Endocr Pract. 2019 Nov;25(11):1158-1165. doi: 10.4158/EP-2018-0558. Epub 2019 Aug 15.
Macrosomia is closely associated with gestational diabetes mellitus (GDM) but its relationship with maternal intermediate state gestational blood glucose (ISGBG; normal fasting blood glucose and 7.8 mmol/L <1 hour blood glucose [BG] <10 mmol/L or 6.7 mmol/L <2 hour BG <8.5 mmol/L) is unclear. Here, we analyzed the clinical characteristics and pregnancy outcomes and explored risk factors for macrosomia in women with ISGBG. A total of 847 women with normal glucose tolerance gestation, 330 with ISGBG, and 99 with GDM were included. Maternal and fetal clinical data were collected and 3-point BG following oral glucose tolerance test, fasting insulin, glycated hemoglobin, and blood lipids profile were measured. The incidence rate of macrosomia among the neonates of women with ISGBG was as high as 10.9%. In the ISGBG group, prepregnancy body mass index (BMI), gestational weight gain (GWG) and the proportion of women with excessive GWG (eGWG) were significantly higher in women with macrosomia compared with those who delivered a normal weight neonate. In women with ISGBG, neonate weight was positively correlated with maternal prepregnancy weight ( = 0.183, <.01), prepregnancy BMI ( = 0.135, <.01), and GWG ( = 0.255, <.01), and negatively correlated with high-density lipoprotein cholesterol ( = -0.172, <.01). Nonetheless, only eGWG was an independent risk factor (odds ratio = 3.18, 95% confidence interval = 1.26 to 7.88, <.05) for macrosomia. The risk of macrosomia in pregnant women with prepregnancy BMI <25 kg/m or BMI ≥25 kg/m and eGWG was 3.39 and 3.27 times, respectively. The incidence rate of macrosomia is increased in women with ISGBG and eGWG is the strongest independent risk factor. In order to reduce the risk for macrosomia, timely lifestyle intervention to promote appropriate weight gain during pregnancy deserves evaluation. = area under the curve; = blood glucose; = 1 hour blood glucose after OGTT; = 2 hour blood glucose after OGTT; = body mass index; = confidence interval; = excessive gestational weight gain; = fasting blood glucose; = fasting insulin; = gestational diabetes mellitus; = glycated hemoglobin; = high-density lipoprotein cholesterol; = homeostasis model assessment of insulin resistance index; = intermediate state gestation blood glucose; = low-density lipoprotein cholesterol; = natural logarithm; = mature low birth weight; = normal glucose tolerance gestation; = oral glucose tolerance test; = odds ratio; = standard deviation.
巨大儿与妊娠期糖尿病（GDM）密切相关，但与母体中间状态妊娠期血糖（ISGBG；正常空腹血糖和 1 小时血糖[BG]＜10mmol/L 或 6.7mmol/L＜2 小时 BG＜8.5mmol/L）的关系尚不清楚。在这里，我们分析了 ISGBG 妇女的临床特征和妊娠结局，并探讨了巨大儿的危险因素。纳入了 847 例糖耐量正常妊娠妇女、330 例 ISGBG 妇女和 99 例 GDM 妇女。收集了母婴临床资料，并检测了口服葡萄糖耐量试验后 3 点 BG、空腹胰岛素、糖化血红蛋白和血脂谱。ISGBG 妇女新生儿巨大儿的发生率高达 10.9%。在 ISGBG 组中，与分娩正常体重新生儿的妇女相比，巨大儿新生儿的孕妇孕前体重指数（BMI）、妊娠体重增加（GWG）和体重增加过多的妇女比例（eGWG）显著更高。在 ISGBG 妇女中，新生儿体重与母亲孕前体重（=0.183，<0.01）、孕前 BMI（=0.135，<0.01）和 GWG（=0.255，<0.01）呈正相关，与高密度脂蛋白胆固醇（=−0.172，<0.01）呈负相关。然而，只有 eGWG 是巨大儿的独立危险因素（比值比=3.18，95%置信区间=1.26-7.88，<0.05）。孕前 BMI＜25kg/m 或 BMI≥25kg/m 且 eGWG 的孕妇发生巨大儿的风险分别为 3.39 倍和 3.27 倍。ISGBG 妇女巨大儿发生率增加，eGWG 是最强的独立危险因素。为了降低巨大儿的风险，值得评估及时的生活方式干预以促进孕期适当的体重增加。AUC=曲线下面积；BG=血糖；1hBG=OGTT 后 1 小时血糖；2hBG=OGTT 后 2 小时血糖；BMI=体重指数；CI=置信区间；eGWG=过多的妊娠体重增加；FBG=空腹血糖；FINS=空腹胰岛素；GDM=妊娠期糖尿病；HbA1c=糖化血红蛋白；HDL-C=高密度脂蛋白胆固醇；HOMA-IR=稳态模型评估的胰岛素抵抗指数；ISGBG=中间状态妊娠血糖；LDL-C=低密度脂蛋白胆固醇；ln=自然对数；LGA-NBW=成熟低出生体重；NGT=正常糖耐量妊娠；OGTT=口服葡萄糖耐量试验；OR=比值比；SD=标准差。
