Department of Obstetrics and Gynecology of Peking University First Hospital, Beijing, China; Beijing Key Laboratory of Maternal Fetal Medicine of Gestational Diabetes Mellitus.
Teaching and Researching Office of Child and Adolescent Health, School of Medicine, Hunan Normal University, Changsha, China.
Diabetes Res Clin Pract. 2021 Apr;174:108736. doi: 10.1016/j.diabres.2021.108736. Epub 2021 Mar 8.
To evaluate the importance and usefulness of fasting plasma glucose (FPG) in the first trimester in predicting adverse pregnancy outcomes.
A retrospective study of 22,398 singleton pregnancies was conducted. Participants were divided into subgroups according to first-trimester FPG (low FPG, FPG < 5.1 mmol/L; medium FPG, 5.1 mmol/L ≤ FPG < 5.6 mmol/L; high FPG, 5.6 ≤ FPG < 7.0 mmol/L) and oral glucose tolerance test(OGTT) results (normal and abnormal) during pregnancy. Patient characteristics and risk of adverse pregnancy outcomes were compared. Then, the whole population of women with abnormal OGTT served as a reference, and the relative risks of maternal and neonatal complications in normal OGTT women were analyzed by categorical analyses and logistic regression. Subgroup analyses were performed according to pre-pregnancy body mass index (BMI).
The frequency of adverse pregnancy outcomes increased with increasing FPG levels during the first trimester, regardless of OGTT results. High FPG + Abnormal OGTT had the worst outcome. Compared to the whole population of women with abnormal OGTT, Normal OGTT + Medium FPG showed the same risk of PIH and macrosomia. Normal OGTT + High FPG showed the same risk of PIH, macrosomia as well as LGA and preterm birth. Additionally, Normal OGTT + Medium FPG + BMI ≥ 24 kg/m showed significantly higher risk of PIH (OR = 1.867, 1.245-2.800), macrosomia (OR = 1.748, 1.304-2.344) and LGA (OR = 1.274, 1.019-1.593). Furthermore, the OR value for PIH was 3.759 (1.680-8.412) in Normal OGTT + High FPG + BMI ≥ 24 kg/m compared to women with abnormal OGTT.
First-trimester FPG values can help identify women at increased risk for adverse pregnancy outcomes. Increased attention and management should be given to women with early pregnancy FPG ≥ 5.10 mmol/L despite a normal OGTT, especially if their BMI ≥ 24 kg/m.
评估孕早期空腹血糖（FPG）在预测不良妊娠结局中的重要性和实用性。
对 22398 例单胎妊娠进行回顾性研究。根据孕早期 FPG（低 FPG，FPG<5.1mmol/L；中 FPG，5.1mmol/L≤FPG<5.6mmol/L；高 FPG，5.6mmol/L≤FPG<7.0mmol/L）和口服葡萄糖耐量试验（OGTT）结果（正常和异常）将参与者分为亚组。比较患者特征和不良妊娠结局的风险。然后，以 OGTT 异常的所有女性为参照，通过分类分析和逻辑回归分析正常 OGTT 女性的母婴并发症的相对风险。根据孕前体质量指数（BMI）进行亚组分析。
无论 OGTT 结果如何，随着孕早期 FPG 水平的升高，不良妊娠结局的发生频率也随之增加。高 FPG+异常 OGTT 的结局最差。与 OGTT 异常的所有女性相比，正常 OGTT+中 FPG 显示出与 PIH 和巨大儿相同的风险。正常 OGTT+高 FPG 与 PIH、巨大儿以及 LGA 和早产的风险相同。此外，正常 OGTT+中 FPG+BMI≥24kg/m2 显示出显著更高的 PIH（OR=1.867，1.245-2.800）、巨大儿（OR=1.748，1.304-2.344）和 LGA（OR=1.274，1.019-1.593）的风险。此外，与 OGTT 异常的女性相比，正常 OGTT+高 FPG+BMI≥24kg/m2 的 PIH 的 OR 值为 3.759（1.680-8.412）。
孕早期 FPG 值可帮助识别不良妊娠结局风险增加的女性。对于尽管 OGTT 正常但孕早期 FPG≥5.10mmol/L 的女性，尤其是 BMI≥24kg/m2 的女性，应给予更多关注和管理。
