Department of Obstetrics and Gynecology, Aalborg University Hospital, Reberbansgade 15, 9000 Aalborg, Denmark.
Department of Obstetrics and Gynecology, Aalborg University Hospital, Reberbansgade 15, 9000 Aalborg, Denmark; Department of Clinical Medicine, Aalborg University, Sdr. Skovvej 15, 9000 Aalborg, Denmark.
Eur J Obstet Gynecol Reprod Biol. 2022 Sep;276:139-143. doi: 10.1016/j.ejogrb.2022.07.015. Epub 2022 Jul 21.
Gestational diabetes mellitus (GDM) is the most common metabolic complication of pregnancy. The incidence of GDM is increasing worldwide and 5-25% of pregnancies are diagnosed with GDM depending on screening strategies and diagnostic criteria. GDM may lead to obstetric complications and increases the risk of adult metabolic disease in the offspring. Timely identification of GDM allows for regulation of maternal glucose levels which may reduce the obstetric complications considerably. The aim of this study is to investigate the association between second trimester ultrasound biometrics and GDM.
This is a retrospective cohort study including 2697 singleton pregnancies attending second trimester ultrasound scan at 20 + 0 to 20 + 6 weeks' gestation and giving birth at Aalborg University Hospital in the year 2020. Ultrasound measurements included head circumference (HC), abdominal circumference (AC), femur length (FL) and estimated fetal weight (EFW) by Hadlock's formula. Women with pregestational diabetes were excluded. GDM screening was performed on indication using oral-glucose-tolerance-test (OGTT) including 75 g glucose and a 2-hour serum glucose value ≥ 9 mmol/L was considered diagnostic. The association between fetal biometrics and GDM was investigated by logistic regression.
A total of 174 (6.5 %) were diagnosed with GDM. The incidence of GDM in pregnancies with biometrics above the 90th centile was; FL: 10.5 %, HC: 8.8 %, AC: 7.6 %, EFW: 9.3 %. Fetal biometrics above the 90th centile was significantly associated with GDM; OR = 2.07, p = 0.001; OR = 1.89, p = 0.001; OR = 1.63, p = 0.033; OR = 1.64, p = 0.036. This association remained significant for HC and FL when adjusted for maternal obesity (Body Mass Index ≥ 27): OR1.56, p = 0.019; OR = 1.57, p = 0.049.
At the second trimester scan, fetal biometrics above the 90th centile increase the risk of GDM. In pregnancies that are later diagnosed with GDM fetal growth is increased already at the second trimester scan. Such knowledge underlines the importance of early identification of GDM.
妊娠糖尿病（GDM）是妊娠期间最常见的代谢并发症。全球范围内，GDM 的发病率正在上升，根据筛查策略和诊断标准，5-25%的妊娠被诊断为 GDM。GDM 可能导致产科并发症，并增加后代成年代谢疾病的风险。及时发现 GDM 可使产妇血糖水平得到控制，从而大大降低产科并发症的风险。本研究旨在探讨孕中期超声生物测量与 GDM 之间的关系。
这是一项回顾性队列研究，纳入了 2020 年在奥尔堡大学医院进行孕中期超声扫描（20+0 至 20+6 周）且分娩的 2697 例单胎妊娠。超声测量包括头围（HC）、腹围（AC）、股骨长（FL）和通过 Hadlock 公式估算的胎儿体重（EFW）。排除患有孕前糖尿病的妇女。GDM 的筛查是根据口服葡萄糖耐量试验（OGTT）进行的，如果 75g 葡萄糖后 2 小时血清葡萄糖值≥9mmol/L，则诊断为 GDM。通过逻辑回归研究胎儿生物测量与 GDM 之间的关系。
共有 174 例（6.5%）被诊断为 GDM。生物测量值高于第 90 百分位数的妊娠中 GDM 的发生率为：FL：10.5%，HC：8.8%，AC：7.6%，EFW：9.3%。生物测量值高于第 90 百分位数与 GDM 显著相关；OR=2.07，p=0.001；OR=1.89，p=0.001；OR=1.63，p=0.033；OR=1.64，p=0.036。当调整母体肥胖（BMI≥27）因素后，HC 和 FL 与 GDM 仍显著相关；OR1.56，p=0.019；OR=1.57，p=0.049。
在孕中期扫描时，生物测量值高于第 90 百分位数会增加 GDM 的风险。在后来被诊断为 GDM 的妊娠中，胎儿生长在孕中期扫描时已经增加。这些知识强调了早期发现 GDM 的重要性。
