Eng Pei Chia, Lee Soo Hoon, Der Teo Ada Ee, Lim Dawn Se Teng, Tan Lyeann Li Ying, Tan Guat Kian, Tai E Shyong, Phan Phillip, Khoo Chin Meng
Division of Endocrinology, Department of Medicine, National University Health Systems, National University Hospital, Singapore.
Divsion of Diabetes, Endocrinology and Metabolism, Imperial College London, London, UK.
Diabetes Obes Metab. 2025 Feb;27(2):845-855. doi: 10.1111/dom.16085. Epub 2024 Nov 27.
Women with gestational diabetes (GDM) have increased lifetime risk of developing diabetes. We aim to determine the factors contributing to poor adherence of the postpartum oral glucose tolerance test (OGTT) and identify key predictors to postpartum dysglycaemia in our Asian cohort.
We conducted a retrospective cohort study of women with high-risk GDM (n = 561). High-risk women with GDM were defined as (1) women with diabetic-range glucose excursions on an antepartum OGTT, (2) women diagnosed GDM on early OGTT and (3) women requiring ≥20 units of insulin during antepartum period. We use logistic regression predictive models to associate maternal variables with postpartum OGTT attendance and glucose tolerance status postnatally.
Between March 2020 to March 2024, 58.7% (n = 329) of women returned for postpartum OGTT. Predictors for attendance of postpartum OGTT were Chinese ethnicity (odds ratio [OR] 2.11, 95% confidence interval [CI] [1.14-3.89]), pre-pregnancy body mass index (BMI) (OR 0.95 [95% CI 0.90-0.99]), first GDM (OR 2.34 [95% CI 1.39-3.96]) and 2-h glucose threshold on antepartum OGTT (OR 0.87 [95% CI 0.76-0.99]). Ethnicity influences postnatal dysglycaemia outcomes in our cohort. Chinese women, compared to women of Malay ethnicity, had a 4.5-odds of persistent postpartum dysglycaemia. An antenatal HbA1c of ≥5.7% and an elevated 2-h post-OGTT glucose value significantly predict postpartum dysglycaemia independent of ethnicity.
Ethnicity-specific prediction models integrating antepartum OGTT and HbA1c predict postpartum dysglycaemia in a multiethnic Southeast Asian cohort. Using these predictive models, we could identify high-risk patients for early intervention.
患有妊娠期糖尿病（GDM）的女性患糖尿病的终生风险增加。我们旨在确定导致产后口服葡萄糖耐量试验（OGTT）依从性差的因素，并确定我们亚洲队列中产后血糖异常的关键预测因素。
我们对高危GDM女性（n = 561）进行了一项回顾性队列研究。高危GDM女性被定义为：（1）产前OGTT血糖值处于糖尿病范围的女性；（2）早期OGTT诊断为GDM的女性；（3）产前期间需要≥20单位胰岛素的女性。我们使用逻辑回归预测模型将母亲变量与产后OGTT检查情况及产后葡萄糖耐量状态相关联。
在2020年3月至2024年3月期间，58.7%（n = 329）的女性返回进行产后OGTT检查。产后OGTT检查的预测因素为华裔（优势比[OR] 2.11，95%置信区间[CI] [1.14 - 3.89]）、孕前体重指数（BMI）（OR 0.95 [95% CI 0.90 - 0.99]）、首次患GDM（OR 2.34 [95% CI 1.39 - 3.96]）和产前OGTT的2小时血糖阈值（OR 0.87 [95% CI 0.76 - 0.99]）。种族影响我们队列中的产后血糖异常结果。与马来族女性相比，华裔女性产后持续性血糖异常的几率高出4.5倍。产前糖化血红蛋白（HbA1c）≥5.7%以及OGTT后2小时血糖值升高可独立于种族显著预测产后血糖异常。
整合产前OGTT和HbA1c的种族特异性预测模型可预测多民族东南亚队列中的产后血糖异常。使用这些预测模型，我们可以识别高危患者以便进行早期干预。
