Liggins Institute, University of Auckland, Auckland, New Zealand.
School of Biomedical Engineering, University of Technology Sydney, Sydney, Australia.
BMC Pregnancy Childbirth. 2023 Dec 16;23(1):869. doi: 10.1186/s12884-023-06190-4.
Gestational diabetes mellitus is associated with perinatal mental disorders. Effective management may reduce this risk, but there is little evidence on effects of different glycaemic treatment targets. We assessed whether tight glycaemic treatment targets compared with less-tight targets reduce the risk of poor mental health outcomes in women with gestational diabetes.
This was a secondary analysis of data from women who consented to complete perinatal mental health questionnaires as participants in the TARGET Trial, a stepped-wedge cluster randomized trial in 10 hospitals in New Zealand. All hospitals initially used less tight glycaemic targets for management of gestational diabetes and were sequentially randomized, in clusters of two at 4-monthly intervals, to using tighter glycaemic targets. Data were collected from 414 participants on anxiety (6-item Spielberger State Anxiety scale), depression (Edinburgh Postnatal Depression Scale), and health-related quality of life (36-Item Short-Form General Health Survey) at the time of diagnosis (baseline), 36 weeks of gestation, and 6 months postpartum. The primary outcome was composite poor mental health (any of anxiety, vulnerability to depression, or poor mental health-related quality of life). Generalized linear mixed models were used to determine the main treatment effect with 95% confidence intervals using an intention-to-treat approach.
We found no differences between randomised glycaemic target groups in the primary outcome at 36 weeks' (relative risk (RR): 1.07; 95% confidence interval 0.58, 1.95) and 6 months postpartum (RR: 1.03; 0.58, 1.81). There were similarly no differences in the components of the primary outcome at 36 weeks' [anxiety (RR: 0.85; 0.44, 1.62), vulnerability to depression (RR: 1.10; 0.43, 2.83), or poor mental health-related quality of life (RR: 1.05; 0.50, 2.20)] or at 6 months postpartum [anxiety (RR:1.21; 0.59, 2.48), vulnerability to depression (RR:1.41; 0.53, 3.79), poor mental health-related quality of life (RR: 1.11; 0.59, 2.08)].
We found no evidence that adoption of tighter glycaemic treatment targets in women with gestational diabetes alters their mental health status at 36 weeks' gestation and at 6 months postpartum.
The Australian New Zealand Clinical Trials Registry (ANZCTR). ACTRN12615000282583 (ANZCTR-Registration). Date of registration: 25 March 2015.
妊娠期糖尿病与围产期精神障碍有关。有效的管理可能会降低这种风险，但对于不同的血糖治疗目标效果的证据很少。我们评估了与不太严格的目标相比，严格的血糖治疗目标是否会降低患有妊娠期糖尿病的女性不良心理健康结局的风险。
这是对同意完成 TARGET 试验期间进行的围产期心理健康问卷调查的女性数据的二次分析，这是新西兰 10 家医院的一项逐步楔形集群随机试验。所有医院最初都使用不太严格的血糖目标来管理妊娠期糖尿病，然后以每 4 个月为间隔的两批集群的方式进行随机分组，以使用更严格的血糖目标。在诊断（基线）、36 周妊娠和产后 6 个月时，414 名参与者使用 6 项斯皮尔伯格状态焦虑量表（Spielberger State Anxiety Scale）评估焦虑症、抑郁（爱丁堡产后抑郁量表）和健康相关生活质量（36 项简短健康调查）。主要结局是复合不良心理健康（焦虑、易患抑郁症或心理健康相关生活质量差中的任何一种）。使用广义线性混合模型，采用意向治疗方法，95%置信区间确定主要治疗效果。
我们没有发现随机血糖目标组在 36 周时（相对风险（RR）：1.07；95%置信区间 0.58，1.95）和产后 6 个月时（RR：1.03；0.58，1.81）主要结局的差异。在 36 周时，主要结局的各个组成部分也没有差异[焦虑症（RR：0.85；0.44，1.62）、易患抑郁症（RR：1.10；0.43，2.83）或心理健康相关生活质量差（RR：1.05；0.50，2.20）]或产后 6 个月[焦虑症（RR：1.21；0.59，2.48）、易患抑郁症（RR：1.41；0.53，3.79）或心理健康相关生活质量差（RR：1.11；0.59，2.08）]。
我们没有发现采用更严格的血糖治疗目标会改变患有妊娠期糖尿病的女性在 36 周妊娠和产后 6 个月时的心理健康状况。
澳大利亚新西兰临床试验注册（ANZCTR）。ACTRN12615000282583（ANZCTR-Registration）。注册日期：2015 年 3 月 25 日。
