Maor-Sagie Esther, Hallak Mordechai, Toledano Yoel, Gabbay-Benziv Rinat
Department of Obstetrics and Gynecology, Hillel Yaffe Medical Center, Hadera 3820302, Israel.
Meuhedet HMO, Rehovot 7610001, Israel.
J Clin Med. 2023 Sep 20;12(18):6072. doi: 10.3390/jcm12186072.
Gestational diabetes mellitus (GDM) is diagnosed by an oral glucose tolerance test (oGTT), preferably performed at 24 + 0-28 + 6 gestational weeks, and is considered a risk factor for type 2 diabetes (T2DM). In this study, we aimed to evaluate the risk of T2DM associated with abnormal oGTT performed after 28 weeks. We conducted a retrospective cohort study that included parturients with available glucose levels during pregnancy and up to 5 years of follow-up after pregnancy. Data were extracted from the computerized laboratory system of Meuhedet HMO and cross-tabulated with the Israeli National Registry of Diabetes (INRD). The women were stratified into two groups: late oGTT (performed after 28 + 6 weeks) and on-time oGTT (performed at 24 + 0-28 + 6 weeks). The incidence of T2DM was evaluated and compared using univariate analysis followed by survival analysis adjusted to confounders. Overall, 78,326 parturients entered the analysis. Of them, 6195 (7.9%) performed on-time oGTT and 5288 (6.8%) performed late oGTT. The rest-66,846 (85.3%)-had normal glucose tolerance. Women who performed late oGTT had lower rates of GDM and T2DM. However, once GDM was diagnosed, regardless of oGTT timing, the risk of T2DM was increased (2.93 (1.69-5.1) vs. 3.64 (2.44-5.44), aHR (95% CI), late vs. on-time oGTT, < 0.001 for both). Unlike in oGTT performed on time, one single abnormal value in late oGTT was not associated with an increased risk for T2DM.
妊娠期糖尿病（GDM）通过口服葡萄糖耐量试验（oGTT）进行诊断，最好在妊娠24 + 0至28 + 6周时进行，并且被认为是2型糖尿病（T2DM）的一个危险因素。在本研究中，我们旨在评估28周后进行的oGTT异常与T2DM的关联风险。我们进行了一项回顾性队列研究，纳入了孕期有可用血糖水平且产后随访长达5年的产妇。数据从Meuhedet健康维护组织的计算机化实验室系统中提取，并与以色列国家糖尿病登记处（INRD）进行交叉制表。这些女性被分为两组：晚期oGTT（在28 + 6周后进行）和按时oGTT（在24 + 0至28 + 6周进行）。使用单因素分析评估并比较T2DM的发病率，随后进行调整混杂因素的生存分析。总体而言，78326名产妇进入分析。其中，6195名（7.9%）进行了按时oGTT，5288名（6.8%）进行了晚期oGTT。其余66846名（85.3%）糖耐量正常。进行晚期oGTT的女性GDM和T2DM的发生率较低。然而，一旦诊断为GDM，无论oGTT时间如何，T2DM的风险都会增加（2.93（1.69 - 5.1）对3.64（2.44 - 5.44），调整后风险比（95%置信区间），晚期与按时oGTT，两者均<0.001）。与按时进行的oGTT不同，晚期oGTT中的一个单一异常值与T2DM风险增加无关。
