McWhorter Ketrell L, Bowers Katherine, Dolan Lawrence M, Deka Ranjan, Jackson Chandra L, Khoury Jane C
Department of Environmental Health, College of Medicine, University of Cincinnati, Cincinnati, Ohio, USA.
Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.
BMJ Open. 2018 Mar 30;8(3):e019617. doi: 10.1136/bmjopen-2017-019617.
Despite improvements in treatment modalities, large-for-gestational age (LGA) prevalence has remained between 30% and 40% among infants of mothers with type 1 insulin-dependent diabetes mellitus (TIDM). Our objective was to estimate LGA prevalence and examine the association between gestational weight gain (GWG) and prepregnancy body mass index (BMI) with LGA among mothers with TIDM.
Cross-sectional study.
Regional data in Cincinnati, Ohio, from the Diabetes in Pregnancy Program Project (PPG), a prospective cohort for the period 1978-1993; national data from Consortium on Safe Labor (CSL), a multicentre cross-sectional study for the period 2002-2008.
The study included 333 pregnancies in the PPG and 358 pregnancies in the CSL. Pregnancies delivered prior to 23 weeks' gestation were excluded. Women with TIDM in the PPG were identified according to physician confirmation of ketoacidosis, and/or c-peptide levels, and by International Classification of Diseases, ninth version codes within the CSL. LGA was identified as birth weight >90th percentile according to gestational age, race and sex.
LGA at birth.
Mean±SD maternal age at delivery was 26.4±5.1 years for PPG women and 27.5±6.0 years for CSL women, p=0.008. LGA prevalence did not significantly differ between cohorts (PPG: 40.2% vs CSL: 36.6%, p=0.32). More women began pregnancy as overweight in the later cohort (PPG (16.8%) vs CSL (27.1%), p<0.001). GWG exceeding Institute of Medicine (IOM) guidelines was higher in the later CSL (56.2%) vs PPG (42.3%) cohort, p<0.001. Normal-weight women with GWG within IOM guidelines had a lower LGA prevalence in CSL (PPG: 30.6% vs CSL: 13.7%), p=0.001.
Normal-weight women with GWG within IOM guidelines experienced a lower LGA prevalence, supporting the importance of adherence to IOM guidelines for GWG to reduce LGA. High BMI and GWG may be hindering a reduction in LGA prevalence.
尽管治疗方式有所改进，但在患有1型胰岛素依赖型糖尿病（TIDM）的母亲所生婴儿中，大于胎龄儿（LGA）的患病率仍在30%至40%之间。我们的目的是估计LGA的患病率，并研究TIDM母亲的孕期体重增加（GWG）和孕前体重指数（BMI）与LGA之间的关联。
横断面研究。
来自俄亥俄州辛辛那提市妊娠糖尿病项目（PPG）的区域数据，这是一项1978 - 1993年期间的前瞻性队列研究；来自安全分娩联盟（CSL）的全国数据，这是一项2002 - 2008年期间的多中心横断面研究。
该研究纳入了PPG中的333例妊娠和CSL中的358例妊娠。排除妊娠23周前分娩的情况。PPG中患有TIDM的女性根据医生对酮症酸中毒的确认和/或C肽水平进行识别，CSL中则根据国际疾病分类第九版编码进行识别。LGA根据胎龄、种族和性别被定义为出生体重>第90百分位数。
出生时为LGA。
PPG组女性分娩时的平均±标准差年龄为26.4±5.1岁，CSL组为27.5±6.0岁，p = 0.008。两组队列中LGA的患病率无显著差异（PPG：40.2% vs CSL：36.6%，p = 0.32）。在后期队列中，超重开始妊娠的女性更多（PPG（16.8%）vs CSL（27.1%），p < 0.001）。CSL后期队列中超过医学研究所（IOM）指南的GWG高于PPG队列（56.2% vs 42.3%），p < 0.001。CSL中GWG在IOM指南范围内的正常体重女性LGA患病率较低（PPG：30.6% vs CSL：13.7%），p = 0.001。
GWG在IOM指南范围内的正常体重女性LGA患病率较低，这支持了遵循IOM指南控制GWG以降低LGA的重要性。高BMI和GWG可能阻碍了LGA患病率的降低。
