Burlina Silvia, Dalfrà Maria Grazia, Belloni Pietro, Ottanelli Serena, Mecacci Federico, Mello Giorgio, Lapolla Annunziata
Department of Medicine-DIMED, University of Padova, Padua, Italy.
Department of Statistical Sciences, University of Padua, Padua, Italy.
Int J Endocrinol. 2022 Apr 11;2022:9633664. doi: 10.1155/2022/9633664. eCollection 2022.
To determine the best cut-off level of pregnant women's first fasting plasma glucose (FFPG) test results for the prediction of subsequent onset of gestational diabetes mellitus (GDM) and to examine the association between FFPG and maternal and neonatal outcomes in a large Caucasian population.
1437 medical records of women with singleton pregnancies followed up between 2015 and 2018 were retrospectively analyzed. Data on FFPG tested in the first trimester and 75 g oral glucose tolerance test (OGTT) findings performed according to IADPSG criteria and Italian guidelines were collected and evaluated. The women's clinical and metabolic characteristics (age, prepregnancy body mass index (BMI), previous pregnancies complicated by GDM, timing of delivery, and gestational hypertension) were also recorded. The fetal variables considered were being large for gestational age (LGA) or small for gestational age (SGA), macrosomia, and hypoglycemia.
Among the 1437 pregnant women studied, 684 had a normal glucose tolerance (NGT) and 753 developed GDM. In a univariate analysis FFPG ≥92 mg/dl predicts the risk of GDM with an OR = 2.36 (95% CI 1.930-3.186; < 0.001). In multivariate analysis, after adjusting for principal risk factors of GDM (BMI, previous GDM, age >35 years, family history of diabetes) FFPG ≥92 mg/dl was associated with the risk of GDM (OR = 1.92; 95% CI 1.488-2.492; < 0.001). In univariate analysis, FFPG ≥92 mg/dl predict the risk of insulin therapy in GDM women with a OR = 1.88 (95% CI 1.230-2.066; < 0.001). As regards LGA, in a multivariate analysis, after adjusting for BMI, FFPG ≥92 mg/dl was associated with the risk of LGA only in NGT women (OR = 2.34; 95% CI 1.173-4.574; =0.014), but not in GDM women. FFPG was not associated with other maternal or neonatal outcomes.
FFPG ≥92 mg/dl is related to GDM diagnosis and to the need of insulin therapy if GDM is diagnosed. An early diagnosis and a prompt start of insulin therapy are essential to prevent maternal and fetal complications.
确定孕妇首次空腹血糖（FFPG）检测结果的最佳截断值，以预测随后发生的妊娠期糖尿病（GDM），并在一大群白种人群体中研究FFPG与母婴结局之间的关联。
回顾性分析了2015年至2018年期间随访的1437名单胎妊娠女性的病历。收集并评估了孕早期检测的FFPG数据以及根据国际糖尿病和妊娠研究组协会（IADPSG）标准和意大利指南进行的75克口服葡萄糖耐量试验（OGTT）结果。还记录了这些女性的临床和代谢特征（年龄、孕前体重指数（BMI）、既往妊娠合并GDM、分娩时间和妊娠期高血压）。所考虑的胎儿变量包括大于胎龄（LGA）或小于胎龄（SGA）、巨大儿和低血糖。
在研究的1437名孕妇中，684名糖耐量正常（NGT），753名发生了GDM。在单因素分析中，FFPG≥92mg/dl预测GDM风险的比值比（OR）=2.36（95%可信区间1.930 - 3.186；P<0.001）。在多因素分析中，在调整了GDM的主要危险因素（BMI、既往GDM、年龄>35岁、糖尿病家族史）后，FFPG≥92mg/dl与GDM风险相关（OR = 1.92；95%可信区间1.488 - 2.492；P<(0.001)）。在单因素分析中，FFPG≥92mg/dl预测GDM女性胰岛素治疗风险的OR = 1.88（95%可信区间1.230 - 2.066；P<0.001）。关于LGA，在多因素分析中，调整BMI后，FFPG≥92mg/dl仅在NGT女性中与LGA风险相关（OR = 2.34；95%可信区间1.173 - 4.574；P = 0.014），而在GDM女性中不相关。FFPG与其他母婴结局无关。
FFPG≥92mg/dl与GDM诊断以及如果诊断为GDM时胰岛素治疗的需求相关。早期诊断和及时开始胰岛素治疗对于预防母婴并发症至关重要。
