Peking University First Hospital, Beijing, China.
J Matern Fetal Neonatal Med. 2022 Mar;35(6):1075-1080. doi: 10.1080/14767058.2020.1742690. Epub 2020 Jul 16.
To investigate the postnatal outcomes of diabetes mellitus (DM) women diagnosed according to two-hour glucose value ≥11.1 mmol/L after 24th gestational weeks in China, and to evaluate if it is suitable for DM diagnosis using the criteria that two-hour glucose value ≥11.1 mmol/L after 24th gestational weeks only. We conducted a retrospective cohort study of the pregnant women with gestational hyperglycemia participated in gestational hyperglycemia day care and delivered in Peking University First Hospital from June 2016 to May 2018. A total of 168 women diagnosed with DM according to the criteria that two-hour glucose value ≥11.1 mmol/L after 24th gestational weeks were included, and 75 DM women did the oral glucose tolerance test (OGTT) from 6 weeks to 1 year postpartum. The general information collected and analyzed included age, prepregnancy body mass index (BMI), prepregnancy weight, gestational weight gain (GWG), OGTT value during pregnancy, OGTT value of postpartum, gestational weeks, and neonatal birth weight.
There were 168 women diagnosed with DM according to the criteria that two-hour glucose value ≥11.1 mmol/L after 24th gestational weeks, and 75 (75/168, 44.6%) women underwent an OGTT from 6 weeks to 1 year postpartum. Among the women followed-up, 56 (56/75, 74.7%) women were diagnosed as hyperglycemia and 19 (19/75, 25.3%) women were diagnosed as normal glucose metabolism. In hyperglycemia women, there are eight (8/56, 10.7%) women diagnosed as DM, 24 (24/56, 32.0%) women diagnosed as impaired glucose tolerance (IGT), eight (8/56, 10.7%) women diagnosed as impaired fasting glucose (IFG), and 16 (16/56, 21.3%) women diagnosed as IFG and IGT. Compared with normal glucose metabolism women, the age of hyperglycemia women is higher significantly (34.8 ± 3.8 versus 32.7 ± 4.7). The incidence of IFG, pharmacy treatment, and the value of HbA1c is also higher in hyperglycemia women than the normal glucose metabolism women, in which it is not statistically significant but clinically significant.
In DM women diagnosed according to the criteria that two-hour glucose value ≥11.1 mmol/L after 24th gestational weeks, there were only eight (10.7%) women could meet DM diagnostic criteria according to the OGTT value of postpartum. Moreover, 25% women had normal OGTT value postpartum. Due to the characteristics of glucose metabolism in Asian population, an abnormal two-hour glucose value in OGTT may not be suitable to diagnose DM during pregnancy in China.
探讨中国妊娠 24 周后两小时血糖值≥11.1mmol/L 诊断为糖尿病（DM）的女性的产后结局，并评估仅用妊娠 24 周后两小时血糖值≥11.1mmol/L 作为 DM 诊断标准是否合适。本研究为妊娠高血糖日门诊就诊并于北京大学第一医院分娩的孕妇进行了回顾性队列研究。共纳入 168 例妊娠 24 周后两小时血糖值≥11.1mmol/L 诊断为 DM 的孕妇，其中 75 例 DM 孕妇在产后 6 周到 1 年内进行了口服葡萄糖耐量试验（OGTT）。收集并分析的一般信息包括年龄、孕前体重指数（BMI）、孕前体重、妊娠体重增加（GWG）、孕期 OGTT 值、产后 OGTT 值、孕周和新生儿出生体重。
根据妊娠 24 周后两小时血糖值≥11.1mmol/L 的标准，诊断为 168 例 DM，其中 75 例（75/168，44.6%）在产后 6 周到 1 年内进行了 OGTT。在随访的女性中，56 例（56/75，74.7%）被诊断为高血糖，19 例（19/75，25.3%）被诊断为正常糖耐量。在高血糖女性中，有 8 例（8/56，10.7%）被诊断为 DM，24 例（24/56，32.0%）被诊断为糖耐量受损（IGT），8 例（8/56，10.7%）被诊断为空腹血糖受损（IFG），16 例（16/56，21.3%）被诊断为 IFG 和 IGT。与正常糖耐量女性相比，高血糖女性的年龄明显较高（34.8±3.8 与 32.7±4.7）。IFG、药物治疗和 HbA1c 值在高血糖女性中也高于正常糖耐量女性，虽然没有统计学意义，但具有临床意义。
根据妊娠 24 周后两小时血糖值≥11.1mmol/L 的标准诊断为 DM 的女性中，仅 8 例（10.7%）根据产后 OGTT 值可符合 DM 诊断标准。此外，25%的女性产后 OGTT 值正常。由于亚洲人群的血糖代谢特点，OGTT 中两小时血糖值异常可能不适合中国妊娠期 DM 的诊断。
