Departamento de Obstetricia e Ginecologia da Faculdade de Medicina da, Universidade de São Paulo, Sao Paulo, SP, Brazil.
Divisão de Clinica Obstetrica do Hospital das Clínicas da Faculdade de Medicina da, Universidade de Sao Paulo, Sao Paulo, SP, Brazil.
BMC Pregnancy Childbirth. 2022 May 3;22(1):385. doi: 10.1186/s12884-022-04708-w.
Recognizing that hyperglycemia in pregnancy can impact both individually a patient's health and collectively the healthcare system and that different levels of hyperglycemia incur different consequences, we aimed to evaluate the differences and similarities between patients who met the diagnostic criteria for gestational diabetes mellitus (GDM) or diabetes in pregnancy (DIP) according to the World Health Organization diagnostic criteria based on the 75 g oral glucose tolerance test (OGTT).
This retrospective study included a cohort of 1064 women followed-up at the Gestational Diabetes Unit of Hospital das Clinicas da Faculdade de Medicina da Universidade de Sao Paulo (Sao Paulo, Brazil). Patients were classified into GDM and DIP groups, according to their OGTT results. Their electronic charts were reviewed to obtain clinical and laboratory data for all participants.
Women in the DIP group had a higher pre-pregnancy body mass index (30.5 vs 28.1 kg/m, odds ratio [OR] 1.07, 95% confidence interval [CI] 1.02-1.11), more frequently experienced GDM in a previous pregnancy (25% vs. 11%, OR 2.71, 95% CI 1.17-6.27), and were more likely to have chronic hypertension (43.1% vs. 23.5%, OR 2.46, 95% CI 1.47-4.11), a current twin pregnancy (10.8% vs. 2.9%, OR 4.04, 95% CI 1.70-9.61), or require insulin (46.1% vs. 14.3%, OR 5.14, 95% CI 3.06-8.65) than those in the GDM group. Patients in the DIP group also had a higher frequency of large-for-gestational-age infants (12.3% vs. 5.1%, OR 2.78, 95% CI 1.23-6.27) and abnormal postpartum OGTT (45.9% vs. 12.6%, OR 5.91, 95% CI 2.93-11.90) than those in the GDM group. Nevertheless, in more than half of the DIP patients, glucose levels returned to normal after birth.
Diabetes in pregnancy is associated with an increased risk of adverse perinatal outcomes but does not equate to a diagnosis of diabetes post-pregnancy. It is necessary to identify and monitor these women more closely during and after pregnancy. Keeping patients with hyperglycemia in pregnancy engaged in healthcare is essential for accurate diagnosis and prevention of complications related to abnormal glucose metabolism.
鉴于妊娠期间的高血糖会对患者个体的健康以及整个医疗体系产生影响，而且不同程度的高血糖会导致不同的后果，我们旨在评估根据世界卫生组织基于 75g 口服葡萄糖耐量试验（OGTT）的诊断标准，符合妊娠糖尿病（GDM）或妊娠期间糖尿病（DIP）诊断标准的患者之间的差异和相似之处。
本回顾性研究纳入了在圣保罗大学医学院附属医院妊娠期糖尿病科接受随访的 1064 名女性。根据 OGTT 结果将患者分为 GDM 和 DIP 组。查阅他们的电子病历以获取所有参与者的临床和实验室数据。
DIP 组的女性在妊娠前的体重指数更高（30.5 与 28.1kg/m2，比值比[OR] 1.07，95%置信区间[CI] 1.02-1.11），更常患有既往妊娠的 GDM（25%与 11%，OR 2.71，95% CI 1.17-6.27），并且更有可能患有慢性高血压（43.1%与 23.5%，OR 2.46，95% CI 1.47-4.11）、当前双胞胎妊娠（10.8%与 2.9%，OR 4.04，95% CI 1.70-9.61）或需要胰岛素（46.1%与 14.3%，OR 5.14，95% CI 3.06-8.65）比 GDM 组。与 GDM 组相比，DIP 组的患者还更常出现巨大儿（12.3%与 5.1%，OR 2.78，95% CI 1.23-6.27）和产后 OGTT 异常（45.9%与 12.6%，OR 5.91，95% CI 2.93-11.90）。然而，在超过一半的 DIP 患者中，血糖水平在分娩后恢复正常。
妊娠期间的糖尿病与不良围产期结局的风险增加有关，但并不等同于产后的糖尿病诊断。有必要在妊娠期间和之后更密切地监测和管理这些女性。让患有妊娠高血糖的患者参与医疗保健对于准确诊断和预防与异常葡萄糖代谢相关的并发症至关重要。
