School of Healthcare, University of Leeds, Leeds, UK.
Leeds Institute for Data Analytics, University of Leeds, Leeds, UK.
BJOG. 2019 Jul;126(8):973-982. doi: 10.1111/1471-0528.15659. Epub 2019 Mar 19.
To explore the separate effects of being 'at risk' of gestational diabetes mellitus (GDM) and screening for GDM, and of raised fasting plasma glucose (FPG) and clinical diagnosis of GDM, on the risk of late stillbirth.
Prospective case-control study.
Forty-one maternity units in the UK.
Women who had a stillbirth ≥28 weeks of gestation (n = 291) and women with an ongoing pregnancy at the time of interview (n = 733).
Causal mediation analysis explored the joint effects of (i) 'at risk' of GDM and screening for GDM and (ii) raised FPG (≥5.6 mmol/l) and clinical diagnosis of GDM on the risks of late stillbirth. Adjusted odds ratios (aOR) were estimated by logistic regression adjusted for confounders identified by directed acyclic graphs.
Screening for GDM and FPG levels RESULTS: Women 'at risk' of GDM, but not screened, experienced 44% greater risk of late stillbirth than those not 'at risk' (aOR 1.44, 95% CI 1.01-2.06). Women 'at risk' of GDM who were screened experienced no such increase (aOR 0.98, 95% CI 0.70-1.36). Women with raised FPG not diagnosed with GDM experienced four-fold greater risk of late stillbirth than women with normal FPG (aOR 4.22, 95% CI 1.04-17.02). Women with raised FPG who were diagnosed with GDM experienced no such increase (aOR 1.10, 95% CI 0.31-3.91).
Optimal screening and diagnosis of GDM mitigate the higher risks of late stillbirth in women 'at risk' of GDM and/or with raised FPG. Failure to diagnose GDM leaves women with raised FPG exposed to avoidable risk of late stillbirth.
Risk of #stillbirth in gestational diabetes is mitigated by effective screening and diagnosis.
探讨妊娠期糖尿病（GDM）风险和 GDM 筛查、空腹血糖升高（FPG）和 GDM 临床诊断分别对晚期死胎风险的影响。
前瞻性病例对照研究。
英国 41 家产科单位。
≥28 周妊娠的死胎妇女（n=291）和接受访谈时仍处于妊娠状态的妇女（n=733）。
因果中介分析探讨了（i）“有患 GDM 的风险”和 GDM 筛查以及（ii）FPG 升高（≥5.6mmol/L）和 GDM 临床诊断对晚期死胎风险的联合影响。通过逻辑回归对由有向无环图确定的混杂因素进行调整，估计调整后的比值比（aOR）。
GDM 筛查和 FPG 水平。
有 GDM 风险但未接受筛查的妇女，其晚期死胎风险比无风险者高 44%（aOR 1.44，95%CI 1.01-2.06）。有 GDM 风险且接受筛查的妇女并未出现这种增加（aOR 0.98，95%CI 0.70-1.36）。FPG 升高但未诊断为 GDM 的妇女，其晚期死胎风险是 FPG 正常妇女的 4 倍（aOR 4.22，95%CI 1.04-17.02）。FPG 升高且被诊断为 GDM 的妇女，其晚期死胎风险没有增加（aOR 1.10，95%CI 0.31-3.91）。
GDM 的最佳筛查和诊断可降低“有患 GDM 风险”和/或 FPG 升高的妇女的晚期死胎风险。未能诊断 GDM 使 FPG 升高的妇女面临可避免的晚期死胎风险。
有效的筛查和诊断可降低妊娠期糖尿病的#死胎风险。
