Cosson Emmanuel, Bentounes Sid Ahmed, Nachtergaele Charlotte, Berkane Narimane, Pinto Sara, Sal Meriem, Bihan Hélène, Tatulashvili Sopio, Portal Jean-Jacques, Carbillon Lionel, Vicaut Eric
AP-HP, Avicenne Hospital, Department of Endocrinology-Diabetology-Nutrition, CRNH-IdF, CINFO, Paris 13 University, Sorbonne Paris Cité, 93000 Bobigny, France.
Nutritional Epidemiology Research Unit, UMR U557 INSERM/U11125 INRAE/CNAM, Paris 13 University, Sorbonne Paris Cité, 93000 Bobigny, France.
J Clin Med. 2021 Aug 30;10(17):3904. doi: 10.3390/jcm10173904.
We aimed to compare pregnancy outcomes in 4665 women according to the following types of hyperglycaemia in pregnancy sub-types: (i) normoglycaemia, (ii) gestational diabetes mellitus (GDM), (iii) diabetes in pregnancy (DIP), (iv) early-diagnosed (i.e., <22 weeks of gestation) GDM (eGDM), and (v) early-diagnosed DIP (eDIP). The prevalence of normoglycaemia, eGDM, eDIP, GDM, and DIP was 76.4%, 10.8%, 0.6%, 11.7%, and 0.6%, respectively. With regard to pregnancy outcomes, gestational weight gain (11.5 ± 5.5, 9.0 ± 5.4, 8.3 ± 4.7, 10.4 ± 5.3, and 10.1 ± 5.0 kg, < 0.0001) and insulin requirement (none, 46.0%, 88.5%, 25.5%, and 51.7%; < 0.001) differed according to the glycaemic sub-types. eGDM and eDIP were associated with higher rates of infant malformation. After adjustment for confounders, with normoglycaemia as the reference, only GDM was associated with large-for-gestational-age infant (odds ratio 1.34 (95% interval confidence 1.01-1.78) and only DIP was associated with hypertensive disorders (OR 3.48 (1.26-9.57)). To conclude, early-diagnosed hyperglycaemia was associated with an increased risk of malformation, suggesting that it was sometimes present at conception. Women with GDM, but not those with eGDM, had an increased risk of having a large-for-gestational-age infant, possibly because those with eGDM were treated early and therefore had less gestational weight gain. Women with DIP might benefit from specific surveillance for hypertensive disorders.
我们旨在根据以下妊娠高血糖亚型，比较4665名女性的妊娠结局：（i）血糖正常，（ii）妊娠期糖尿病（GDM），（iii）妊娠糖尿病（DIP），（iv）早发型（即妊娠<22周）GDM（eGDM），以及（v）早发型DIP（eDIP）。血糖正常、eGDM、eDIP、GDM和DIP的患病率分别为76.4%、10.8%、0.6%、11.7%和0.6%。关于妊娠结局，根据血糖亚型不同，孕期体重增加（分别为11.5±5.5、9.0±5.4、8.3±4.7、10.4±5.3和10.1±5.0 kg，<0.0001）以及胰岛素需求（无需求、46.0%、88.5%、25.5%和51.7%；<0.001）存在差异。eGDM和eDIP与较高的婴儿畸形率相关。在对混杂因素进行校正后，以血糖正常为参照，仅GDM与大于胎龄儿相关（优势比1.34（95%置信区间1.01 - 1.78）），且仅DIP与高血压疾病相关（优势比3.48（1.26 - 9.57））。总之，早发型高血糖与畸形风险增加相关，提示其在受孕时可能就已存在。GDM女性而非eGDM女性生育大于胎龄儿的风险增加，可能是因为eGDM女性得到了早期治疗，因此孕期体重增加较少。DIP女性可能受益于针对高血压疾病的特定监测。
