School of Clinical Medicine, Addenbrooke's Hospital, Cambridge, UK.
Department of Obstetrics and Gynaecology, Rosie Hospital, Cambridge University Hospitals, Cambridge, UK.
Diabet Med. 2021 Sep;38(9):e14596. doi: 10.1111/dme.14596. Epub 2021 May 19.
There is seasonal variation in the incidence of gestational diabetes (GDM) and delivery outcomes of affected patients. We assessed whether there was also evidence of temporal variation in maternal treatment requirements and early neonatal outcomes.
We performed a retrospective analysis of women diagnosed with GDM (75 g oral glucose tolerance test, 0 h ≥ 5.1; 1 h ≥ 10.0; 2 h ≥ 8.5 mmol/L) in a UK tertiary obstetric centre (2015-2019) with a singleton infant. Data regarding demographic characteristics, total insulin requirements and neonatal outcomes were extracted from contemporaneous electronic medical records. Linear/logistic regression models using month of the year as a predictor of outcomes were used to assess annual variation.
In all, 791 women (50.6% receiving pharmacological treatment) and 790 neonates were included. The likelihood of requiring insulin treatment was highest in November (p < 0.05). The average total daily insulin dose was higher at peak (January) compared to average by 19 units/day (p < 0.05). There was no temporal variation in neonatal intensive care admission, or neonatal capillary blood glucose. However, rates of neonatal hypoglycaemia (defined as <2.6 mmol/L) were highest in December (40% above average; p < 0.05).
Women with GDM diagnosed in winter are more likely to require insulin treatment and to require higher insulin doses. Neonates born to winter-diagnosed mothers had a corresponding increased risk of neonatal hypoglycaemia. Maternal treatment requirements and neonatal outcomes of GDM vary significantly throughout the year, even in a relatively temperate climate.
妊娠糖尿病（GDM）的发病率和患病产妇的分娩结局存在季节性变化。我们评估了母体治疗需求和新生儿早期结局是否也存在时间变化的证据。
我们对英国一家三级产科中心（2015-2019 年）诊断为 GDM（75g 口服葡萄糖耐量试验，0 小时≥5.1mmol/L；1 小时≥10.0mmol/L；2 小时≥8.5mmol/L）的女性患者进行了回顾性分析，其婴儿均为单胎。从同期电子病历中提取人口统计学特征、总胰岛素需求和新生儿结局的数据。使用月作为预测指标的线性/逻辑回归模型评估年度变化。
共纳入 791 名女性（50.6%接受药物治疗）和 790 名新生儿。需要胰岛素治疗的可能性在 11 月最高（p<0.05）。与平均水平相比，峰值（1 月）时的平均每日胰岛素剂量高 19 单位/天（p<0.05）。新生儿入住重症监护病房和新生儿毛细血管血糖无时间变化。然而，12 月新生儿低血糖（定义为<2.6mmol/L）的发生率最高（比平均水平高 40%；p<0.05）。
冬季诊断为 GDM 的女性更有可能需要胰岛素治疗和更高的胰岛素剂量。冬季诊断的母亲所生的新生儿发生新生儿低血糖的风险相应增加。即使在气候相对温和的地区，GDM 的母体治疗需求和新生儿结局也会在一年中发生显著变化。
