Diabetes Centre, Bankstown-Lidcombe Hospital, New South Wales, Australia
School of Health Sciences, Faculty of Health and Medicine, University of Newcastle, Callaghan, New South Wales, Australia.
Diabetes Care. 2020 Jan;43(1):74-81. doi: 10.2337/dc19-0800. Epub 2019 Nov 5.
Conventional gestational diabetes mellitus (GDM) management focuses on managing blood glucose in order to prevent adverse outcomes. We hypothesized that excessive weight gain at first presentation with GDM (excessive gestational weight gain [EGWG]) and continued EGWG (cEGWG) after commencing GDM management would increase the risk of adverse outcomes, despite treatment to optimize glycemia.
Data collected prospectively from pregnant women with GDM at a single institution were analyzed. GDM was diagnosed on the basis of Australasian Diabetes in Pregnancy Society 1998 guidelines (1992-2015). EGWG means having exceeded the upper limit of the Institute of Medicine-recommended target ranges for the entire pregnancy, by GDM presentation. The relationship between EGWG and antenatal 75-g oral glucose tolerance test (oGTT) values and adverse outcomes was evaluated. Relationships were examined between cEGWG, insulin requirements, and large-for-gestational-age (LGA) infants.
Of 3,281 pregnant women, 776 (23.6%) had EGWG. Women with EGWG had higher mean fasting plasma glucose (FPG) on oGTT (5.2 mmol/L [95% CI 5.1-5.3] vs. 5.0 mmol/L [95% CI 4.9-5.0]; < 0.01), after adjusting for confounders, and more often received insulin therapy (47.0% vs. 33.6%; < 0.0001), with an adjusted odds ratio (aOR) of 1.4 (95% CI 1.1-1.7; < 0.01). aORs for each 2-kg increment of cEGWG were a 1.3-fold higher use of insulin therapy (95% CI 1.1-1.5; < 0.001), an 8-unit increase in final daily insulin dose (95% CI 5.4-11.0; < 0.0001), and a 1.4-fold increase in the rate of delivery of LGA infants (95% CI 1.2-1.7; < 0.0001).
The absence of EGWG and restricting cEGWG in GDM have a mitigating effect on oGTT-based FPG, the risk of having an LGA infant, and insulin requirements.
传统的妊娠糖尿病（GDM）管理侧重于控制血糖以预防不良结局。我们假设，在 GDM 首次就诊时体重过度增加（过度妊娠体重增加[EGWG]）和在开始 GDM 管理后继续出现 EGWG（cEGWG），尽管血糖优化治疗，也会增加不良结局的风险。
对单一机构的 GDM 孕妇前瞻性收集的数据进行了分析。GDM 基于澳大拉西亚妊娠糖尿病学会 1998 年指南（1992-2015 年）进行诊断。EGWG 是指在 GDM 就诊时，整个妊娠期间体重超过医学研究所推荐目标范围的上限。评估了 EGWG 与产前 75 克口服葡萄糖耐量试验（oGTT）值和不良结局之间的关系。还检查了 cEGWG、胰岛素需求与巨大儿（LGA）之间的关系。
在 3281 名孕妇中，有 776 名（23.6%）发生 EGWG。与 EGWG 相关的孕妇，oGTT 时平均空腹血糖（FPG）更高（5.2mmol/L [95%CI 5.1-5.3] vs. 5.0mmol/L [95%CI 4.9-5.0]；<0.01），经过混杂因素调整后，更常接受胰岛素治疗（47.0% vs. 33.6%；<0.0001），调整后的优势比（aOR）为 1.4（95%CI 1.1-1.7；<0.01）。cEGWG 每增加 2 公斤，胰岛素治疗的使用率就会增加 1.3 倍（95%CI 1.1-1.5；<0.01），最终每日胰岛素剂量增加 8 单位（95%CI 5.4-11.0；<0.0001），LGA 婴儿的分娩率增加 1.4 倍（95%CI 1.2-1.7；<0.0001）。
在 GDM 中不存在 EGWG 并限制 cEGWG 可减轻基于 oGTT 的 FPG、LGA 婴儿的风险以及胰岛素的需求。
