Department of Obstetrics, Shenzhen Maternity & Child Healthcare Hospital, The First School of Clinical Medicine, Southern Medical University, Hongli Road, Futian District, Shenzhen, Guangdong Province, China.
Endocrine. 2022 Jan;75(1):70-81. doi: 10.1007/s12020-021-02831-w. Epub 2021 Aug 3.
To investigate and identify first-trimester fasting plasma glucose (FPG) is related to gestational diabetes mellitus (GDM) and other adverse pregnancy outcomes in Shenzhen population.
We used data of 48,444 pregnant women that had been retrospectively collected between 2017 and 2019. Logistic regression analysis was used to evaluated the associations between first-trimester FPG and GDM and adverse pregnancy outcomes, and used to construct a nomogram model for predicting the risk of GDM. The performance of the nomogram was evaluated by using ROC and calibration curves. Decision curve analysis (DCA) was used to determine the clinical usefulness of the first-trimester FPG by quantifying the net benefits at different threshold probabilities.
The mean first-trimester FPG was 4.62 ± 0.42 mmol/L. A total of 6998 (14.4%) pregnancies developed GDM.489(1.01%) pregnancies developed polyhydramnios, the prevalence rates of gestational hypertensive disorder (GHD), cesarean section, primary cesarean section, preterm delivery before 37 weeks (PD) and dystocia was 1130 (2.33%), 20,426 (42.16%), 7237 (14.94%), 2386 (4.93%), and 1865 (3.85%), respectively. 4233 (8.74%) of the newborns were LGA, and the number of macrosomia was 2272 (4.69%), LBW was 1701 (3.51%) and 5084 (10.49%) newborns had admission to the ICU, which all showed significances between GDM and non-GDM groups (all P < 0.05). The univariate analysis showed that first-trimester FPG was strongly associated with risks of outcomes including GDM, cesarean section, macrosomia, GHD, primary cesarean section, and LGA (all OR > 1, all P < 0.05), furthermore, the risks of GDM, primary cesarean section, and LGA was increasing with first-trimester FPG as early as it was at 4.19-4.63 mmol/L. The multivariable analysis showed that the risks of GDM (ORs for FPG 4.19-4.63, 4.63-5.11 and 5.11-7.0 mmol/L were 1.137, 1.592, and 4.031, respectively, all P < 0.05) increased as early as first-trimester FPG was at 4.19-4.63 mmol/L, and first-trimester FPG which was also associated with the risks of cesarean section, macrosomia and LGA (OR for FPG 5.11-7.0 mmol/L of cesarean section: 1.128; OR for FPG 5.11-7.0 mmol/L of macrosomia: 1.561; OR for FPG 4.63-5.11 and 5.11-7.0 mmol/L of LGA: 1.149 and 1.426, respectively, all P < 0.05) and with its increasing, the risks of LGA increased. Furthermore, the nomogram had a C-indices 0.771(95% CI: 0.7630.779) and 0.770(95% CI:0.7580.781) in training and testing validation respectively, which showed an acceptable consistency between the observed, validation and nomogram-predicted probabilities, the DAC curve analysis indicated that the nomogram had important clinical application value for GDM risk prediction.
FPG in the first trimester was an independent risk factor for GDM which can be used as a screening test for identifying pregnancies at risk of GDM and adverse pregnancy outcomes.
探讨和识别深圳人群中早孕期空腹血糖（FPG）与妊娠糖尿病（GDM）及其他不良妊娠结局的关系。
我们使用了 2017 年至 2019 年间回顾性收集的 48444 名孕妇的数据。采用 logistic 回归分析评估早孕期 FPG 与 GDM 及不良妊娠结局之间的关系，并构建预测 GDM 风险的列线图模型。使用 ROC 和校准曲线评估列线图的性能。通过量化不同阈值概率下的净收益，决策曲线分析（DCA）用于确定早孕期 FPG 的临床应用价值。
平均早孕期 FPG 为 4.62±0.42mmol/L。共有 6998（14.4%）例妊娠发生 GDM。489（1.01%）例妊娠发生羊水过多，妊娠期高血压疾病（GHD）、剖宫产、初次剖宫产、37 周前早产（PD）和难产的发生率分别为 1130（2.33%）、20426（42.16%）、7237（14.94%）、2386（4.93%）和 1865（3.85%）。4233（8.74%）例新生儿为巨大儿，巨大儿的数量为 2272（4.69%）、低体重儿（LBW）为 1701（3.51%）和 5084（10.49%）例新生儿入住 ICU，所有这些指标在 GDM 和非 GDM 组之间均有显著差异（均 P<0.05）。单因素分析显示，早孕期 FPG 与 GDM、剖宫产、巨大儿、GHD、初次剖宫产和 LGA 等结局的风险呈显著正相关（所有 OR>1，均 P<0.05），而且，随着早孕期 FPG 逐渐升高至 4.19-4.63mmol/L，GDM、初次剖宫产和 LGA 的风险也随之增加。多因素分析显示，随着早孕期 FPG 逐渐升高至 4.19-4.63mmol/L，GDM（FPG 4.19-4.63、4.63-5.11 和 5.11-7.0mmol/L 的 OR 分别为 1.137、1.592 和 4.031，均 P<0.05）的风险逐渐增加，而且早孕期 FPG 与剖宫产、巨大儿和 LGA 的风险相关（FPG 5.11-7.0mmol/L 的剖宫产 OR：1.128；FPG 5.11-7.0mmol/L 的巨大儿 OR：1.561；FPG 4.63-5.11 和 5.11-7.0mmol/L 的 LGA OR 分别为 1.149 和 1.426，均 P<0.05），且随着 FPG 的升高，LGA 的风险逐渐增加。此外，列线图在训练和验证中分别具有 0.771（95%CI：0.7630.779）和 0.770（95%CI：0.7580.781）的 C 指数，这表明观察、验证和列线图预测概率之间具有可接受的一致性，DCA 曲线分析表明列线图对 GDM 风险预测具有重要的临床应用价值。
早孕期 FPG 是 GDM 的独立危险因素，可作为识别 GDM 高危妊娠和不良妊娠结局的筛查试验。
