Iwama Noriyuki, Sugiyama Takashi, Metoki Hirohito, Kusaka Hideto, Maki Jota, Nishigori Hidekazu, Yaegashi Nobuo, Sagawa Norimasa, Hiramatsu Yuji, Toyoda Nagayasu
Department of Obstetrics and Gynecology, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan; Department of Obstetrics and Gynecology, Osaki Citizen Hospital, Osaki, Miyagi, Japan.
Department of Obstetrics and Gynecology, Ehime University Graduate School of Medicine, Toon, Ehime, Japan.
Diabetes Res Clin Pract. 2017 Oct;132:10-18. doi: 10.1016/j.diabres.2017.07.017. Epub 2017 Jul 22.
There is no previous study comparing the predictive ability of maternal pre-pregnancy body mass index (BMI) versus a 75-g oral glucose tolerance test (OGTT) in early pregnancy for large-for-gestational-age (LGA) infants.
This multi-institutional prospective cohort study included 966 pregnant Japanese women. A multiple logistic regression model was applied to compare the effect size of pre-pregnancy BMI, fasting plasma glucose (PG), and 1- and 2-h PG levels after a 75-g OGTT performed before 22weeks gestation for LGA. After these variables were included separately into the model as per continuous variables 1 standard deviation (SD) increase, they were included simultaneously.
When pre-pregnancy BMI, fasting PG, and 1- and 2-h PG after a 75-g OGTT were separately included in the model, the adjusted odds ratios (ORs) for LGA per 1 SD increase in pre-pregnancy BMI, fasting, and 1- and 2-h PG were 1.55 (95% confidence interval [CI]: 1.26-1.91), 1.26 (95% CI: 1.03-1.54), 0.99 (95% CI: 0.78-1.25), and 1.17 (95% CI: 0.93-1.49), respectively. When these variables were included simultaneously, the adjusted ORs per 1 SD increase in pre-pregnancy BMI, fasting, and 1- and 2-h PG were 1.52 (95% CI: 1.23-1.88), 1.19 (95% CI: 0.96-1.46), 0.77 (95% CI: 0.57-1.03), and 1.30 (95% CI: 0.96-1.76), respectively.
Maternal pre-pregnancy BMI was more strongly associated with LGA compared with a 75-g OGTT in early pregnancy. Health-care providers should recognize that women with a higher pre-pregnancy BMI carry a higher risk for having LGA infants regardless of the results of a 75-g OGTT.
既往尚无研究比较孕早期孕妇孕前体重指数（BMI）与75克口服葡萄糖耐量试验（OGTT）对大于胎龄（LGA）儿的预测能力。
这项多机构前瞻性队列研究纳入了966名日本孕妇。应用多元逻辑回归模型，比较孕前BMI、空腹血糖（PG）以及妊娠22周前进行75克OGTT后的1小时和2小时PG水平升高1个标准差（SD）对LGA的效应大小。这些变量分别作为连续变量按1个SD的增加纳入模型后，再同时纳入。
当分别将孕前BMI、空腹PG以及75克OGTT后的1小时和2小时PG纳入模型时，孕前BMI、空腹、1小时和2小时PG每增加1个SD，LGA的校正比值比（OR）分别为1.55（95%置信区间[CI]：1.26 - 1.91）、1.26（95%CI：1.03 - 1.54）、0.99（95%CI：0.78 - 1.25）和1.17（95%CI：0.93 - 1.49）。当这些变量同时纳入时，孕前BMI、空腹、1小时和2小时PG每增加1个SD的校正OR分别为1.52（95%CI：1.23 - 1.88）、1.19（95%CI：0.96 - 1.46）、0.77（95%CI：0.57 - 1.03）和1.30（95%CI：0.96 - 1.76）。
与孕早期75克OGTT相比，孕妇孕前BMI与LGA的关联更强。医疗保健人员应认识到，无论75克OGTT结果如何，孕前BMI较高的女性生育LGA儿的风险更高。
