Department of Obstetrics and Gynecology, Peking University First Hospital, Beijing 100034, China.
Department of Obstetrics, Tianjin Central Obstetrics and Gynecology Hospital, Tianjin 300199, China.
Chin Med J (Engl). 2022 Mar 20;135(6):665-671. doi: 10.1097/CM9.0000000000002036.
Gestational diabetes mellitus (GDM) brings health issues for both mothers and offspring, and GDM prevention is as important as GDM management. It was shown that a history of GDM was significantly associated with a higher maternal risk for GDM recurrence. The incidence of GDM recurrence was unclear because of the incidence of second-child was low before 2016 in China. We aim to investigate the prevalence of GDM recurrence and its associated high-risk factors which may be useful for the prediction of GDM recurrence in China.
A retrospective study was conducted which enrolled participants who underwent regular prenatal examination and delivered twice in the same hospital of 18 research centers. All participants were enrolled from January 2018 to October 2018, where they delivered the second baby during this period. A total of 6204 women were enrolled in this study, and 1002 women with a history of GDM were analyzed further. All participants enrolled in the study had an oral glucose tolerance test (OGTT) result at 24 to 28 weeks and were diagnosed as GDM in the first pregnancy according to the OGTT value (when any one of the following values is met or exceeded to the 75-g OGTT: 0 h [fasting], ≥5.10 mmol/L; 1 h, ≥10.00 mmol/L; and 2 h, ≥8.50 mmol/L). The prevalence of GDM recurrence and development of type 2 diabetes mellitus were calculated, and its related risk factors were analyzed.
In 6204 participants, there are 1002 women (1002/6204,16.15%) with a history of GDM and 5202 women (5202/6204, 83.85%) without a history of GDM. There are significant differences in age (32.43 ± 4.03 years vs. 33.00 ± 3.34 years vs. 32.19 ± 3.37 years, P < 0.001), pregnancy interval (4.06 ± 1.44 years vs. 3.52 ± 1.43 years vs. 3.38 ± 1.35 years, P = 0.004), prepregnancy body mass index (BMI) (27.40 ± 4.62 kg/m2vs. 23.50 ± 3.52 kg/m2vs. 22.55 ± 3.47 kg/m2, P < 0.001), history of delivered macrosomia (22.7% vs. 11.0% vs. 6.2%, P < 0.001) among the development of diabetes mellitus (DM), recurrence of GDM, and normal women. Moreover, it seems so important in the degree of abnormal glucose metabolism in the first pregnancy to the recurrence of GDM and the development of DM. There are significant differences in OGTT levels of the first pregnancy such as area under the curve of OGTT value (18.31 ± 1.90 mmol/L vs. 16.27 ± 1.93 mmol/L vs. 15.55 ± 1.92 mmol/L, P < 0.001), OGTT fasting value (5.43 ± 0.48 mmol/L vs. 5.16 ± 0.49 mmol/L vs. 5.02 ± 0.47 mmol/L, P < 0.001), OGTT 1-hour value (10.93 ± 1.34 mmol/L vs. 9.69 ± 1.53 mmol/L vs. 9.15 ± 1.58 mmol/L, P < 0.001), OGTT 2-hour value (9.30 ± 1.66 mmol/L vs. 8.01 ± 1.32 mmol/L vs. 7.79 ± 1.38 mmol/L, P < 0.001), incidence of impaired fasting glucose (IFG) (fasting plasma glucose ≥5.6 mmol/L) (31.3% vs. 14.6% vs. 8.8%, P < 0.001), and incidence of two or more abnormal OGTT values (68.8% vs. 39.7% vs. 23.9%, P < 0.001) among the three groups. Using multivariate analysis, the factors, such as age (1.07 [1.02-1.12], P = 0.006), prepregnancy BMI (1.07 [1.02, 1.12], P = 0.003), and area under the curve of OGTT in the first pregnancy (1.14 [1.02, 1.26], P = 0.02), have an effect on maternal GDM recurrence; the factors, such as age (1.28 [1.01-1.61], P = 0.04), pre-pregnancy BMI (1.26 [1.04, 1.53], P = 0.02), and area under the curve of OGTT in the first pregnancy (1.65 [1.04, 2.62], P = 0.03), have an effect on maternal DM developed further.
The history of GDM was significantly associated with a higher maternal risk for GDM recurrence during follow-up after the first pregnancy. The associated risk factors for GDM recurrence or development of DM include age, high pre-pregnancy BMI, history of delivered macrosomia, the OGTT level in the first pregnancy, such as the high area under the curve of OGTT, IFG, and two or more abnormal OGTT values. To prevent GDM recurrence, women with a history of GDM should do the preconception counseling before preparing next pregnancy.
妊娠期糖尿病（GDM）会给母亲和后代带来健康问题，因此 GDM 的预防与管理同样重要。有研究表明，有 GDM 病史的女性再次发生 GDM 的风险显著增加。在中国，2016 年之前，由于生育二胎的比例较低，GDM 复发的发生率尚不清楚。我们旨在调查 GDM 复发的流行率及其相关的高危因素，这可能有助于预测中国 GDM 复发。
本研究为回顾性研究，纳入了 18 个研究中心的 6204 名在同一家医院接受定期产前检查并分娩两次的参与者。所有参与者均于 2018 年 1 月至 2018 年 10 月期间入组，在此期间她们在该医院分娩二胎。共有 1002 名有 GDM 病史的女性被纳入进一步分析。所有参与者均在 24-28 周时进行口服葡萄糖耐量试验（OGTT），根据 OGTT 值（当 75g OGTT 的任何一个值达到或超过以下标准时诊断为 GDM：0 h[空腹]≥5.10mmol/L；1 h≥10.00mmol/L；和 2 h≥8.50mmol/L）诊断为 GDM 。计算 GDM 复发和 2 型糖尿病的发生率，并分析其相关危险因素。
在 6204 名参与者中，有 1002 名（1002/6204，16.15%）有 GDM 病史，5202 名（5202/6204，83.85%）无 GDM 病史。年龄（32.43±4.03 岁比 33.00±3.34 岁比 32.19±3.37 岁，P＜0.001）、妊娠间隔（4.06±1.44 年比 3.52±1.43 年比 3.38±1.35 年，P=0.004）、孕前 BMI（27.40±4.62kg/m2比 23.50±3.52kg/m2比 22.55±3.47kg/m2，P＜0.001）、巨大儿分娩史（22.7%比 11.0%比 6.2%，P＜0.001）在发展为糖尿病（DM）、GDM 复发和正常女性中存在差异。此外，GDM 患者在首次妊娠中血糖代谢异常的严重程度对 GDM 复发和 DM 的发生有重要意义。首次妊娠的 OGTT 水平（OGTT 值曲线下面积：18.31±1.90mmol/L 比 16.27±1.93mmol/L 比 15.55±1.92mmol/L，P＜0.001）、OGTT 空腹值（5.43±0.48mmol/L 比 5.16±0.49mmol/L 比 5.02±0.47mmol/L，P＜0.001）、OGTT 1 小时值（10.93±1.34mmol/L 比 9.69±1.53mmol/L 比 9.15±1.58mmol/L，P＜0.001）、OGTT 2 小时值（9.30±1.66mmol/L 比 8.01±1.32mmol/L 比 7.79±1.38mmol/L，P＜0.001）、空腹血糖受损（IFG）（空腹血糖≥5.6mmol/L）发生率（31.3%比 14.6%比 8.8%，P＜0.001）和 2 项或以上 OGTT 值异常的发生率（68.8%比 39.7%比 23.9%，P＜0.001）在三组之间存在差异。多因素分析显示，年龄（1.07[1.02-1.12]，P=0.006）、孕前 BMI（1.07[1.02，1.12]，P=0.003）和首次妊娠 OGTT 值曲线下面积（1.14[1.02，1.26]，P=0.02）与 GDM 患者的复发有关；年龄（1.28[1.01-1.61]，P=0.04）、孕前 BMI（1.26[1.04，1.53]，P=0.02）和首次妊娠 OGTT 值曲线下面积（1.65[1.04，2.62]，P=0.03）与 GDM 患者进一步发生 DM 有关。
GDM 病史与首次妊娠后 GDM 复发的风险增加有关。GDM 复发或发展为 DM 的相关危险因素包括年龄、高孕前 BMI、巨大儿分娩史、首次妊娠 OGTT 水平，如高 OGTT 值曲线下面积、IFG 和两项或以上 OGTT 值异常。为了预防 GDM 复发，有 GDM 病史的女性应在准备再次妊娠前进行孕前咨询。
