Division of Pediatric Endocrinology and Metabolism, Children's Medical Center, Osaka, Japan.
Department of Genetic Medicine, Osaka City General Hospital, Osaka, Japan.
J Diabetes Investig. 2019 Nov;10(6):1586-1589. doi: 10.1111/jdi.13046. Epub 2019 Apr 23.
AIMS/INTRODUCTION: Glucokinase-maturity-onset diabetes of the young (GCK-MODY; also known as MODY2) is a benign hyperglycemic condition, which generally does not require medical interventions. The only known exception is increased birthweight and related perinatal complications in unaffected offspring of affected women. As previous data were obtained mostly from white Europeans, the present study analyzed the pregnancy outcomes of Japanese women with GCK-MODY to better formulate the management plan for this population.
The study participants were 34 GCK-MODY families whose members were diagnosed at Osaka City General Hospital during 2010-2017. A total of 53 pregnancies (40 from 23 affected women, 13 from 11 unaffected women) were retrospectively analyzed by chart review.
Birthweights of unaffected offspring born to affected women were significantly greater as compared with those of affected offspring (P = 0.003). The risk of >4,000 g birthweight (16%), however, was lower as compared with that previously reported for white Europeans, and none of the offspring had complications related to large birthweight. Insulin treatment of the affected women resulted in a significant reduction in the birthweights of unaffected offspring. Perinatal complications including small-for-gestational age birthweight were found only in affected offspring born to insulin-treated women.
In Japanese GCK-MODY families, unaffected offspring born to affected women were heavier than affected offspring. However, insulin treatment of affected women might not be advisable because of the lower risk of macrosomic birth injury, and an increased risk of perinatal complications in affected offspring.
目的/引言:青年发病的成年型糖尿病(GCK-MODY;也称为 MODY2)是一种良性高血糖状态,通常不需要医疗干预。唯一已知的例外是受影响女性的未受影响后代的出生体重增加和相关围产期并发症。由于之前的数据主要来自白种欧洲人,本研究分析了日本 GCK-MODY 女性的妊娠结局,以便为该人群制定更好的管理计划。
本研究的参与者是 2010-2017 年在大阪市立医院诊断出的 34 个 GCK-MODY 家族的成员。通过病历回顾分析了总共 53 例妊娠(40 例来自 23 例受影响女性,13 例来自 11 例未受影响女性)。
受影响女性所生的未受影响后代的出生体重明显大于受影响后代(P=0.003)。然而,>4000g 出生体重的风险(16%)低于以前报道的白种欧洲人,并且没有后代有与大出生体重相关的并发症。受影响女性的胰岛素治疗导致未受影响后代的出生体重显著降低。仅在接受胰岛素治疗的女性所生的受影响后代中发现与小胎龄相关的围产期并发症。
在日本 GCK-MODY 家族中,受影响女性所生的未受影响后代比受影响后代更重。然而,由于巨大儿出生损伤的风险较低,并且受影响后代的围产期并发症风险增加,因此不建议对受影响女性进行胰岛素治疗。