Wang Qiaohong, Bai Wenxin, Li Congcong, Zhang Xiaoxin, Zhao Aimin
Department of Obstetrics and Gynecology, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
Department of Obstetrics and Gynecology, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
J Reprod Immunol. 2024 Dec;166:104395. doi: 10.1016/j.jri.2024.104395. Epub 2024 Nov 19.
In this single-center, prospective cohort study, we aimed to explore the effect of low dose prednisone treatment during pregnancy on blood glucose levels in patients with spontaneous abortion. Patients with a history of spontaneous abortion were enrolled and were assigned to two groups according to whether they were exposed to low dose prednisone during pregnancy. All patients received OGTT at early and late pregnancy. Fasting serum C-peptide and HbA1c levels were measured at the same time. We then analyzed the incidence of DM, impaired fasting glucose, impaired glucose tolerance and the incidence of GDM. A total of 355 patients were enrolled. No significant difference in OGTT between the two groups were observed in the first trimester (P=0.142). However, patients in the prednisone group showed a significant increase in fasting serum C-peptide (P<0.001). Regarding late pregnancy, patients in the prednisone group showed a significant increase in 2-h plasma glucose (P=0.010). Patients in the prednisone group also had a higher incidence of GDM (P=0.005). Furthermore, family history of DM and receiving low dose prednisone were significantly associated with higher risk of gestational glycometabolism abnormality in patients with spontaneous abortion. Therefore, our study suggested that long-term exposure of low dose prednisone during pregnancy could impair postprandial blood glucose and increase the incidence of GDM. Routine monitor of blood glucose and C-peptide levels should be recommended in patients who received prednisone treatment during pregnancy.
在这项单中心前瞻性队列研究中，我们旨在探讨孕期低剂量泼尼松治疗对自然流产患者血糖水平的影响。纳入有自然流产史的患者，并根据她们孕期是否暴露于低剂量泼尼松分为两组。所有患者在孕早期和孕晚期均接受口服葡萄糖耐量试验（OGTT）。同时测量空腹血清C肽和糖化血红蛋白（HbA1c）水平。然后我们分析了糖尿病（DM）、空腹血糖受损、糖耐量受损和妊娠期糖尿病（GDM）的发生率。共纳入355例患者。孕早期两组间OGTT无显著差异（P = 0.142）。然而，泼尼松组患者空腹血清C肽显著升高（P < 0.001）。关于孕晚期，泼尼松组患者2小时血糖显著升高（P = 0.010）。泼尼松组患者GDM发生率也更高（P = 0.005）。此外，DM家族史和接受低剂量泼尼松与自然流产患者发生妊娠期糖代谢异常的较高风险显著相关。因此，我们的研究表明孕期长期暴露于低剂量泼尼松可能损害餐后血糖并增加GDM的发生率。对于孕期接受泼尼松治疗的患者，建议常规监测血糖和C肽水平。
