Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden.
Department of Nursing, Umeå University, Umeå, Sweden.
BMC Med. 2023 Jul 19;21(1):260. doi: 10.1186/s12916-023-02926-3.
Gestational diabetes mellitus (GDM) is associated with both short- and long-term risks, although it is unknown if risks vary by severity, timing, and duration of gestational hyperglycemia. We aimed to identify trajectories of random capillary glucose (RCG) levels throughout pregnancy and assess their associations with both obstetric/neonatal outcomes and children's risk of neurodevelopmental conditions (NDCs) (i.e., autism, intellectual disability, and attention-deficit/hyperactivity disorders [ADHD]).
A population-based cohort study was conducted involving 76,228 children born to 68,768 mothers without pregestational diabetes. Group-based trajectory modeling was utilized to identify distinct glucose trajectories across RCG values throughout the course of pregnancy. The associations between these trajectory groups and obstetric/neonatal outcomes as well as children's NDCs were then assessed using generalized estimating equation models with a logit link. The Benjamini-Hochberg (BH) procedure was employed to adjust P-values for multiple comparisons, controlling the false discovery rate (FDR).
Five distinct glucose trajectory groups were identified, each with varying percentages diagnosed with GDM. Their associations with obstetric/neonatal outcomes as well as children's NDCs varied. For example, when compared to the "Persistently Low" group, other groups exhibited varying degrees of increased risk for large-for-gestational-age babies, with the exception of the "High in Early Pregnancy" group. Compared to the "Persistently Low" group, all other trajectory groups were associated with NDC outcomes, except the "High in Mid-Pregnancy" group. However, none of the associations with offspring NDCs remained significant after accounting for the FDR correction.
Persistent high glucose levels or moderately elevated glucose levels throughout pregnancy, as well as transient states of hyperglycemia in early or mid-pregnancy, were found to be associated with increased risks of specific obstetric and neonatal complications, and potentially offspring NDCs. These risks varied depending on the severity, timing, duration, and management of hyperglycemia. The findings underscore the need for continuous surveillance and individualized management strategies for women displaying different glucose trajectories during pregnancy. Limitations such as potential residual confounding, the role of mediators, and small sample size should be addressed in future studies.
妊娠糖尿病（GDM）与短期和长期风险相关，尽管目前尚不清楚这些风险是否因严重程度、妊娠期间高血糖的时间和持续时间而异。我们旨在确定整个孕期随机毛细血管血糖（RCG）水平的轨迹，并评估它们与产科/新生儿结局以及儿童神经发育障碍（NDC）（即自闭症、智力障碍和注意缺陷/多动障碍[ADHD]）风险之间的关系。
一项基于人群的队列研究涉及 76228 名无孕前糖尿病母亲所生的 68768 名儿童。采用基于群组的轨迹建模方法来确定整个孕期 RCG 值的不同血糖轨迹。然后，使用广义估计方程模型和对数链接来评估这些轨迹组与产科/新生儿结局以及儿童 NDC 之间的关系。贝叶斯错误发现率（BH）程序用于调整多重比较的 P 值，以控制假发现率（FDR）。
确定了五个不同的血糖轨迹组，每个组的 GDM 诊断率各不相同。它们与产科/新生儿结局以及儿童 NDC 的关系也各不相同。例如，与“持续低”组相比，其他组的巨大儿风险程度有所增加，但“早孕期高”组除外。与“持续低”组相比，除“中孕期高”组外，所有其他轨迹组均与 NDC 结局相关。然而，在进行 FDR 校正后，与后代 NDC 相关的所有关联均不再显著。
孕期持续高血糖或血糖中度升高，以及早孕期或中孕期短暂的高血糖状态，与特定的产科和新生儿并发症以及潜在的后代 NDC 风险增加相关。这些风险因高血糖的严重程度、时间、持续时间和管理而异。这些发现强调了需要对孕期血糖轨迹不同的女性进行持续监测和个体化管理策略。未来的研究应解决潜在的残余混杂因素、中介作用以及样本量小等局限性。
