Division of Endocrinology and Metabolism, Department of Internal Medicine, CHA Gangnam Medical Center, CHA University School of Medicine, Seoul, Korea.
Yonsei University College of Medicine, Seoul, Korea.
Diabetes Metab J. 2021 Jul;45(4):547-557. doi: 10.4093/dmj.2020.0078. Epub 2021 Mar 5.
Fetal abdominal obesity (FAO) has been reported to be affected at gestational diabetes mellitus (GDM) diagnosis at 24 to 28 weeks of gestation in older and/or obese women. This study investigated whether the management of GDM improves FAO in GDM subjects near term.
Medical records of 7,099 singleton pregnant women delivering at CHA Gangnam Medical Center were reviewed retrospectively. GDM was diagnosed by 100-g oral glucose tolerance test after 50-g glucose challenge test based on Carpenter-Coustan criteria. GDM subjects were divided into four study groups according to maternal age and obesity. FAO was defined as ≥90th percentile of fetal abdominal overgrowth ratios (FAORs) of the ultrasonographically estimated gestational age (GA) of abdominal circumference per actual GA by the last menstruation period, biparietal diameter, or femur length, respectively.
As compared with normal glucose tolerance (NGT) subjects near term, FAORs and odds ratio for FAO were significantly higher in old and/or obese women with GDM but not in young and nonobese women with GDM. For fetuses of GDM subjects with FAO at the time of GDM diagnosis, the odds ratio for exhibiting FAO near term and being large for GA at birth were 7.87 (95% confidence interval [CI], 4.38 to 14.15) and 10.96 (95% CI, 5.58 to 20.53) compared with fetuses of NGT subjects without FAO at GDM diagnosis.
Despite treatment, FAO detected at the time of GDM diagnosis persisted until delivery. Early diagnosis and treatment might be necessary to prevent near term FAO in high-risk older and/or obese women.
在妊娠 24-28 周时，对于年龄较大和/或肥胖的女性，胎儿腹部肥胖（FAO）已被报道与妊娠糖尿病（GDM）的诊断相关。本研究旨在探讨 GDM 管理是否能改善近足月时 GDM 患者的 FAO。
回顾性分析了在 CHA Gangnam 医疗中心分娩的 7099 例单胎孕妇的病历。GDM 是根据 Carpenter-Coustan 标准，在 50g 葡萄糖筛查试验后，通过 100g 口服葡萄糖耐量试验诊断的。根据母亲的年龄和肥胖程度，将 GDM 患者分为四组。FAO 定义为根据末次月经、双顶径或股骨长估计的超声胎龄（GA）的腹围生长比（FAOR）≥第 90 百分位数，与实际 GA 的比值，分别为腹部周长、双顶径或股骨长。
与近足月的正常糖耐量（NGT）受试者相比，年龄较大和/或肥胖的 GDM 患者的 FAOR 和 FAO 发生的比值比明显较高，但年轻且不肥胖的 GDM 患者则不然。对于 GDM 诊断时存在 FAO 的 GDM 患者的胎儿，近足月时出现 FAO 和出生时为巨大儿的比值比分别为 7.87（95%可信区间 [CI]，4.38 至 14.15）和 10.96（95% CI，5.58 至 20.53），与 GDM 诊断时无 FAO 的 NGT 患者的胎儿相比。
尽管进行了治疗，但在 GDM 诊断时发现的 FAO 仍持续到分娩。对于年龄较大和/或肥胖的高危女性，可能需要早期诊断和治疗以预防近足月 FAO。
