Health Research Institute (HRI), University of Limerick, Limerick, Ireland; School of Allied Health (SAH), University of Limerick, Limerick, Ireland; Institute of Nutrition & Dietetics (INDI), Dublin, Ireland.
Health Research Institute (HRI), University of Limerick, Limerick, Ireland; School of Medicine, University of Limerick, Limerick, Ireland; Department of Paediatrics, University Hospital Limerick (UHL), Limerick, Ireland.
Clin Nutr ESPEN. 2021 Oct;45:312-321. doi: 10.1016/j.clnesp.2021.08.002. Epub 2021 Aug 18.
Accurate early risk-prediction for gestational diabetes mellitus (GDM) would target intervention and prevention in women at the highest risk. We evaluated maternal risk-factors and parameters of body-composition to develop a prediction model for GDM in early gestation.
A prospective observational study was undertaken. Pregnant women aged between 18 and 50 y of age with gestational age between 10 and 16 weeks were included in the study. Women aged ≤18 y, twin-pregnancies, known foetal anomaly or pre-existing condition affecting oedema status were excluded. 8-point-skinfold thickness (SFT), mid-upper-arm-circumference (MUAC), waist, hip, weight and ultrasound measurements of subcutaneous (SAT) and visceral abdominal-adipose (VAT) were measured. Oral-glucose-tolerance-test (OGTT) for GDM diagnosis was undertaken at 28 weeks gestation. Binomial logistic-regression models were used to predict GDM. ROC-analysis determined discrimination and concordance of model and individual variables.
188 women underwent OGTT at ~28 weeks gestation. 20 women developed GDM. BMI (24.7 kg m (±6.1), 29.9 kg m (±7.8), p = 0.022), abdominal SAT(1.32 cm (CI 1.31, 1.53), 1.99 cm (CI 1.64, 2.31), p = 0.027), abdominal VAT(0.78 cm (CI 0.8, 0.96), 1.41 cm (CI 1.11, 1.65), p = 0.002), truncal SFT (84.8 mm (CI 88.2, 101.6), 130.4 mm (CI 105.1, 140.1), p = 0.010), waist (79.8 cm (CI 80.3, 84.1), 90.3 cm (CI 85.9, 96.2), p = 0.006) and gluteal hip (94.3 cm (CI 93.9, 98.0), 108.6 cm (CI 99.9, 111.6), p = 0.023) were higher in GDM vs. non-GDM. After screening variables for inclusion into the multivariate model, family history of diabetes, previous perinatal death, overall insulin resistant condition, abdominal SAT and VAT, 8-point SFT, MUAC and weight were included. The combined multivariate prediction model achieved an excellent level of discrimination, with an AUC of 0.860 (CI 0.774, 0.945) for GDM.
An early gestation risk prediction model, incorporating known risk-factors, and parameters of body-composition, accurately identify pregnant women in their first-trimester who developed GDM later on in gestation. This methodology could be used clinically to identify at-risk pregnancies, and target specific treatment through referred services to those mothers who would most benefit.
准确预测妊娠糖尿病（GDM）的早期风险，将针对高危妇女进行干预和预防。我们评估了母体危险因素和身体成分参数，以建立一种在早期妊娠时预测 GDM 的模型。
进行了一项前瞻性观察性研究。纳入年龄在 18 至 50 岁之间，妊娠 10 至 16 周的孕妇。排除年龄≤18 岁、双胎妊娠、已知胎儿异常或影响水肿状态的现有疾病的孕妇。测量 8 点皮褶厚度（SFT）、上臂中部周长（MUAC）、腰围、臀围、体重以及皮下（SAT）和内脏腹部脂肪（VAT）的超声测量值。在 28 周妊娠时进行口服葡萄糖耐量试验（OGTT）以诊断 GDM。二项逻辑回归模型用于预测 GDM。ROC 分析确定模型和个体变量的区分度和一致性。
188 名孕妇在大约 28 周时进行了 OGTT。20 名孕妇发生 GDM。BMI（24.7kg/m（±6.1），29.9kg/m（±7.8），p=0.022）、腹部 SAT（1.32cm（CI 1.31，1.53），1.99cm（CI 1.64，2.31），p=0.027）、腹部 VAT（0.78cm（CI 0.8，0.96），1.41cm（CI 1.11，1.65），p=0.002）、躯干 SFT（84.8mm（CI 88.2，101.6），130.4mm（CI 105.1，140.1），p=0.010）、腰围（79.8cm（CI 80.3，84.1），90.3cm（CI 85.9，96.2），p=0.006）和臀围（94.3cm（CI 93.9，98.0），108.6cm（CI 99.9，111.6），p=0.023）在 GDM 与非 GDM 之间更高。在筛选变量纳入多变量模型后，纳入了糖尿病家族史、围产期死亡史、整体胰岛素抵抗情况、腹部 SAT 和 VAT、8 点 SFT、MUAC 和体重。综合多变量预测模型具有出色的区分度，AUC 为 0.860（CI 0.774，0.945），用于预测 GDM。
该早期妊娠风险预测模型结合了已知的危险因素和身体成分参数，能够准确识别出在妊娠早期出现 GDM 的孕妇。这种方法可在临床上用于识别高危妊娠，并通过向那些最受益的母亲提供转诊服务，针对特定的治疗方法。
