Department of Obstetrics and Gynecology, Women and Children's Hospital of Chongqing Medical University, Chongqing, China.
Department of Bioinformatics, School of Basic Medical Sciences, Chongqing Medical University, Chongqing, China.
J Diabetes. 2024 Oct;16(10):e70016. doi: 10.1111/1753-0407.70016.
Traditional fixed thresholds for oral glucose tolerance test (OGTT) results may inadequately prevent adverse pregnancy outcomes in twin pregnancies. This study explores latent OGTT patterns and their association with adverse outcomes.
This study retrospectively analyzed 2644 twin pregnancies using latent mixture models to identify glucose level patterns (high, HG; medium, MG; and low, LG) and their relationship with maternal/neonatal characteristics, gestational age at delivery, and adverse outcomes.
Three distinct glucose patterns, HG, MG, and LG patterns were identified. Among the participants, 16.3% were categorized in the HG pattern. After adjustment, compared with the LG pattern, the HG pattern was associated with a 1.79-fold, 1.66-fold, and 1.32-fold increased risk of stillbirth, neonatal respiratory distress, and neonatal hyperbilirubinemia, respectively. The risk of neonatal ICU admission for MG and HG patterns increased by 1.22 times and 1.32 times, respectively, compared with the LG pattern. As gestational weeks increase, although there is an overlap in the confidence intervals between the HG pattern and other patterns in the restricted cubic splines analysis, the trend suggests that pregnant women with the HG pattern are more likely to face risks of their newborns requiring neonatal intensive care unit admission, and adverse comprehensive outcomes, compared with other patterns. In addition, with age and body mass index increasing in HG mode, gestation weeks at delivery tend to be later than in other modes.
Distinct OGTT glucose patterns in twin pregnancies correlate with different risks of adverse perinatal outcomes. The HG pattern warrants closer glucose monitoring and targeted intervention.
传统的口服葡萄糖耐量试验（OGTT）结果固定阈值可能无法充分预防双胎妊娠的不良妊娠结局。本研究探讨了潜在的 OGTT 模式及其与不良结局的关系。
本研究回顾性分析了 2644 例双胎妊娠病例，使用潜在混合模型来识别血糖水平模式（高、HG；中、MG；低、LG）及其与母婴/新生儿特征、分娩时的胎龄和不良结局的关系。
确定了三种不同的葡萄糖模式，HG、MG 和 LG 模式。在参与者中，16.3%被归类为 HG 模式。调整后，与 LG 模式相比，HG 模式与死产、新生儿呼吸窘迫和新生儿高胆红素血症的风险分别增加了 1.79 倍、1.66 倍和 1.32 倍。与 LG 模式相比，MG 和 HG 模式的新生儿 ICU 入院风险分别增加了 1.22 倍和 1.32 倍。随着孕周的增加，尽管在受限立方样条分析中，HG 模式与其他模式的置信区间存在重叠，但趋势表明，与其他模式相比，HG 模式的孕妇其新生儿需要入住新生儿重症监护病房和不良综合结局的风险更高。此外，在 HG 模式中，随着年龄和体重指数的增加，分娩时的孕周往往比其他模式晚。
双胎妊娠中不同的 OGTT 葡萄糖模式与不良围产结局的不同风险相关。HG 模式需要更密切的血糖监测和有针对性的干预。
