妊娠期糖尿病孕妇的母性预测因素对胎儿体格发育的性别依赖性影响。
Sex-dependent influence of maternal predictors on fetal anthropometry in pregnancies with gestational diabetes mellitus.
机构信息
Pediatric Service, Department Woman Mother Child, University Hospital of Lausanne, 1011, Lausanne, Switzerland.
Obstetric Service, Department Woman Mother Child, University Hospital of Lausanne, 1011, Lausanne, Switzerland.
出版信息
BMC Pregnancy Childbirth. 2022 Jun 1;22(1):460. doi: 10.1186/s12884-022-04767-z.
BACKGROUND
Third trimester fetal anthropometric parameters are known to predict neonatal complications. A better understanding of predictors of adverse fetal parameters might help to personalize the use and frequency of fetal ultrasound. The objectives of this study were: (a) to evaluate the utility of maternal sociodemographic, anthropometric and metabolic predictors to predict 3 trimester fetal anthropometric parameters in women with gestational diabetes mellitus (GDM), (b) to assess whether the impact of these maternal predictors is fetal sex-dependent, and (c) to provide a risk stratification for markers of fetal overgrowth (fetal weight centile (FWC) and fetal abdominal circumference centile (FACC) depending on prepregnancy BMI and gestational weight gain (GWG) until the 1 GDM visit.
METHODS
This prospective study included 189 women with GDM. Maternal predictors were age, ethnicity, prepregnancy BMI, GWG and excessive weight gain until the 1 GDM visit, fasting, 1-hour and 2-hour blood glucose oral glucose tolerance test values, HbA1c at the 1 visit and medical treatment requirement. Fetal outcomes included FWC, FWC >90% and <10%, FACC, FACC >90% and <10%, at 29 0/7 to 35 6/7 weeks of gestational age. We performed univariate and multivariate regression analyses and probability analyses.
RESULTS
In multivariate analyses, prepregnancy BMI was associated with FWC, FWC > 90% and FACC. GWG until the 1 GDM visit was associated with FWC, FACC and FACC > 90% (all p ≤ 0.045). Other maternal parameters were not significantly associated with fetal anthropometry in multivariate analyses (all p ≥ 0.054). In female fetuses, only GWG was associated with FACC (p= 0.044). However, in male fetuses, prepregnancy BMI was associated with FWC, FWC > 90% and FACC and GWG with FWC in multivariate analyses (all p ≤ 0.030). In women with a prepregnancy BMI of ≥ 25 kg/m and a GWG until the 1 GDM visit ≥ 10.3 kg (mean GWG), the risk for FWC > 90% and FACC > 90% was 5.3 and 4 times higher than in their counterparts.
CONCLUSIONS
A personalized fetal ultrasound surveillance guided by fetal sex, prepregnancy BMI and GWG may be beneficial in reducing adverse fetal and neonatal outcomes.
背景
第三孕期胎儿人体测量参数可预测新生儿并发症。更好地了解不良胎儿参数的预测因素可能有助于个性化使用和频率的胎儿超声。本研究的目的是：（a）评估母体社会人口统计学，人体测量和代谢预测因子对患有妊娠糖尿病（GDM）的女性第三孕期胎儿人体测量参数的预测能力，（b）评估这些母体预测因子的影响是否依赖于胎儿性别，（c）根据孕前 BMI 和妊娠体重增加（GWG）提供胎儿生长过度的标志物（胎儿体重百分位数（FWC）和胎儿腹围百分位数（FACC）的风险分层，直到 1 次 GDM 就诊。
方法
本前瞻性研究纳入了 189 例 GDM 女性。母体预测因子包括年龄、种族、孕前 BMI、GWG 和直到 1 次 GDM 就诊时的体重过度增加、空腹、1 小时和 2 小时口服葡萄糖耐量试验值、1 次就诊时的 HbA1c 和治疗需求。胎儿结局包括 29 0/7 至 35 6/7 孕周时的 FWC、FWC>90%和<10%、FACC、FACC>90%和<10%。我们进行了单变量和多变量回归分析和概率分析。
结果
多变量分析中，孕前 BMI 与 FWC、FWC>90%和 FACC 相关。GWG 直到 1 次 GDM 就诊与 FWC、FACC 和 FACC>90%相关（均 p≤0.045）。其他母体参数在多变量分析中与胎儿人体测量无显著相关性（均 p≥0.054）。在女性胎儿中，仅 GWG 与 FACC 相关（p=0.044）。然而，在男性胎儿中，孕前 BMI 与 FWC、FWC>90%和 FACC 相关，GWG 与 FWC 相关（均 p≤0.030）。在孕前 BMI≥25kg/m 和 GWG 直到 1 次 GDM 就诊≥10.3kg（平均 GWG）的女性中，FWC>90%和 FACC>90%的风险是其对应者的 5.3 和 4 倍。
结论
根据胎儿性别、孕前 BMI 和 GWG 指导的个体化胎儿超声监测可能有助于降低不良胎儿和新生儿结局的风险。
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