Sachdev Devika, Sauer Mark V, Ananth Cande V
Department of Obstetrics, Gynecology, and Reproductive Sciences, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey.
Division of Epidemiology and Biostatistics, Department of Obstetrics, Gynecology, and Reproductive Sciences, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey.
F S Rep. 2023 Nov 17;5(1):102-110. doi: 10.1016/j.xfre.2023.11.008. eCollection 2024 Mar.
To evaluate the risk of gestational diabetes mellitus (GDM) in singleton pregnancies conceived using infertility treatment and examine the influence of race and ethnicity as well as prepregnancy body mass index (BMI).
Cross-sectional study using the US vital records data of women that delivered singleton births.
United States, 2015-2020.
Any infertility treatment was divided into two groups: those that used fertility-enhancing drugs, artificial insemination, or intrauterine insemination, and those that used assisted reproductive technology (ART).
Gestational diabetes mellitus, defined as a diagnosis of diabetes mellitus during pregnancy, includes both diet-controlled GDM and medication-controlled GDM in singleton pregnancies conceived with infertility treatment or spontaneously and delivered between 20- and 44-weeks' gestation. We also examined whether the infertility treatment-GDM association was modified by maternal race and ethnicity as well as prepregnancy BMI. Associations were expressed as a rate ratio (RR) and 95% confidence interval (CI), derived from log-linear models after adjustment for potential confounders.
A total of 21,943,384 singleton births were included, with 1.5% (n = 318,086) undergoing infertility treatment. Rates of GDM among women undergoing infertility treatment and those who conceived spontaneously were 11.0% (n = 34,946) and 6.5% (n = 1,398,613), respectively (adjusted RR 1.24, 95% CI 1.23, 1.26). The RRs were adjusted for maternal age, parity, education, race and ethnicity, smoking, BMI, chronic hypertension, and year of delivery. The risk of GDM was modestly increased for those using fertility-enhancing drugs (adjusted RR 1.28, 95% CI 1.27, 1.30) compared with ART (adjusted RR 1.18, 95% CI 1.17, 1.20), and this risk was especially apparent for non-Hispanic White women (adjusted RR 1.29, 95% CI 1.26, 1.31) and Hispanic women (adjusted RR 1.35, 95% CI 1.29, 1.41). The number of women who needed to be exposed to infertility treatment to diagnose one case of GDM was 46. Prepregnancy BMI did not modify the infertility treatment-GDM association overall and within strata of race and ethnicity. These general patterns were stronger after potential corrections for misclassification of infertility treatment and unmeasured confounding.
Infertility treatment, among those who received fertility-enhancing drugs, is associated with an increased GDM risk. The persistently higher risk of GDM among women who seek infertility treatment, irrespective of prepregnancy weight classification, deserves attention. Infertility specialists must be vigilant with preconception counseling and ensure that all patients, regardless of race and ethnicity or BMI, are adequately tested for GDM early in pregnancy using a fasting blood glucose level or a traditional 50-g oral glucose tolerance test. Testing may be completed by the infertility specialist or deferred to the primary prenatal care provider at the first prenatal visit.
评估采用不孕治疗怀上单胎妊娠的妊娠期糖尿病（GDM）风险，并研究种族和民族以及孕前体重指数（BMI）的影响。
使用美国单胎分娩女性生命记录数据的横断面研究。
美国，2015 - 2020年。
任何不孕治疗分为两组：使用促排卵药物、人工授精或宫内人工授精的，以及使用辅助生殖技术（ART）的。
妊娠期糖尿病定义为孕期诊断的糖尿病，包括在采用不孕治疗或自然受孕并在妊娠20至44周分娩的单胎妊娠中通过饮食控制的GDM和药物控制的GDM。我们还研究了不孕治疗与GDM之间的关联是否因母亲的种族和民族以及孕前BMI而改变。关联以率比（RR）和95%置信区间（CI）表示，通过对潜在混杂因素进行调整后的对数线性模型得出。
共纳入21943384例单胎分娩，其中1.5%（n = 318086）接受了不孕治疗。接受不孕治疗的女性和自然受孕女性的GDM发生率分别为11.0%（n = 34946）和6.5%（n = 1398613）（调整后的RR为1.24，95% CI为1.23，1.26）。RR对母亲年龄、产次、教育程度、种族和民族、吸烟、BMI、慢性高血压和分娩年份进行了调整。与ART相比，使用促排卵药物的女性患GDM的风险适度增加（调整后的RR为1.28，95% CI为1.27，1.30），而ART组为（调整后的RR为1.18，95% CI为1.17，1.20），这种风险在非西班牙裔白人女性（调整后的RR为1.29，95% CI为1.26，1.31）和西班牙裔女性中尤为明显（调整后的RR为1.35，95% CI为1.29，1.41）。诊断一例GDM需要接受不孕治疗的女性人数为46人。孕前BMI总体上以及在种族和民族分层内均未改变不孕治疗与GDM之间的关联。在对不孕治疗的错误分类和未测量的混杂因素进行潜在校正后，这些总体模式更为明显。
在接受促排卵药物治疗的人群中，不孕治疗与GDM风险增加有关。寻求不孕治疗的女性中GDM风险持续较高，无论孕前体重分类如何，都值得关注。不孕专科医生必须在孕前咨询时保持警惕，并确保所有患者，无论种族和民族或BMI如何，在孕早期使用空腹血糖水平或传统的50克口服葡萄糖耐量试验对GDM进行充分检测。检测可由不孕专科医生完成，或在首次产前检查时转交给初级产前护理提供者。
