Gitlin Emily S, Demetres Michelle, Vaidyanathan Arthi, Palmer Nicole, Lee Hannah, Loureiro Sabrina, Radwan Eman, Tuschman Abigail, Mathad Jyoti, Chebrolu Puja
Weill Cornell Medicine, New York, NY, United States.
Duke University School of Medicine, Durham, NC, United States.
Front Clin Diabetes Healthc. 2024 Jul 10;5:1415069. doi: 10.3389/fcdhc.2024.1415069. eCollection 2024.
Gestational diabetes (GDM) affects nearly 15% of pregnancies worldwide and is increasing globally. While this growth is thought to be primarily from overweight and obesity, normal and underweight women are affected as well, particularly in low and middle-income countries. However, GDM in non-overweight women remains understudied. Thus, we examined the prevalence among normal and underweight women globally.
A comprehensive literature search was performed in Ovid MEDLINE, Ovid EMBASE, and The Cochrane Library. Studies retrieved were screened for eligibility against predefined inclusion/exclusion criteria. Prevalence of GDM among women with normal and underweight body mass index (BMI) was extracted, and average prevalence was calculated globally, by World Health Organization region, and by country. Pregnancy outcomes were described when available.
A total of 145 studies were included. The average global prevalence of GDM among non-overweight women (BMI <25 kg/m) was 7.3% and among underweight women (BMI <18.5 kg/m) was 5.0%. GDM prevalence in non-overweight women was highest in Asia (average 12.1%) and lowest in the African region (0.7%). The countries with the highest prevalence were Vietnam (21.1%), Finland (19.8%), Poland (19.3%), Bangladesh (18.65%), and China (17.7%). The average global prevalence of large for gestational age infants (LGA) born to non-overweight women with GDM was 9.9%, which is lower than the average prevalence in the general population with GDM (14%).
GDM is more common than previously recognized in non-overweight women, particularly in Asia, but also in European countries. Non-overweight women with GDM had lower prevalence of LGA babies compared to prior reported prevalence in all women with GDM, though data on pregnancy outcomes was limited. These findings challenge guidelines that recommend restriction of weight gain for GDM management. Further research on the pathophysiology and complications of GDM in women who are not overweight should be urgently conducted to inform appropriate management guidelines and support optimal pregnancy outcomes.
妊娠期糖尿病（GDM）影响着全球近15%的孕期女性，且在全球范围内呈上升趋势。虽然这种增长被认为主要源于超重和肥胖，但正常体重及体重过轻的女性也会受到影响，尤其是在低收入和中等收入国家。然而，非超重女性中的GDM仍未得到充分研究。因此，我们调查了全球正常体重及体重过轻女性中的GDM患病率。
在Ovid MEDLINE、Ovid EMBASE和Cochrane图书馆进行了全面的文献检索。根据预先设定的纳入/排除标准对检索到的研究进行资格筛选。提取正常体重指数（BMI）和体重过轻的女性中GDM的患病率，并计算全球、世界卫生组织各区域以及各个国家的平均患病率。如有可用数据，描述妊娠结局。
共纳入145项研究。非超重女性（BMI<25kg/m²）中GDM的全球平均患病率为7.3%；体重过轻的女性（BMI<18.5kg/m²）中GDM患病率为5.0%。非超重女性中GDM患病率在亚洲最高（平均12.1%），在非洲地区最低（0.7%）。患病率最高的国家是越南（21.1%）、芬兰（19.8%）、波兰（19.3%）、孟加拉国（18.65%）和中国（17.7%）。患有GDM的非超重女性所分娩的大于胎龄儿（LGA）的全球平均患病率为9.9%，低于患有GDM的普通人群的平均患病率（14%）。
GDM在非超重女性中比之前认为的更为常见，尤其是在亚洲，但在欧洲国家也较为常见。与先前报道的所有患有GDM的女性相比，患有GDM的非超重女性中LGA婴儿的患病率较低，不过关于妊娠结局的数据有限。这些发现对推荐限制体重增加以管理GDM的指南提出了挑战。应紧急开展关于非超重女性GDM的病理生理学和并发症的进一步研究，以制定合适的管理指南并支持实现最佳妊娠结局。
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