Division of Endocrinology and Metabolism, Department of Internal Medicine, CHA Gangnam Medical Center, CHA University School of Medicine, Seoul, Korea.
Department of Biostatics and Data Science, School of Public Health, University of Texas Health Science Center at Houston, Houston, Texas, United States of America.
PLoS One. 2024 Jun 4;19(6):e0304875. doi: 10.1371/journal.pone.0304875. eCollection 2024.
Previous studies have shown that fetal abdominal obesity (FAO) was already observed at the time of gestational diabetes mellitus (GDM) diagnosis and persisted until delivery despite management in older and/or obese women. In this study, we investigated whether fetuses of women with milder hyperglycemia than GDM have accelerated abdominal growth, leading to adverse pregnancy outcomes. We retrospectively reviewed the medical records of 7,569 singleton pregnant women who were universally screened using a 50-g glucose challenge test (GCT) and underwent a 3-h 100-g oral glucose tolerance test (OGTT) if GCT result was ≥140mg/dL. GDM, one value abnormality (OVA), and normal glucose tolerance (NGT, NGT1: GCT negative, NGT2: GCT positive & OGTT negative) were diagnosed using Carpenter-Coustan criteria. With fetal biometry data measured simultaneously with 50-g GCT, relative fetal abdominal overgrowth was investigated by assessing the fetal abdominal overgrowth ratios (FAORs) of the ultrasonographically estimated gestational age (GA) of abdominal circumference(AC) per actual GA by the last menstruation period(LMP), biparietal diameter(BPD) or femur length(FL), respectively. FAO was defined as FAOR ≥90th percentile The FAORs of GA-AC/GA-LMP and GA-AC/GA-BPD were significantly higher in OVA subjects compared to NGT subjects but not in NGT2 subjects. Although the frequency of FAO in OVA (12.1%) was between that of NGT (9.6%) and GDM (18.3%) without statistically significant difference, the prevalence of large for gestational age at birth and primary cesarean delivery rates were significantly higher in OVA (9.8% and 29.7%) than in NGT (5.1% and 21.5%, p<0.05). Particularly, among OVA subjects with FAO, the prevalence (33.3% and 66.7%) was significantly higher than in those without FAO (9.7% and 24.2%, p<0.05). The degree of fetal abdominal growth acceleration in OVA subjects was intermediate between that of NGT and GDM subjects. OVA subjects with FAO at the time of GDM diagnosis were strongly associated with adverse pregnancy outcomes.
先前的研究表明，即使在患有妊娠糖尿病（GDM）的老年和/或肥胖女性中进行了管理，胎儿腹部肥胖（FAO）在 GDM 诊断时已经存在，并持续到分娩。在这项研究中，我们研究了 GDM 血糖水平轻度升高的女性胎儿是否存在腹部生长加速，从而导致不良的妊娠结局。我们回顾性分析了 7569 例单胎孕妇的病历，这些孕妇均使用 50g 葡萄糖筛查试验（GCT）进行了普遍筛查，如果 GCT 结果≥140mg/dL，则进行 3 小时 100g 口服葡萄糖耐量试验（OGTT）。GDM、单项值异常（OVA）和正常糖耐量（NGT，NGT1：GCT 阴性，NGT2：GCT 阳性和 OGTT 阴性）采用 Carpenter-Coustan 标准诊断。使用同时测量 50g GCT 的胎儿生物测量数据，通过分别评估超声估计的腹围（AC）相对于末次月经周期（LMP）、双顶径（BPD）或股骨长（FL）的实际 GA 的胎儿腹部过度生长比（FAOR）来研究相对胎儿腹部过度生长。FAO 定义为 FAOR≥90 百分位 OVA 受试者的 GA-AC/GA-LMP 和 GA-AC/GA-BPD 的 FAOR 明显高于 NGT 受试者，但在 NGT2 受试者中则不然。尽管 OVA 中的 FAO 频率（12.1%）在 NGT（9.6%）和 GDM（18.3%）之间，但无统计学差异，但 OVA（9.8%和 29.7%）出生时大于胎龄儿和初次剖宫产率明显高于 NGT（5.1%和 21.5%，p<0.05）。特别是在 OVA 中有 FAO 的受试者中，其发生率（33.3%和 66.7%）明显高于无 FAO 的受试者（9.7%和 24.2%，p<0.05）。OVA 受试者的胎儿腹部生长加速程度介于 NGT 和 GDM 受试者之间。在 GDM 诊断时患有 OVA 且存在 FAO 的受试者与不良妊娠结局密切相关。
