妊娠期糖尿病在孕晚期诊断对妊娠结局的影响：一项病例对照研究。
Impact of gestational diabetes mellitus diagnosed during the third trimester on pregnancy outcomes: a case-control study.
机构信息
Perinatal Center for Maternity and Neonates, Yokohama City University Medical Center, 4-57 Urafunecho, Minami-ku, Yokohama City, Kanagawa, 232-0024, Japan.
Department of Biostatistics, Yokohama City University Graduate School of Medicine, Yokohama, Japan.
出版信息
BMC Pregnancy Childbirth. 2021 Mar 24;21(1):246. doi: 10.1186/s12884-021-03730-8.
BACKGROUND
In 2010, the International Association of Diabetes and Pregnancy Study Group (IADPSG) proposed new criteria indicating that gestational diabetes mellitus (GDM) can be diagnosed if the fasting threshold of ≤92 mg/dL, 1-h threshold of ≤180 mg/dL, or 2-h threshold of ≤153 mg/dL are exceeded during the 75-g 2-h oral glucose tolerance test (OGTT) performed at 24-28 weeks of gestation. The World Health Organization (WHO) recommends using the proposed diagnostic threshold values of the IADPSG to diagnose GDM; however, it does not limit the timing of the 75-g OGTT. Since 2010 in Japan, GDM has been diagnosed using the same criteria as that proposed by the WHO. However, neither the JSOG nor the WHO has provided any evidence that it is appropriate to use a threshold beyond the range recommended by the IADPSG.
METHODS
This was a single-centre retrospective study based on the medical records and delivery registry database of our centre. We included women who underwent a 50-g glucose challenge test (GCT) with results < 140 mg/dL at 24-28 weeks of gestation and subsequently underwent a 75-g OGTT after 29 weeks of gestation with abnormal glucose tolerance suspected based on clinical findings. The reference values for the 75-g OGTT followed the IADPSG criteria. Subjects were classified into the normal glucose tolerance (NGT) group and the GDM group. The type of delivery and neonatal outcomes of the two groups were compared. A multivariable analysis was performed to match the backgrounds of both groups.
RESULTS
In total, the NGT and GDM group comprised 189 and 49 women, respectively. Emergency caesarean delivery rates were similar in the GDM and NGT groups (10.6 and 12.2%, respectively; adjusted odds ratio [OR], 1.25; 95% confidence interval [CI], 0.43-3.64; p = 0.74); however, the elective caesarean delivery rate was higher in the GDM group than in the NGT group (16.3 and 5.3%, respectively, adjusted OR, 3.60; 95% CI, 1.27-10.19; p = 0.01). No significant differences were observed in other maternal and neonatal outcomes between both groups.
CONCLUSION
Although a diagnosis of GDM during the third trimester does not improve pregnancy outcomes, it increases the elective caesarean delivery rate.
背景
2010 年，国际妊娠合并糖尿病研究组织（IADPSG）提出了新的标准，即在妊娠 24-28 周行 75g 2 小时口服葡萄糖耐量试验（OGTT）时，如果空腹阈值≤92mg/dL、1 小时阈值≤180mg/dL 或 2 小时阈值≤153mg/dL，可诊断为妊娠期糖尿病（GDM）。世界卫生组织（WHO）建议使用 IADPSG 提出的诊断阈值来诊断 GDM；然而，它并没有限制 75g OGTT 的时间。自 2010 年在日本，GDM 的诊断标准与 WHO 提出的标准相同。然而，JSOG 和 WHO 都没有提供任何证据表明，超出 IADPSG 推荐范围使用阈值是合适的。
方法
这是一项基于我们中心的病历和分娩登记数据库的单中心回顾性研究。我们纳入了在妊娠 24-28 周时行 50g 葡萄糖筛查试验（GCT）且结果<140mg/dL，随后在妊娠 29 周后因临床发现怀疑葡萄糖耐量异常而再次行 75g OGTT 的女性。75g OGTT 的参考值遵循 IADPSG 标准。受试者分为正常糖耐量（NGT）组和 GDM 组。比较两组的分娩方式和新生儿结局。进行多变量分析以匹配两组的背景。
结果
共纳入 NGT 组和 GDM 组 189 例和 49 例女性。GDM 组和 NGT 组的急诊剖宫产率相似（分别为 10.6%和 12.2%；校正优势比[OR]，1.25；95%置信区间[CI]，0.43-3.64；p=0.74）；然而，GDM 组的选择性剖宫产率高于 NGT 组（分别为 16.3%和 5.3%，校正 OR，3.60；95%CI，1.27-10.19；p=0.01）。两组间其他母婴结局无显著差异。
结论
虽然在孕晚期诊断 GDM 并不能改善妊娠结局，但会增加选择性剖宫产率。
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