行量化。主要结局为年龄和性别校正后的儿童期肥胖。次要结局包括儿童期体重、腰围以及试验期间的母体低血糖（安全性结局）。
四项符合条件的试验（n = 767名儿童）同样采用生活方式和胰岛素治疗妊娠期高血糖，但只有两项测量了子代肥胖和腰围，且这两项结局可进行合并分析。我们发现，强化妊娠期血糖管理与7至10岁儿童期肥胖之间无关联（相对危险度0.89，95%置信区间（CI）0.65至1.22；两项试验；n = 568名儿童）。治疗组和对照组的腰围也无差异（平均差值，-2.68 cm；95% CI，-8.17至2.81 cm；两项试验；n = 568名儿童）。
强化妊娠期血糖管理与子代儿童期肥胖风险降低无关，但随机对照试验数据较少。应优先对试验进行长期随访，并在未来试验中考虑将儿童期代谢风险的综合指标作为结局指标。
