Tano Sho, Kotani Tomomi, Ushida Takafumi, Yoshihara Masato, Imai Kenji, Nakamura Noriyuki, Iitani Yukako, Moriyama Yoshinori, Emoto Ryo, Kato Sawako, Yoshida Shigeru, Yamashita Mamoru, Kishigami Yasuyuki, Oguchi Hidenori, Matsui Shigeyuki, Kajiyama Hiroaki
Department of Obstetrics and Gynecology, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan.
Department of Obstetrics, Perinatal Medical Center, TOYOTA Memorial Hospital, Nagoya, Aichi, Japan.
Diabetol Metab Syndr. 2023 Jun 9;15(1):123. doi: 10.1186/s13098-023-01103-z.
Recent evidence suggests increased glucose variability (GV) causes endothelial dysfunction, a central pathology of hypertensive disorders of pregnancy (HDP). We aimed to investigate the association between GV in early pregnancy and subsequent HDP development among non-diabetes mellitus (DM) pregnancies.
This multicenter retrospective study used data from singleton pregnancies between 2009 and 2019. Among individuals who had 75 g-OGTT before 20 weeks of gestation, we evaluated GV by 75 g-OGTT parameters and examined its relationship with HDP development, defining an initial-increase from fasting-plasma glucose (PG) to 1-h-PG and subsequent-decrease from 1-h-PG to 2-h-PG.
Approximately 3.0% pregnancies (802/26,995) had 75 g-OGTT before 20 weeks of gestation, and they had a higher prevalence of HDP (14.3% vs. 7.5%). The initial-increase was significantly associated with overall HDP (aOR 1.20, 95% CI 1.02-1.42), and the subsequent-decrease was associated with decreased and increased development of early-onset (EoHDP: aOR 0.56, 95% CI 0.38-0.82) and late-onset HDP (LoHDP: aOR 1.38, 95% CI 1.11-1.73), respectively.
A pattern of marked initial-increase and minor subsequent-decrease (i.e., sustained hyperglycemia) was associated with EoHDP. Contrarily, the pattern of marked initial-increase and subsequent-decrease (i.e., increased GV) was associated with LoHDP. This provides a new perspective for future study strategies.
最近的证据表明，血糖变异性（GV）增加会导致内皮功能障碍，这是妊娠期高血压疾病（HDP）的核心病理改变。我们旨在研究非糖尿病（DM）妊娠早期的GV与随后发生HDP之间的关联。
这项多中心回顾性研究使用了2009年至2019年单胎妊娠的数据。在妊娠20周前进行75g口服葡萄糖耐量试验（OGTT）的个体中，我们通过75g OGTT参数评估GV，并检查其与HDP发生的关系，定义为从空腹血糖（PG）到1小时PG的初始升高以及随后从1小时PG到2小时PG的降低。
约3.0%的妊娠（802/26,995）在妊娠20周前进行了75g OGTT，且她们的HDP患病率更高（14.3%对7.5%）。初始升高与总体HDP显著相关（调整后比值比[aOR]1.20，95%置信区间[CI]1.02-1.42），随后降低分别与早发型HDP（EoHDP：aOR 0.56，95%CI 0.38-0.82）和晚发型HDP（LoHDP：aOR 1.38，95%CI 1.11-1.73）发生的减少和增加相关。
显著的初始升高和随后轻微降低的模式（即持续高血糖）与EoHDP相关。相反，显著的初始升高和随后降低的模式（即GV增加）与LoHDP相关。这为未来的研究策略提供了新的视角。
