He Zhangya, Mi Yang, Yang Hexiang, Ji Jing, Gao Jiayi, Zhang Wanyu, Wu Pei, Xu Zhangrui, Wang Shanshan, Luo Xiaoqin
Department of Nutrition and Food Safety, School of Public Health, Xi'an Jiaotong University, Xi'an, China.
Key Laboratory for Disease Prevention and Control and Health Promotion of Shaanxi Province, Xi'an, China.
Front Pediatr. 2022 May 17;10:829706. doi: 10.3389/fped.2022.829706. eCollection 2022.
The implications of gestational diabetes mellitus (GDM) on the short- and long-term health outcomes of both mother and child have been extensively studied. However, studies related to negative Oral Glucose Tolerance Test (OGTT) results in the second trimester but dysglycemia in late pregnancy on maternal and infant pregnancy outcomes are rare.
We conducted a nest case-control study within the Xi'an Longitudinal Mother-Child Cohort study (XAMC) to investigate the risk of adverse pregnancy outcomes in mothers and children with maternal negative mid-pregnancy OGTT results but high glycated hemoglobin (HbA) levels (≥5.7%) in late pregnancy. All target women who delivered from January 1st, 2017 to December 31st, 2018 in Northwest Women's and Children's Hospital in Xi'an were enrolled as the case group (HbA ≥ 5.7%). Others with HbA < 5.7% but without GDM were selected as the control group (HbA < 5.7%) by matching with the same delivery period. The logistic regression models were used to find out the risk factors of adverse pregnancy outcomes in the target population.
A total of 2,116 and 1,907 women were finally enrolled in the case and control groups, respectively. Compared to the control group, more newborns with macrosomia (9.2% vs 4.1%, < 0.001) and large for gestational age (LGA) (23.7% vs. 13.5%, < 0.001), but less small for gestational age (SGA) (4.4% vs. 6.1%, = 0.017) were found in the case group. The differences in other outcomes were not statistically significant. The multiple logistic regression analysis showed that gestational age, fetal length, prenatal HbA, and total cholesterol (TG) were independent risk factors for newborns with large-for-gestational-age (LGA). The case group had a 2.516-fold (95% CI, 1.692-3.739) risk of delivering LGA newborns compared to the control group.
The glycemic management during the late pregnancy of non-GDM women should be given special consideration to reduce the risk of overweight offspring at birth.
妊娠糖尿病（GDM）对母婴短期和长期健康结局的影响已得到广泛研究。然而，关于孕中期口服葡萄糖耐量试验（OGTT）结果为阴性但妊娠晚期血糖异常对母婴妊娠结局影响的研究却很少见。
我们在西安母子纵向队列研究（XAMC）中进行了一项巢式病例对照研究，以调查孕中期OGTT结果为阴性但妊娠晚期糖化血红蛋白（HbA）水平较高（≥5.7%）的母亲和儿童出现不良妊娠结局的风险。2017年1月1日至2018年12月31日在西安西北妇女儿童医院分娩的所有目标女性被纳入病例组（HbA≥5.7%）。通过匹配相同分娩时期，选择其他HbA<5.7%且无GDM的女性作为对照组（HbA<5.7%）。采用逻辑回归模型找出目标人群中不良妊娠结局的危险因素。
最终分别有2116名和1907名女性被纳入病例组和对照组。与对照组相比，病例组中巨大儿（9.2%对4.1%，<0.001）和大于胎龄儿（LGA）（23.7%对13.5%，<0.001）的新生儿更多，但小于胎龄儿（SGA）的新生儿更少（4.4%对6.1%，=0.017）。其他结局的差异无统计学意义。多因素逻辑回归分析显示，孕周、胎儿身长、产前HbA和总胆固醇（TG）是大于胎龄儿（LGA）新生儿的独立危险因素。与对照组相比，病例组分娩LGA新生儿的风险高2.516倍（95%CI，1.692 - 3.739）。
应特别考虑非GDM女性妊娠晚期的血糖管理，以降低出生时后代超重的风险。
