School of Public Health, Fudan University, Shanghai, China.
NHC Key Lab. of Reproduction Regulation (Shanghai Institute for Biomedical and Pharmaceutical Technologies), Fudan University, Shanghai, China.
BMJ Open. 2021 Sep 7;11(9):e048530. doi: 10.1136/bmjopen-2020-048530.
To investigate the association between maternal pregestational blood glucose level and adverse pregnancy outcomes.
Retrospective cohort study.
This study was conducted in the Chongqing Municipality of China between April 2010 and December 2016.
A total of 60 222 women (60 360 pregnancies) from all 39 counties of Chongqing who participated in the National Free Preconception Health Examination Project and had pregnancy outcomes were included.
Adverse pregnancy outcomes included spontaneous abortion, induced abortion or labour due to medical reasons, stillbirth, preterm birth (PTB), macrosomia, large for gestational age, low birth weight (LBW) and small for gestational age.
Of the 60 360 pregnancies, rates of hypoglycaemic, normoglycaemia, impaired fasting glycaemia (IFG) and diabetic hyperglycaemic before conception were 5.06%, 89.30%, 4.59% and 1.05%, respectively. Compared with women with normoglycaemia, women with pregestational glucose at the diabetic level (≥7.0 mmol/L) might have a higher rate of macrosomia (6.18% vs 4.16%), whereas pregestational IFG seemed to be associated with reduced risks of many adverse outcomes, including spontaneous abortion, induced abortion due to medical reasons, PTB and LBW. After adjusting for potential confounders, pregestational diabetic hyperglycaemic was remained to be significantly associated with an increased risk of macrosomia (adjusted risk ratio 1.49, 95% CI 1.07 to 2.09). Abnormal maternal glucose levels before pregnancy (either hypoglycaemic or hyperglycaemic) seemed to have no significant negative effect on spontaneous abortion or induced abortion due to medical reasons.
Although without overt diabetes mellitus, women with once diabetic fasting glucose level during their preconception examinations could be associated with an increased risk for macrosomia. Uniform guidelines are needed for maternal blood glucose management during pre-pregnancy care to improve pregnancy outcomes.
探讨孕妇孕前血糖水平与不良妊娠结局的关系。
回顾性队列研究。
本研究于 2010 年 4 月至 2016 年 12 月在中国重庆市 39 个县进行。
共有 60360 例（60222 例妊娠）来自重庆所有 39 个县参加国家免费孕前健康检查项目且有妊娠结局的孕妇纳入研究。
不良妊娠结局包括自然流产、因医学原因人工流产或引产、死胎、早产（PTB）、巨大儿、大于胎龄儿、低出生体重儿（LBW）和小于胎龄儿。
在 60360 例妊娠中，低血糖、正常血糖、空腹血糖受损（IFG）和孕前糖尿病高血糖的发生率分别为 5.06%、89.30%、4.59%和 1.05%。与正常血糖孕妇相比，孕前血糖达糖尿病水平（≥7.0mmol/L）的孕妇巨大儿发生率较高（6.18%比 4.16%），而孕前 IFG 似乎与许多不良结局的风险降低相关，包括自然流产、因医学原因人工流产、PTB 和 LBW。在调整潜在混杂因素后，孕前糖尿病高血糖仍与巨大儿风险增加显著相关（调整后的风险比 1.49，95%CI 1.07 至 2.09）。孕前异常血糖水平（低血糖或高血糖）似乎对自然流产或因医学原因人工流产无明显负面影响。
虽然没有明显的糖尿病，但孕前空腹血糖水平异常的孕妇可能与巨大儿风险增加相关。需要制定统一的孕前血糖管理指南，以改善妊娠结局。
