Discipline of Paediatrics, The University of Sydney Nepean Clinical School, Faculty of Medicine and Health, The University of Sydney, Penrith, New South Wales, Australia.
Department of Endocrinology and Diabetes, Division of Medicine, The University of Sydney Nepean Clinical School, Faculty of Medicine and Health, The University of Sydney, Penrith, New South Wales, Australia.
J Diabetes. 2020 Aug;12(8):562-572. doi: 10.1111/1753-0407.13042. Epub 2020 Apr 20.
Gestational diabetes mellitus (GDM) is one of the most common complications of pregnancy. Left untreated or poorly controlled, GDM results in adverse infant outcomes such as large for gestational age (LGA). This study aims to identify nonglycemic maternal and fetal factors predictive of LGA outcomes in pregnancies complicated by diet-managed GDM.
This was a retrospective cohort study of singleton pregnancies complicated by diet-managed GDM from 2004 to 2015. Multiple logistic regression analysis was performed on maternal and perinatal factors to identify risk factors for LGA. In addition, a subset univariate analysis was conducted for pregnancies in which fetal ultrasound abdominal circumference measurements were available at gestational weeks 18 to 22, 24 to 28, and 29 to 33.
A total of 1064 women were included, delivering 123 LGA infants. Women with higher parity (odds ratio [OR] 1.44; CI, 1.23-1.68; P < .001) and higher prepregnancy body mass index (BMI) (OR 1.09; CI, 1.06-1.12; P < .001) were more likely to have LGA infants. Maternal smoking (OR 0.30; CI, 0.14-0.62; P = .001) and higher gestational age at birth (OR 0.91; CI, 0.84-0.99; P = .018) were associated with reduced risk. Subset univariate analysis showed that fetal abdominal circumference measurements at weeks 24 to 28 and 29 to 33 beyond the 75th percentile (OR 5.92 and 13.74, respectively) and 90th percentile (OR 4.57 and 15.89, respectively) were highly predictive of LGA.
Parity, smoking status, maternal BMI, gestational age, and ultrasound fetal abdominal circumference measurements were identified as useful predictors of LGA. Presence of these predictors may prompt closer monitoring of pregnancy and early therapeutic intervention to improve management and reduce the risk of adverse fetal and maternal outcomes.
妊娠糖尿病（GDM）是妊娠最常见的并发症之一。如果不进行治疗或控制不佳，GDM 会导致不良的婴儿结局，如巨大儿（LGA）。本研究旨在确定预测饮食管理 GDM 孕妇中 LGA 结局的非血糖相关的母体和胎儿因素。
这是一项回顾性队列研究，纳入了 2004 年至 2015 年间接受饮食管理的 GDM 单胎妊娠。对母体和围产期因素进行多因素逻辑回归分析，以确定 LGA 的危险因素。此外，还对胎儿超声腹部周长测量值可获得的妊娠进行了亚组单因素分析，这些妊娠的测量值分别在妊娠 18-22 周、24-28 周和 29-33 周进行。
共纳入 1064 名女性，分娩 123 例 LGA 婴儿。较高的产次（比值比 [OR] 1.44；95%置信区间 [CI]，1.23-1.68；P < .001）和较高的孕前体重指数（OR 1.09；95%CI，1.06-1.12；P < .001）的女性更有可能分娩 LGA 婴儿。母亲吸烟（OR 0.30；95%CI，0.14-0.62；P =.001）和较高的出生胎龄（OR 0.91；95%CI，0.84-0.99；P =.018）与较低的风险相关。亚组单因素分析显示，24-28 周和 29-33 周胎儿腹部周长测量值超过第 75 百分位（OR 分别为 5.92 和 13.74）和第 90 百分位（OR 分别为 4.57 和 15.89）时，LGA 的预测性较高。
产次、吸烟状况、母体 BMI、胎龄和胎儿超声腹部周长测量值被确定为预测 LGA 的有用指标。这些预测因素的存在可能提示更密切地监测妊娠并进行早期治疗干预，以改善管理并降低不良母婴结局的风险。
