早孕期母血 pGCD59 水平在预测新生儿低血糖中的作用——DALI 研究的亚组分析。

The Role of Early Pregnancy Maternal pGCD59 Levels in Predicting Neonatal Hypoglycemia-Subanalysis of the DALI Study.

机构信息

College of Medicine, Nursing and Health Sciences, School of Medicine, National University of Ireland, Galway H91TK33, Ireland.

Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, MA 02115, USA.

出版信息

J Clin Endocrinol Metab. 2022 Nov 23;107(11):e4311-e4319. doi: 10.1210/clinem/dgac498.

DOI:10.1210/clinem/dgac498

PMID:36054347

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC9681607/

Abstract

CONTEXT

Neonatal hypoglycaemia (NH) is the most common metabolic problem in infants born of mothers with gestational diabetes. Plasma glycated CD59 (pGCD59) is an emerging biomarker that has shown potential in identifying women at risk of developing gestational diabetes. The aim of this study was to assess the association between early maternal levels of pGCD59 and NH.

OBJECTIVE

The aim of this study was to assess the association between early pregnancy maternal levels of plasma glycated CD59 (pGCD59) and neonatal hypoglycemia (NH).

METHODS

This is an observational study of pregnant women with a prepregnancy body mass index (BMI) greater than or equal to 29 screened for eligibility to participate in the Vitamin D and Lifestyle Intervention for Gestational Diabetes (DALI) trial. This analysis included 399 pregnancies. Levels of pGCD59 were measured in fasting maternal samples taken at the time of a 75-g, 2-hour oral glucose tolerance test performed in early pregnancy (< 20 weeks). NH, the study outcome, was defined as a heel-prick capillary glucose level of less than 2.6 mmol/L within 48 hours of delivery.

RESULTS

We identified 30 infants with NH. Maternal levels of pGCD59 in early pregnancy were positively associated with the prevalence of NH (one-way analysis of variance, P < .001). The odds of NH were higher in infants from mothers in tertile 3 of pGCD59 levels compared to those from mothers in tertile 1 (odds ratio [OR]: 2.41; 95% CI, 1.03-5.63). However, this was attenuated when adjusted for maternal BMI (OR: 2.28; 95% CI, 0.96-5.43). The cross-validated area under the curve (AUC) was 0.64 (95% CI, 0.54-0.74), and adjusted for maternal BMI, age, and ethnicity, the AUC was 0.70 (95% CI, 0.56-0.78).

CONCLUSION

Although pGCD59 levels in early pregnancy in women with BMI greater than or equal to 29 are associated with NH, our results indicate that this biomarker by itself is only a fair predictor of NH.

摘要

背景

新生儿低血糖症（NH）是母亲患有妊娠期糖尿病的婴儿最常见的代谢问题。血浆糖化 CD59（pGCD59）是一种新兴的生物标志物，已显示出识别有发生妊娠期糖尿病风险的女性的潜力。本研究旨在评估孕早期母亲的 pGCD59 水平与 NH 之间的关系。

目的

本研究旨在评估孕早期孕妇血浆糖化 CD59（pGCD59）水平与新生儿低血糖症（NH）之间的关系。

方法

这是一项对符合条件参加维生素 D 和生活方式干预妊娠期糖尿病（DALI）试验的 BMI 大于或等于 29 的孕妇进行的前瞻性研究。该分析包括 399 例妊娠。在孕早期（<20 周）进行的 75g、2 小时口服葡萄糖耐量试验时，空腹采集母亲样本，检测 pGCD59 水平。NH 是本研究的结局，定义为出生后 48 小时内足跟毛细血管血糖水平<2.6mmol/L。

结果

我们发现 30 例婴儿有 NH。孕早期母亲 pGCD59 水平与 NH 的发生率呈正相关（单向方差分析，P<0.001）。与 pGCD59 水平 1 组的母亲相比，pGCD59 水平 3 组的婴儿 NH 的发生率更高（优势比[OR]：2.41；95%可信区间，1.03-5.63）。然而，当调整母亲 BMI 时，这种相关性减弱（OR：2.28；95%可信区间，0.96-5.43）。交叉验证曲线下面积（AUC）为 0.64（95%可信区间，0.54-0.74），调整母亲 BMI、年龄和种族后，AUC 为 0.70（95%可信区间，0.56-0.78）。