Paris 13 University, Sorbonne Paris Cité, AP-HP, Jean-Verdier Hospital, Department of Endocrinology-Diabetology-Nutrition, CRNH-IdF, CINFO, 93143 Bondy, France; Paris 13 University, Sorbonne Paris Cité, UMR U557 INSERM, U11125 INRA CNAM, Université Paris 13, Unité de Recherche Épidémiologique Nutritionnelle, 93000 Bobigny, France.
Université Denis-Diderot, AP-HP, Unité de Recherche Clinique Saint-Louis-Lariboisière, 75010 Paris, France.
Diabetes Metab. 2020 Sep;46(4):311-318. doi: 10.1016/j.diabet.2019.09.002. Epub 2019 Oct 30.
Our study evaluated the performance of a selective screening strategy for hyperglycaemia in pregnancy (HIP) based on the presence of risk factors (RFs; body mass index≥25kg/m, age≥35years, family history of diabetes, personal history of HIP or macrosomic infant) to diagnose HIP and to predict HIP-related events.
Women with no known diabetes who had undergone complete universal screening (early, before 22weeks of gestation and, if normal, in the second part of pregnancy) at our department (2012-2016) were selected, resulting in four groups of women according to the presence of HIP and/or RFs, with a predefined composite endpoint (preeclampsia or large-for-gestational-age infant or shoulder dystocia).
Included were 4518 women: 23.5% had HIP and 71.1% had at least one RF. The distribution among our four groups was: HIP-/RF- (n=1144); HIP-/RF+ (n=2313); HIP+/RF- (n=163); and HIP+/RF+ (n=898). HIP was more frequent when RFs were present rather than absent (33.1% vs 15.4%, respectively; P<0.001). Incidence of the composite endpoint differed significantly (P<0.0001) across groups [HIP-/RF- 6.3%; HIP-/RF+ 13.2%; HIP+/RF- 8.6%; and HIP+/RF+ 17.1% (HIP effect: P<0.05; RF effect: P<0.001; interaction HIP * RF: P=0.94)] and significantly increased with the number of RFs (no RF: 6.3%, 1 RF: 10.8%, 2 RFs: 14.7%, 3 RFs: 28.0%, 4-5 RFs: 25.0%; P<0.0001).
RFs are predictive of HIP, although 15.4% of women with HIP have no RFs. Also, irrespective of HIP status, RFs are predictive of HIP-related events, suggesting that overweight/obesity, the only modifiable RFs, could be targets of interventions to improve pregnancy prognosis.
我们的研究评估了一种基于危险因素（BMI≥25kg/m、年龄≥35 岁、糖尿病家族史、既往妊娠糖尿病或巨大儿史）存在情况的妊娠高血糖症（HIP）选择性筛查策略的性能，以诊断 HIP 和预测与 HIP 相关的事件。
选择了 2012 年至 2016 年在我院进行过全面常规筛查（早期，妊娠 22 周前，若正常，则在妊娠后期）且无已知糖尿病的女性，根据是否存在 HIP 和/或 RFs 以及预先定义的复合终点（子痫前期或巨大儿或肩难产）将这些女性分为四组。
共纳入 4518 名女性：23.5%患有 HIP，71.1%有至少一种 RF。我们的四组分布如下：HIP-/RF-（n=1144）；HIP-/RF+（n=2313）；HIP+/RF-（n=163）；HIP+/RF+（n=898）。RF 存在时，HIP 更为常见（分别为 33.1%和 15.4%，P<0.001）。复合终点的发生率在各组之间有显著差异（P<0.0001）[HIP-/RF-6.3%；HIP-/RF+13.2%；HIP+/RF-8.6%；HIP+/RF+17.1%（HIP 效应：P<0.05；RF 效应：P<0.001；HIP*RF 交互作用：P=0.94）]，且随着 RFs 数量的增加而显著增加（无 RF：6.3%，1 RF：10.8%，2 RFs：14.7%，3 RFs：28.0%，4-5 RFs：25.0%；P<0.0001）。
RFs 可预测 HIP，但 15.4%的 HIP 女性没有 RFs。此外，无论 HIP 状态如何，RFs 均可预测与 HIP 相关的事件，这表明超重/肥胖（唯一可改变的 RFs）可能是改善妊娠预后的干预目标。
