Department of Obstetrics and Gynaecology, Queen Mary Hospital, The University of Hong Kong, 6/F, Professorial Block, 102 Pokfulam Road, Hong Kong, China.
Department of Obstetrics and Gynaecology, Tuen Mun Hospital, Tuen Mun, Hong Kong SAR, China.
Sci Rep. 2024 Oct 24;14(1):25157. doi: 10.1038/s41598-024-76497-5.
The current diagnostic criteria for gestational diabetes (GDM) were based on data from women after 24 weeks of gestation, but this may not be equally applicable for earlier gestation. There is insufficient data regarding early pregnancy glycaemia and the associated complications. We retrospectively reviewed 39,483 deliveries and 12,918 with risk factors for GDM underwent oral glucose tolerance test (OGTT) before 24 weeks of gestation. A strong and progressively positive association was observed with any pregnancy complications in both fasting glucose (FG) and 2 h glucose (2hG). The increased risk of developing any pregnancy complications started from FG 4.5-4.7 mmol/L and 2hG of 6.2-6.9mmol/L. Every increase by 1 mmol/L in FG or 2 hG levels increased the risk of developing any complications (aOR 1.614 for FG and 1.131 for 2hG), pre-eclampsia (aOR 1.472 for FG and 1.143 for 2hG), maternal insulin use (aOR 12.821 for FG and 2.366 for 2hG), primary Caesarean section(aOR 1.274 for FG and 1.099 for 2hG), shoulder dystocia (aOR 1.941 for FG and 1.282 for 2hG), macrosomia(aOR 2.203 for FG and 1.072 for 2hG), and large for gestation age(aOR 2.157 for FG and 1.074 for 2hG). Therefore, glycaemic levels in early pregnancy among high-risk women positively associated with pregnancy complications, even at levels below the current recommended diagnostic criteria for GDM.
目前的妊娠期糖尿病（GDM）诊断标准基于 24 周后孕妇的数据，但这可能不适用于更早的妊娠。关于早期妊娠血糖和相关并发症的数据不足。我们回顾性分析了 39483 例分娩和 12918 例有 GDM 危险因素的患者，他们在 24 周前进行了口服葡萄糖耐量试验（OGTT）。空腹血糖（FG）和 2 小时血糖（2hG）与任何妊娠并发症均呈强正相关且呈逐渐递增趋势。从 FG 4.5-4.7mmol/L 和 2hG 6.2-6.9mmol/L 开始，发生任何妊娠并发症的风险增加。FG 或 2hG 水平每增加 1mmol/L，发生任何并发症的风险增加（FG 的比值比[aOR]为 1.614，2hG 的 aOR 为 1.131）、子痫前期（FG 的 aOR 为 1.472，2hG 的 aOR 为 1.143）、产妇胰岛素使用（FG 的 aOR 为 12.821，2hG 的 aOR 为 2.366）、初次剖宫产（FG 的 aOR 为 1.274，2hG 的 aOR 为 1.099）、肩难产（FG 的 aOR 为 1.941，2hG 的 aOR 为 1.282）、巨大儿（FG 的 aOR 为 2.203，2hG 的 aOR 为 1.072）和大于胎龄儿（FG 的 aOR 为 2.157，2hG 的 aOR 为 1.074）。因此，高危孕妇的早期妊娠血糖水平与妊娠并发症呈正相关，即使在低于目前 GDM 诊断标准的水平也是如此。
