Department of Community Medicine, Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka, Anuradhapura, Sri Lanka.
Department of Gynaecology and Obstetrics, Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka, Anuradhapura, Sri Lanka.
BMC Pregnancy Childbirth. 2023 Apr 5;23(1):231. doi: 10.1186/s12884-023-05548-y.
Despite the intergenerational effects of metabolic disorders, evidence is greatly lacking on early pregnancy metabolic syndrome (MetS) and its effects on pregnancy outcomes from low- and middle-income countries. Thus, this prospective cohort of South Asian pregnant women aimed to evaluate how early pregnancy MetS would affect pregnancy outcomes.
A prospective cohort study was conducted among first-trimester (T1) pregnant women of Anuradhapura district, Sri Lanka recruited to the Rajarata Pregnancy Cohort in 2019. MetS was diagnosed by the Joint Interim Statement criteria before 13 weeks of gestational age (GA). Participants were followed up until their delivery, and the major outcomes measured were large for gestational age (LGA), small for gestational age (SGA), preterm birth (PTB) and miscarriage (MC). Gestational weight gain, gestational age at delivery and neonatal birth weight were used as measurements to define the outcomes. Additionally, outcome measures were re-assessed with adjusting fasting plasma glucose (FPG) thresholds of MetS to be compatible with hyperglycemia in pregnancy (Revised MetS).
2326 T1 pregnant women with a mean age of 28.1 years (SD-5.4), and a median GA of 8.0 weeks (IQR-2) were included. Baseline MetS prevalence was 5.9% (n = 137, 95%CI-5.0-6.9). Only 2027 (87.1%) women from baseline, had a live singleton birth, while 221(9.5%) had MC and 14(0.6%) had other pregnancy losses. Additionally, 64(2.8%) were lost to follow-up. A higher cumulative incidence of LGA, PTB, and MC was noted among the T1-MetS women. T1-MetS carried significant risk (RR-2.59, 95%CI-1.65-3.93) for LGA, but reduced the risk for SGA (RR-0.41, 95%CI-0.29-0.78). Revised MetS moderately increased the risk for PTB (RR-1.54, 95%CI-1.04-2.21). T1-MetS was not associated (p = 0.48) with MC. Lowered FPG thresholds were significantly associated with risk for all major pregnancy outcomes. After adjusting for sociodemographic and anthropometric confounders, revised MetS remained the only significant risk predictor for LGA.
Pregnant women with T1 MetS in this population are at an increased risk for LGA and PTB and a reduced risk for SGA. We observed that a revised MetS definition with lower threshold for FPG compatible with GDM would provide a better estimation of MetS in pregnancy in relation to predicting LGA.
尽管代谢紊乱具有代际效应，但低中等收入国家在早期妊娠代谢综合征（MetS）及其对妊娠结局的影响方面的证据非常缺乏。因此，这项针对南亚孕妇的前瞻性队列研究旨在评估早期妊娠 MetS 如何影响妊娠结局。
2019 年在斯里兰卡阿努拉达普拉区招募了第一孕期（T1）孕妇进行前瞻性队列研究，参加了拉贾拉特纳妊娠队列。在妊娠 13 周前（GA）根据联合临时声明标准诊断 MetS。参与者一直随访到分娩，主要结局为巨大儿（LGA）、小于胎龄儿（SGA）、早产（PTB）和流产（MC）。妊娠体重增加、分娩时 GA 和新生儿出生体重被用作定义结局的指标。此外，还通过调整与妊娠糖尿病一致的 MetS 空腹血糖（FPG）阈值来重新评估结局（修订后的 MetS）。
共纳入 2326 名 T1 孕妇，平均年龄 28.1 岁（SD-5.4），中位 GA 为 8.0 周（IQR-2）。基线 MetS 患病率为 5.9%（n=137，95%CI-5.0-6.9）。只有 2027 名（87.1%）基线孕妇有活单胎分娩，221 名（9.5%）流产，14 名（0.6%）有其他妊娠丢失。此外，有 64 名（2.8%）失访。T1-MetS 孕妇的 LGA、PTB 和 MC 的累积发生率更高。T1-MetS 对 LGA 有显著风险（RR-2.59，95%CI-1.65-3.93），但降低了 SGA 的风险（RR-0.41，95%CI-0.29-0.78）。修订后的 MetS 略微增加了 PTB 的风险（RR-1.54，95%CI-1.04-2.21）。T1-MetS 与 MC 无关（p=0.48）。较低的 FPG 阈值与所有主要妊娠结局的风险显著相关。在调整社会人口统计学和人体测量学混杂因素后，修订后的 MetS 仍然是 LGA 的唯一显著风险预测因素。
在该人群中，T1 MetS 孕妇的 LGA 和 PTB 风险增加，SGA 风险降低。我们观察到，修订后的 MetS 定义具有较低的 FPG 阈值，与 GDM 一致，这将更好地估计妊娠期间的 MetS，从而更好地预测 LGA。
