Yuen Lili, Wong Vincent, Immanuel Jincy, Hague William M, Cheung N Wah, Teede Helena, Hibbert Emily, Nolan Christopher J, Peek Michael, Flack Jeff R, McLean Mark, Sweeting Arianne, Kautzky-Willer Alexandra, Harreiter Jürgen, Gianatti Emily, Mohan Viswanathan, Backman Helena, Simmons David
Western Sydney University, Campbelltown, Australia.
UNSW, Sydney Australia.
J Clin Endocrinol Metab. 2024 Dec 6. doi: 10.1210/clinem/dgae838.
To compare the prevalence and clinical characteristics of early gestational diabetes (eGDM) and associated birth outcomes amongst women of different ethnic groups.
This is a secondary analysis of an international, multicentre randomized controlled trial of treating eGDM among pregnant women with GDM risk factors enrolled <20 weeks' gestation. The diagnosis of GDM was made using WHO-2013 criteria. While Europids required at least one risk factor for recruitment, for others, ethnicity itself was a risk factor.
Among women of Europid (n=1,567), South Asian (SA: n=971), East and South-East Asian (ESEA: n=498), Middle Eastern (ME: n=242) and Māori and Pasifika (MP: n=174) ethnicities; MP (26.4%) had the highest eGDM crude prevalence compared with Europid (20.3%), SA (24.7%), ESEA (22.3%) and ME (21.1%) (p<0.001). Compared with Europid, the highest eGDM adjusted odds ratio (aOR) was seen in SA (2.43 [95%CI 1.9-3.11]) and ESEA (aOR 2.28 [95%CI 1.68-3.08]); in late GDM, SA had the highest prevalence (20.4%: aOR 2.16 [95%CI 1.61-2.9]). Glucose patterns varied between ethnic groups and ESEA were predominantly diagnosed with eGDM through post-glucose load values, while all other ethnic groups were mainly diagnosed on fasting glucose values. There were no differences in the eGDM composite primary outcome or neonatal and pregnancy-related hypertension outcomes between the ethnic groups.
In women with risk factors, eGDM was most prevalent in SA and ESEA women, particularly identified by the post-glucose load samples. These findings suggest an early OGTT should particularly be performed in women from these ethnic groups.
比较不同种族女性中早期妊娠糖尿病（eGDM）的患病率、临床特征及相关分娩结局。
这是一项针对妊娠<20周且具有GDM风险因素的孕妇进行的治疗eGDM的国际多中心随机对照试验的二次分析。GDM的诊断采用WHO-2013标准。欧洲裔女性入组需要至少一个风险因素，而对于其他种族，种族本身就是一个风险因素。
在欧洲裔（n=1567）、南亚裔（SA：n=971）、东亚和东南亚裔（ESEA：n=498）、中东裔（ME：n=242）以及毛利和太平洋岛民裔（MP：n=174）的女性中；MP（26.4%）的eGDM粗患病率最高，高于欧洲裔（20.3%）、SA（24.7%）、ESEA（22.3%）和ME（21.1%）（p<0.001）。与欧洲裔相比，SA（2.43 [95%CI 1.9 - 3.11]）和ESEA（调整后的优势比[aOR] 2.28 [95%CI 1.68 - 3.08]）的eGDM调整后优势比最高；在晚期GDM中，SA的患病率最高（20.4%：aOR 2.16 [95%CI 1.61 - 2.9]）。不同种族的血糖模式有所不同，ESEA主要通过葡萄糖负荷后值诊断为eGDM，而其他所有种族主要通过空腹血糖值诊断。各族群在eGDM综合主要结局或新生儿及妊娠相关高血压结局方面无差异。
在有风险因素的女性中，eGDM在SA和ESEA女性中最为普遍，尤其是通过葡萄糖负荷后样本确定。这些发现表明，应特别对这些种族的女性进行早期口服葡萄糖耐量试验（OGTT）。
