Moon Joon Ho, Won Sookyung, Won Hojeong, Son Heejun, Oh Tae Jung, Kwak Soo Heon, Choi Sung Hee, Jang Hak Chul
Division of Endocrinology and Metabolism, Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea.
Division of Endocrinology and Metabolism, Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea.
Endocrinol Metab (Seoul). 2025 Apr;40(2):247-257. doi: 10.3803/EnM.2024.2089. Epub 2024 Nov 28.
Gestational diabetes mellitus (GDM) affects women with diverse pathological phenotypes, but little is known about the effects of this variation on perinatal outcomes. We explored the metabolic phenotypes of GDM and their impact on adverse pregnancy outcomes.
Women diagnosed with gestational glucose intolerance or GDM were categorized into subgroups according to their prepregnancy body mass index (BMI) and the median values of the gestational Matsuda and Stumvoll indices. Logistic regression analysis was employed to assess the odds of adverse pregnancy outcomes, such as large-for-gestational age (LGA), small-for-gestational age, preterm birth, low Apgar score, and cesarean section.
A total of 309 women were included, with a median age of 31 years and a median BMI of 22.3 kg/m2. Women with a higher pre-pregnancy BMI had a higher risk of LGA newborns (adjusted odds ratio [aOR] for pre-pregnancy BMI ≥25 kg/m2 compared to 20-23 kg/m2, 4.26; 95% confidence interval [CI], 1.99 to 9.12; P<0.001; P for trend=0.001), but the risk of other adverse pregnancy outcomes did not differ according to pre-pregnancy BMI. Women with insulin resistance had a higher risk of LGA (aOR, 1.88; 95% CI, 1.02 to 3.47; P=0.043) and cesarean section (aOR, 2.12; 95% CI, 1.29 to 3.50; P=0.003) than women in the insulin-sensitive group. In contrast, defective β-cell function did not affect adverse pregnancy outcomes.
Different metabolic phenotypes of GDM were associated with heterogeneous pregnancy outcomes. Women with obesity and those with insulin resistance are at greater risk of adverse outcomes and might need strict glycemic management during pregnancy.
妊娠期糖尿病（GDM）影响具有不同病理表型的女性，但关于这种变异对围产期结局的影响知之甚少。我们探讨了GDM的代谢表型及其对不良妊娠结局的影响。
根据孕前体重指数（BMI）以及妊娠松田指数和施图姆沃尔指数的中位数，将诊断为妊娠糖耐量异常或GDM的女性分为亚组。采用逻辑回归分析评估不良妊娠结局的几率，如大于胎龄儿（LGA）、小于胎龄儿、早产、阿氏评分低和剖宫产。
共纳入309名女性，中位年龄为31岁，中位BMI为22.3kg/m²。孕前BMI较高的女性生出LGA新生儿的风险更高（与20 - 23kg/m²相比，孕前BMI≥25kg/m²的调整优势比[aOR]为4.26；95%置信区间[CI]为1.99至9.12；P<0.001；趋势P = 0.001），但根据孕前BMI，其他不良妊娠结局的风险并无差异。与胰岛素敏感组的女性相比，胰岛素抵抗的女性生出LGA的风险更高（aOR为1.88；95%CI为1.02至3.47；P = 0.043）以及剖宫产的风险更高（aOR为2.12；95%CI为1.29至3.50；P = 0.003）。相比之下，β细胞功能缺陷并不影响不良妊娠结局。
GDM的不同代谢表型与不同的妊娠结局相关。肥胖女性和胰岛素抵抗女性发生不良结局的风险更高，孕期可能需要严格的血糖管理。
