College of Nursing, University of Colorado, Anschutz Medical Campus, Aurora, CO 80045, USA.
Division of Endocrinology, Metabolism, and Diabetes, Department of Medicine, University of Colorado School of Medicine, Aurora, CO 80045, USA.
Nutrients. 2024 Oct 15;16(20):3489. doi: 10.3390/nu16203489.
Fasting glucose is higher in pregnancies with obesity (OB); less is known about postprandial (PP) and nocturnal patterns when the diet is eucaloric and fixed or about the continuous-glucose-monitor (CGM) metrics that predict neonatal adiposity (NB%fat). We hypothesized that continuous glucose monitors (CGMs) would reveal higher glycemia in OB vs. normal weight (NW) during (14-16 weeks) and (26-28 weeks) gestation despite macronutrient-controlled eucaloric diets and elucidate unique predictors of NB%fat.
In a prospective, parallel-group comparative study, a eucaloric diet (NW: 25 kcal/kg; OB: 30 kcal/kg) was provided (50% carbohydrate [20% simple/30% complex; of total calories], 35% fat, 15% protein) to Early and Later gestation groups wearing a blinded CGM for three days. CGM metrics (mean fasting; 1 h and 2 h PP; daytime and nocturnal glucose; percent time-in-range (%TIR: 63-140 mg/dL); PP excursions; and area-under-the-curve [AUC]) were interrogated between groups and as predictors of NB%fat by dual X-ray absorptiometry(DXA).
Fifty-four women with NW (BMI: 23 kg/m; = 27) and OB (BMI: 32; = 27) provided their informed consent to participate. Early, the daytime glucose was higher in OB vs. NW (mean ± SEM) (91 ± 2 vs. 85 ± 2 mg/dL, = 0.017), driven by 2 h PP glucose (95 ± 2 vs. 88 ± 2, = 0.004). Later, those with OB exhibited higher nocturnal (89 ± 2 vs. 81 ± 2), daytime (95 ± 2 vs. 87 ± 2), 1 h (109 ± 3 vs. 98 ± 2), and 2 h PP (101 ± 3 vs. 92 ± 2) glucose (all < 0.05) but no difference in %TIR (95-99%). Postprandial peak excursions for all meals were markedly blunted in both the Early (9-19 mg/dL) and Later (15-26 mg/dL). In OB, the Later group's 24 h AUC was correlated with NB%fat (r = 0.534, = 0.02). Despite similar weight gain, infants of OB had higher birthweight (3528 ± 107 vs. 3258 ± 74 g, = 0.037); differences in NB%fat did not reach statistical significance (11.0 vs. 8.9%; > 0.05).
Despite macronutrient-controlled eucaloric diets, pregnancies with OB had higher glycemia Early and Later in gestation; the Later 24 h glucose AUC correlated with NB%fat. However, glycemic patterns were strikingly lower than current management targets.
肥胖（OB）孕妇的空腹血糖更高；当饮食为热量均衡且固定或使用连续血糖监测仪（CGM）时，关于餐后（PP）和夜间模式以及预测新生儿脂肪量（NB%fat）的 CGM 指标知之甚少。我们假设尽管进行了宏量营养素控制的热量均衡饮食，连续血糖监测仪（CGMs）仍会在妊娠 14-16 周和 26-28 周时显示 OB 与正常体重（NW）之间的血糖升高，并阐明 NB%fat 的独特预测因子。
在一项前瞻性、平行组比较研究中，为早孕期和晚孕期组的参与者提供热量均衡饮食（NW：25 kcal/kg；OB：30 kcal/kg）（50%碳水化合物[20%简单/30%复杂；总热量]，35%脂肪，15%蛋白质），并佩戴盲法 CGM 三天。通过双能 X 线吸收法（DXA）检测 CGM 指标（平均空腹；1 h 和 2 h PP；白天和夜间血糖；血糖达标时间百分比（%TIR：63-140mg/dL）；PP 波动；和曲线下面积[AUC]），并作为 NB%fat 的预测因子。
54 名 NW 体重指数（BMI）为 23kg/m²（n=27）和 OB（BMI：32kg/m²；n=27）的女性同意参与本研究。早期，OB 的日间血糖高于 NW（平均±SEM）（91±2 vs. 85±2mg/dL，=0.017），主要由 2 h PP 血糖升高（95±2 vs. 88±2，=0.004）引起。后期，OB 组夜间（89±2 vs. 81±2）、日间（95±2 vs. 87±2）、1 h（109±3 vs. 98±2）和 2 h PP（101±3 vs. 92±2）血糖均升高（均<0.05），但%TIR 无差异（95-99%）。两餐之间的所有餐点的餐后峰值波动在早期（9-19mg/dL）和后期（15-26mg/dL）均明显减弱。在 OB 组中，后期 24 h AUC 与 NB%fat 相关（r=0.534，=0.02）。尽管体重增加相似，但 OB 组婴儿的出生体重更高（3528±107 vs. 3258±74g，=0.037）；NB%fat 差异没有达到统计学意义（11.0 vs. 8.9%；>0.05）。
尽管进行了宏量营养素控制的热量均衡饮食，OB 孕妇在妊娠早期和晚期的血糖仍然升高；后期 24 h 血糖 AUC 与 NB%fat 相关。然而，血糖模式明显低于当前的管理目标。
