School of Health and Social Care, University of Lincoln, Lincoln, U.K.
Division of Clinical and Population Sciences, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, U.K.
Diabetes Care. 2019 May;42(5):810-815. doi: 10.2337/dc18-2212. Epub 2019 Feb 14.
Continuous glucose monitoring (CGM) provides far greater detail about fetal exposure to maternal glucose across the 24-h day. Our aim was to examine the role of temporal glucose variation on the development of large for gestational age (LGA) infants in women with treated gestational diabetes mellitus (GDM).
We performed a prospective observational study of 162 pregnant women with GDM in specialist multidisciplinary antenatal diabetes clinics. Participants undertook 7-day masked CGM at 30-32 weeks' gestation. Standard summary indices and glycemic variability measures of CGM were calculated. Functional data analysis was applied to determine differences in temporal glucose profiles. LGA was defined as birth weight ≥90th percentile adjusted for infant sex, gestational age, maternal BMI, ethnicity, and parity.
Mean glucose was significantly higher in women who delivered an LGA infant (6.2 vs. 5.8 mmol/L, = 0.025, or 111.6 mg/dL vs. 104.4 mg/dL). There were no significant differences in percentage time in, above, or below the target glucose range or in glucose variability measures (all > 0.05). Functional data analysis revealed that the higher mean glucose was driven by a significantly higher glucose for 6 h overnight (0030-0630 h) in mothers of LGA infants (6.0 ± 1.0 mmol/L vs. 5.5 ± 0.8 mmol/L, = 0.005, and 108.0 ± 18.0 mg/dL vs. 99.0 ± 14.4 mg/dL).
Mothers of LGA infants run significantly higher glucose overnight compared with mothers without LGA infants. Detecting and addressing nocturnal glucose control may help to further reduce rates of LGA in women with GDM.
连续血糖监测（CGM）能更详细地反映胎儿在 24 小时内暴露于母体葡萄糖的情况。我们旨在研究妊娠期糖尿病（GDM）女性中，血糖波动对巨大儿（LGA）发生的作用。
我们对在多学科专科产前糖尿病诊所就诊的 162 例 GDM 孕妇进行了前瞻性观察研究。参与者在 30-32 孕周时接受 7 天的 CGM 掩蔽检测。计算了 CGM 的标准汇总指标和血糖变异性测量值。应用功能数据分析来确定时间血糖谱的差异。巨大儿定义为出生体重≥按婴儿性别、胎龄、母亲 BMI、种族和产次调整的第 90 百分位数。
分娩 LGA 婴儿的女性平均血糖明显更高（6.2 与 5.8 mmol/L， = 0.025，或 111.6 与 104.4 mg/dL）。目标血糖范围内、以上或以下的时间百分比或血糖变异性测量值均无显著差异（均 > 0.05）。功能数据分析显示，LGA 母亲夜间（0030-0630 h）的平均血糖显著升高，高 6 h（6.0 ± 1.0 mmol/L 与 5.5 ± 0.8 mmol/L， = 0.005，108.0 ± 18.0 与 99.0 ± 14.4 mg/dL）。
与无 LGA 婴儿的母亲相比，LGA 婴儿的母亲夜间血糖明显升高。检测和解决夜间血糖控制问题可能有助于进一步降低 GDM 女性的 LGA 发生率。
