Department of Endocrinology, Lasarettsgatan 15, Skane University Hospital, S-221 85, Lund, Sweden.
Department of Clinical Sciences, Lund University, Lund, Sweden.
BMC Pregnancy Childbirth. 2020 Feb 3;20(1):74. doi: 10.1186/s12884-020-2741-5.
Overweight and gestational diabetes are risk factors for pregnancy complications. We hypothesized that the metabolic impact of overweight on pregnancy outcome, would be different if it was combined with a predisposition for diabetes. The aim of this study was to compare the outcome of pregnancies in women with diabetes diagnosed later in life, to the outcome of pregnancies of women who did not develop diabetes.
Women in a population-based cohort who also were registered in the Swedish Medical Birth Registry (n = 4738) were included. A predisposition for diabetes (GDM or diabetes after pregnancy) was found in 455 pregnancies. The number of pregnancies with maternal BMI ≥ 25 kg/m and without diabetes were 2466, and in 10,405 pregnancies the mother had a BMI < 25 kg/m without diabetes at any time. Maternal BMI, gestational length, gestational weight gain, frequency of caesarean section, infant birth weight, frequency of large for gestational age (LGA) and Apgar score were retrospectively compared.
Pregnancies with normal maternal BMI ≤25 kg/m with predisposition for diabetes had a higher frequency of LGA (11.6% vs. 2.9%; p < 0.001), a higher frequency of macrosomia (28.6% vs. 17.6%; p < 0.001), and a shorter gestational length (39.7 vs. 40 weeks; p = 0.08) when compared to pregnancies in women without a predisposition for diabetes. In addition, pregnancies with both maternal predisposition for diabetes and BMI ≥ 25 kg/m there was a higher frequency of LGA (23.3% vs. 7.1%; p < 0.001), caesarean section (24.0% vs. 14.9%, p = 0.031) compared to pregnancies in women who were only overweight. A predisposition for diabetes significantly increases the risk of macrosomia (OR1.5; 95% CI 1.07-2.15; p = 0.02).
In pregnancy, there is an increased frequency of LGA, macrosomia and caesarean section if the woman has a predisposition for diabetes. The frequency of overweight young women is increasing, and it is urgent to identify pregnant women with a predisposition to diabetes. How to distinguish the women with the highest risk for adverse pregnancy outcome and the highest risk of future disease, remains to be studied.
超重和妊娠糖尿病是妊娠并发症的危险因素。我们假设，如果超重与糖尿病易感性相结合，超重对妊娠结局的代谢影响将会不同。本研究旨在比较在生命后期被诊断为糖尿病的女性的妊娠结局与未发生糖尿病的女性的妊娠结局。
在一项基于人群的队列研究中，纳入了同时在瑞典医学出生登记处（n=4738）登记的女性。在 455 例妊娠中发现存在糖尿病易感性（妊娠期糖尿病或妊娠后糖尿病）。母亲 BMI≥25kg/m2且无糖尿病的妊娠例数为 2466 例，在 10405 例母亲在任何时候 BMI<25kg/m2且无糖尿病的妊娠中。回顾性比较了母亲 BMI、妊娠长度、妊娠体重增加、剖宫产率、婴儿出生体重、巨大儿（LGA）的发生率和阿普加评分。
正常母亲 BMI≤25kg/m2且存在糖尿病易感性的妊娠 LGA 发生率较高（11.6% vs. 2.9%；p<0.001），巨大儿发生率较高（28.6% vs. 17.6%；p<0.001），妊娠长度较短（39.7 周 vs. 40 周；p=0.08）与无糖尿病易感性的妊娠相比。此外，母亲存在糖尿病易感性且 BMI≥25kg/m2的妊娠 LGA 发生率更高（23.3% vs. 7.1%；p<0.001），剖宫产率更高（24.0% vs. 14.9%，p=0.031）与仅超重的妊娠相比。糖尿病易感性显著增加了巨大儿的风险（OR1.5；95%CI 1.07-2.15；p=0.02）。
在妊娠期间，如果女性有糖尿病易感性，则 LGA、巨大儿和剖宫产的发生率会增加。年轻超重女性的比例正在增加，迫切需要识别有糖尿病易感性的孕妇。如何区分具有不良妊娠结局和未来疾病风险最高的女性，仍有待研究。
