Obstetric Service, Department Woman-Mother-Child, Lausanne University Hospital, Lausanne, Switzerland.
Service of Endocrinology, Diabetes and Metabolism, Department of Medicine, Lausanne University Hospital, Lausanne, Switzerland.
J Clin Endocrinol Metab. 2022 Feb 17;107(3):e996-e1008. doi: 10.1210/clinem/dgab791.
Early diagnosis and treatment of gestational diabetes (GDM) may reduce adverse obstetric and neonatal outcomes, especially in high-risk women. However, there is a lack of data for other outcomes.
We compared cardiometabolic and mental health outcomes in women with early (eGDM) and classical (cGDM) GDM.
This prospective cohort included 1185 All women with cGDM and 76 women with eGDM. The eGDM group had GDM risk factors (BMI >30 kg/m2, family history of diabetes, history of GDM, ethnicity), were tested at <20 weeks gestational age, and diagnosed using American Diabetes Association prediabetes criteria. All women underwent lifestyle adaptations. Obstetric, neonatal, mental, and cardiometabolic outcomes were assessed during pregnancy and postpartum.
The eGDM group had lower gestational weight gain than cGDM (10.7 ± 6.2 vs 12.6 ± 6.4; P = 0.03) but needed more medical treatment (66% vs 42%; P < 0.001). They had similar rates of adverse maternal and neonatal outcomes, except for increased large-for-gestational-age infants (25% vs 15%; P = 0.02). Mental health during pregnancy and postpartum did not differ between groups. eGDM had more atherogenic postpartum lipid profile than cGDM (P ≤ 0.001). In eGDM, the postpartum prevalence of the metabolic syndrome (MetS) was 1.8-fold, prediabetes was 3.1-fold, and diabetes was 7.4-fold higher than cGDM (waist circumference-based MetS: 62% vs 34%/BMI-based MetS: 46% vs 24%; prediabetes: 47.5% vs 15.3%; diabetes: 11.9% vs 1.6%, all P < 0.001). These differences remained unchanged after adjusting for GDM risk factors.
Compared with cGDM, eGDM was not associated with differences in mental health, but with increased adverse cardiometabolic outcomes, independent of GDM risk factors and gestational weight gain. This hints to a preexisting risk profile in eGDM.
早期诊断和治疗妊娠期糖尿病（GDM）可能会降低不良产科和新生儿结局的风险，尤其是在高危女性中。然而，对于其他结局，数据仍然缺乏。
我们比较了早发型（eGDM）和经典型（cGDM）GDM 女性的心血管代谢和心理健康结局。
这项前瞻性队列研究纳入了 1185 例 cGDM 女性和 76 例 eGDM 女性。eGDM 组具有 GDM 危险因素（BMI>30kg/m2、糖尿病家族史、GDM 病史、种族），在妊娠 20 周前进行检查，并根据美国糖尿病协会的糖尿病前期标准诊断。所有女性均接受生活方式调整。在妊娠和产后期间评估产科、新生儿、精神和心血管代谢结局。
eGDM 组的妊娠期体重增加低于 cGDM 组（10.7±6.2 与 12.6±6.4；P=0.03），但需要更多的医疗治疗（66%与 42%；P<0.001）。两组的不良母婴结局发生率相似，但巨大儿发生率较高（25%与 15%；P=0.02）。两组的妊娠和产后期间心理健康状况无差异。eGDM 的产后血脂谱具有更多的动脉粥样硬化性（P≤0.001）。在 eGDM 中，产后代谢综合征（MetS）的患病率是 cGDM 的 1.8 倍，糖尿病前期是 3.1 倍，糖尿病是 7.4 倍（基于腰围的 MetS：62%与 34%/基于 BMI 的 MetS：46%与 24%；糖尿病前期：47.5%与 15.3%；糖尿病：11.9%与 1.6%，均 P<0.001）。在调整 GDM 危险因素后，这些差异仍然存在。
与 cGDM 相比，eGDM 与心理健康差异无关，但与不良心血管代谢结局相关，与 GDM 危险因素和妊娠期体重增加无关。这暗示 eGDM 存在预先存在的风险特征。
