Center for Pregnant Women with Diabetes, Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen O, Denmark.
Department of Endocrinology, Rigshospitalet, Copenhagen, Denmark.
Diabetologia. 2018 Dec;61(12):2528-2538. doi: 10.1007/s00125-018-4736-6. Epub 2018 Sep 25.
AIMS/HYPOTHESIS: We aimed to investigate the impact of maternal gestational weight gain (GWG) during dietary treatment on fetal growth in pregnancies complicated by gestational diabetes (GDM).
This was a retrospective cohort study of 382 women consecutively diagnosed with GDM before 34 weeks' gestation with live singleton births in our centre (Center for Pregnant Women with Diabetes, Rigshospitalet, Copenhagen, Denmark) between 2011 and 2017. The women were stratified into three groups according to restricted (53%), appropriate (16%) and excessive (31%) weekly GWG during dietary treatment (using the Institute of Medicine guidelines) to estimate compliance with an energy-restricted 'diabetes diet' (6000 kJ/day [1434 kcal/day], with approximately 50% of energy intake coming from carbohydrates with a low glycaemic index, and a carbohydrate intake of 175 g/day). Insulin therapy was initiated if necessary, according to local clinical guidelines.
Glucose tolerance, HbA, weekly GWG before dietary treatment (difference between weight at GDM diagnosis and pre-pregnancy weight, divided by the number of weeks) and SD score for fetal abdominal circumference were comparable across the three groups at diagnosis of GDM at 27 ± 5 weeks (gestation time is given as weeks). The women were followed for 10 ± 5 weeks, during which 54% received supplementary insulin therapy and the average (mean) GWG during dietary treatment was 0 kg, 3 kg and 5 kg in the three groups, respectively. Excessive weekly GWG during dietary treatment, reflecting poor dietary adherence was associated with increasing HbA (p = 0.014) from diagnosis of GDM to late pregnancy and infants with a birthweight-SD score of 0.59 ± 1.6. In contrast, restricted weekly GWG during dietary treatment, reflecting strict dietary adherence, was associated with decreasing HbA (p = 0.001) from diagnosis of GDM to late pregnancy and infants with a birthweight-SD score of 0.15 ± 1.1, without increased prevalence of infants born small for gestational age. Excessive GWG during dietary treatment and late-pregnancy HbA were identified as potentially modifiable clinical predictors of infant birthweight-SD score (p = 0.02 for both variables) after correction for confounders.
CONCLUSIONS/INTERPRETATION: Restricted GWG during dietary treatment was associated with healthier fetal growth in women with GDM. GWG during dietary treatment and late-pregnancy HbA were identified as potentially modifiable clinical predictors of infant birthweight-SD score.
目的/假设：我们旨在研究妊娠期糖尿病（GDM）患者饮食治疗期间母体体重增加（GWG）对胎儿生长的影响。
这是一项回顾性队列研究，纳入了 2011 年至 2017 年期间在丹麦哥本哈根里希特菲尔德医院（丹麦妊娠糖尿病妇女中心）连续诊断为 34 周前 GDM 的 382 名单胎活产孕妇。根据饮食治疗期间（采用医学研究所指南）的限制（53%）、适当（16%）和过度（31%）每周 GWG，将这些女性分为三组，以估计对能量限制的“糖尿病饮食”（6000 kJ/天[1434 kcal/天]，约 50%的能量来自低血糖指数碳水化合物，碳水化合物摄入量为 175 g/天）的依从性。根据当地临床指南，如果需要，会启动胰岛素治疗。
三组孕妇在诊断为 GDM 时（27±5 周，即妊娠时间以周为单位）的葡萄糖耐量、HbA、饮食治疗前每周 GWG（GDM 诊断时体重与孕前体重之差除以周数）和胎儿腹围 SD 评分相似。这些女性随访了 10±5 周，在此期间，54%的孕妇接受了补充胰岛素治疗，三组孕妇的平均（平均）GWG 分别为 0kg、3kg 和 5kg。饮食治疗期间每周 GWG 过度，反映了饮食依从性差，与从 GDM 诊断到妊娠晚期的 HbA 升高有关（p=0.014），并与出生体重-SD 评分增加至 0.59±1.6 有关。相比之下，饮食治疗期间每周 GWG 受限，反映了严格的饮食依从性，与从 GDM 诊断到妊娠晚期的 HbA 降低有关（p=0.001），与出生体重-SD 评分降低至 0.15±1.1 有关，而不会增加小于胎龄儿的发生率。饮食治疗期间的 GWG 过度和妊娠晚期的 HbA 被确定为婴儿出生体重-SD 评分的潜在可改变的临床预测因素（两个变量的校正后 p 值均为 0.02）。
结论/解释：在 GDM 女性中，饮食治疗期间的限制 GWG 与更健康的胎儿生长有关。GWG 在饮食治疗期间和妊娠晚期的 HbA 被确定为婴儿出生体重-SD 评分的潜在可改变的临床预测因素。
