Harvard Medical School, Boston, MA, USA.
Diabetes Unit, Massachusetts General Hospital, Boston, MA, USA.
Diabetologia. 2022 Mar;65(3):541-551. doi: 10.1007/s00125-021-05622-0. Epub 2021 Dec 30.
AIMS/HYPOTHESIS: Despite recommendations to screen women with diabetes risk factors for hyperglycaemia in the first trimester, criteria for normal glucose values in early pregnancy have not been firmly established. We aimed to compare glucose levels in early pregnancy with those later in gestation and outside of pregnancy in women with diabetes risk factors.
In pregnant women (N = 123) followed longitudinally through the postpartum period, and a separate cohort of non-pregnant women (N = 65), we performed 75 g oral glucose tolerance tests. All participants had one or more risk factors for diabetes. Using linear regression, we tested for differences in glucose levels between non-pregnant and pregnant women at early (7-15 weeks) and mid-late (24-32 weeks) gestation as well as postpartum, with adjustment for maternal age, parity, marital status and BMI. In a longitudinal analysis using mixed-effects models, we tested for differences in glucose levels across early and mid-late pregnancy compared with postpartum. Differences are expressed as β (95% CI).
Fasting glucose was lower in pregnant compared with non-pregnant women by 0.34 (0.18, 0.51) mmol/l (p < 0.0001) in early pregnancy and by 0.45 (0.29, 0.61) mmol/l (p < 0.0001) in mid-late pregnancy. In longitudinal models, fasting glucose was lower by 0.13 (0.04, 0.21) mmol/l (p = 0.003) in early pregnancy and by 0.16 (0.08, 0.25) mmol/l (p = 0.0003) in mid-late pregnancy compared with the same women postpartum. Early pregnancy post-load glucose levels did not differ from those in non-pregnant women or the same women postpartum. In mid-late pregnancy, compared with non-pregnant women, elevations in 1 h post-load glucose level (0.60 [-0.12, 1.33] mmol/l, p = 0.10) and 2 h post-load glucose (0.49 [-0.21, 1.19] mmol/l, p = 0.17) were not statistically significant. However, in longitudinal analyses, 1 h and 2 h post-load glucose levels were higher in mid-late pregnancy (by 0.78 [0.35, 1.21] mmol/l, p = 0.0004, and 0.67 [0.30, 1.04] mmol/l, p = 0.0005, respectively) when compared with postpartum.
CONCLUSIONS/INTERPRETATION: In women with diabetes risk factors, fasting glucose declines in the first trimester. Post-load glucose increases later in pregnancy. These findings may inform criteria for diagnosing hyperglycaemia early in pregnancy.
目的/假设：尽管建议对有糖尿病危险因素的女性在孕早期筛查高血糖，但妊娠早期正常血糖值的标准尚未确定。我们旨在比较有糖尿病危险因素的女性在妊娠早期、中期和产后的血糖水平。
在随访至产后的孕妇（N=123）和另一组非孕妇（N=65）中，我们进行了 75g 口服葡萄糖耐量试验。所有参与者都有一个或多个糖尿病危险因素。使用线性回归，我们测试了非孕妇和孕妇在妊娠早期（7-15 周）和中期晚期（24-32 周）以及产后的血糖水平差异，并调整了母亲的年龄、产次、婚姻状况和 BMI。在使用混合效应模型的纵向分析中，我们测试了与产后相比，妊娠早期和中期晚期的血糖水平差异。差异以β（95%置信区间）表示。
与非孕妇相比，孕妇在妊娠早期的空腹血糖低 0.34（0.18，0.51）mmol/L（p<0.0001），在妊娠中期晚期低 0.45（0.29，0.61）mmol/L（p<0.0001）。在纵向模型中，孕妇在妊娠早期的空腹血糖低 0.13（0.04，0.21）mmol/L（p=0.003），在妊娠中期晚期低 0.16（0.08，0.25）mmol/L（p=0.0003），与产后相同的女性相比。妊娠早期的负荷后血糖水平与非孕妇或产后相同的女性没有差异。在妊娠中期晚期，与非孕妇相比，负荷后 1 小时血糖水平升高（0.60[-0.12，1.33]mmol/L，p=0.10）和负荷后 2 小时血糖水平升高（0.49[-0.21，1.19]mmol/L，p=0.17）无统计学意义。然而，在纵向分析中，妊娠中期晚期的负荷后 1 小时和 2 小时血糖水平升高（分别升高 0.78[0.35，1.21]mmol/L，p=0.0004 和 0.67[0.30，1.04]mmol/L，p=0.0005），与产后相比。
结论/解释：在有糖尿病危险因素的女性中，空腹血糖在孕早期下降。妊娠后期负荷后血糖升高。这些发现可能为妊娠早期诊断高血糖提供依据。
