Department of Obstetrics, Obstetrics and Gynecology Hospital of Fudan University, Fudan University, Shanghai, China.
Laboratory of Female Reproduction and Endocrinology, Obstetrics and Gynecology Hospital of Fudan University, Fudan University, Shanghai, China.
Front Endocrinol (Lausanne). 2021 Dec 15;12:743170. doi: 10.3389/fendo.2021.743170. eCollection 2021.
Intermediate hyperglycemia in the first half of pregnancy, defined as a fasting plasma glucose level between 5.1- 6.9 mM, increases the risk of gestational diabetes mellitus, but clinical evidence for further management is lacking. We aim to evaluate the effectiveness of an early oral glucose tolerance test (OGTT) followed by the identification of intermediate hyperglycemia on pregnancy outcomes in real world setting.
A retrospective cohort study was conducted at the Obstetrics and Gynecology Hospital, Shanghai, China, between 2013 and 2017. Women with intermediate hyperglycemia at the first prenatal visit were identified and underwent an immediate (within one week) or a routine OGTT (24-28 gw) according to their wishes and received nutrition and exercise advice. Women diagnosed of gestational diabetes (GDM) were managed by standard interventions. Primary outcome was larger for gestational age (LGA). Secondary outcomes were primary cesarean delivery, preterm birth, shoulder dystocia or forceps delivery, preeclampsia, neonatal hypoglycemia, hyperbilirubinemia, and low Apgar score. Logistic regressions with or without a further propensity score-matched analysis were performed.
Among 42406 women involved, 1104 (2.6%) with intermediate hyperglycemia at the first prenatal visit were identified, of whom 176 (15.9%) underwent an early OGTT and 741 (67.1%) received a routine OGTT. Logistic regression showed that an early OGTT was not significantly associated with an altered risk of LGA (adjusted OR 1.13, 95% CI 0.73-1.75) but was related to an increased odds for neonatal hyperbilirubinemia (adjusted OR 2.89; 95% CI 1.55-5.37). No significant associations were observed for other secondary outcomes. These trends remained consistent in propensity score-matched models.
Our data from a real-world setting did not support that an early OGTT among women with intermediate hyperglycemia at the first prenatal visit improved pregnancy outcomes.
妊娠早期的中间高血糖（定义为空腹血浆葡萄糖水平在 5.1-6.9mM 之间）会增加妊娠糖尿病的风险，但缺乏进一步管理的临床证据。我们旨在评估在真实环境中，初次产前检查时发现中间高血糖的情况下，早期口服葡萄糖耐量试验（OGTT）后对妊娠结局的有效性。
这是一项在中国上海妇产科医院进行的回顾性队列研究，时间为 2013 年至 2017 年。在初次产前检查时发现中间高血糖的女性，根据自己的意愿进行即时（一周内）或常规 OGTT（24-28 周），并接受营养和运动建议。诊断为妊娠糖尿病（GDM）的女性采用标准干预措施进行管理。主要结局为胎儿过大（LGA）。次要结局为初次剖宫产、早产、肩难产或产钳分娩、子痫前期、新生儿低血糖、高胆红素血症和低 Apgar 评分。进行了有或无进一步倾向评分匹配分析的逻辑回归。
在涉及的 42406 名女性中，有 1104 名（2.6%）在初次产前检查时发现中间高血糖，其中 176 名（15.9%）进行了早期 OGTT，741 名（67.1%）进行了常规 OGTT。逻辑回归显示，早期 OGTT 与 LGA 风险的改变无显著相关性（调整后的 OR 1.13，95%CI 0.73-1.75），但与新生儿高胆红素血症的几率增加相关（调整后的 OR 2.89；95%CI 1.55-5.37）。其他次要结局没有观察到显著关联。这些趋势在倾向评分匹配模型中仍然一致。
我们在真实环境中的数据不支持在初次产前检查时发现中间高血糖的女性进行早期 OGTT 能改善妊娠结局。
