de Souza Reis Fabiana Vieira Duarte, Filho Carlos Izaias Sartorão, Sobrevia Luis, Prudencio Caroline Baldini, Bologna Bruna, Iamundo Luana Favaro, Magyori Adriely, Takano Luiz, Avramidis Raissa Escandiussi, de Oliveira Rafael Guilen, Rudge Marilza Vieira Cunha, Barbosa Angélica Mércia Pascon
Postgraduate Program on Tocogynecology, Botucatu Medical School, São Paulo State University (Unesp), Botucatu, Brazil.
Medical School, Educational Foundation of the Municipality of Assis, FEMA, Assis, Sao Paulo, Brazil.
Clin Diabetes Endocrinol. 2024 Dec 12;10(1):45. doi: 10.1186/s40842-024-00196-3.
The literature has been evolving to standardize gestational diabetes mellitus (GDM) diagnosis and terminology. The significance of timing in diagnosing hyperglycemia during pregnancy is underlined by evidence that women diagnosed at 24 weeks of gestation or earlier are at a higher risk of developing postpartum prediabetes, but its association with adverse outcomes for the newborn is controversial. We aimed to investigate the association between early-onset GDM and adverse outcomes in newborns and neonates, comparing it with the late-onset GDM model.
It was a retrospective cohort study conducted at the Perinatal Diabetes Research Center in Assis/SP, affiliated with the Botucatu Medical School-UNESP in Brazil. The group composition was as follows: early-onset participants had fasting glucose levels ≥ 92 mg/dL and < 126 mg/dL before 20 weeks of gestation, while late-onset participants had a negative first-trimester screening and a positive 75g-OGTT at 24-28 weeks. For early-onset GDM, a fasting glucose level of ≥ 92 mg/dL is a recognized threshold associated with an increased risk of adverse pregnancy outcomes, while < 126 mg/dL ensures the exclusion of overt diabetes. The criteria for late-onset GDM, involving a negative initial screening and a positive OGTT at 24-28 weeks, align with the standard diagnostic timeframe when insulin resistance typically peaks due to placental hormone secretion. The maternal baseline characteristics included pre-pregnancy body mass index (BMI; kg/m2) and pregnancy weight gain (kg), calculated as the difference between the final pregnancy weight (36 gestational weeks or more) and pre-pregnancy maternal weight, classified according to the pre-pregnancy BMI. Additionally, the perinatal outcomes evaluated in this study included gestational age (GA) at birth, birth weight (BW) categorized according to GA as adequate, large, or small and Apgar scores at the first and 5th minutes.
Eight hundred eighty pregnant women were selected, of whom 203 (23.07%) presented GDM and were eligible from December 2016 to December 2021. Based on the timing onset of GDM, 89 (43.8%) were in the early-onset group, and 114 (56.2%) were in the late-onset group. The fasting plasma glucose values in the first trimester were higher in the early-onset group. The 75-g OGTT values were higher in the late-onset group. The final BMI was higher in the early-onset group. Univariate linear regression was performed to determine the relationship between late-onset and maternal and neonatal outcomes; however, no significant relation was detected.
Pregnant women with early-onset GDM showed a higher BMI during pregnancy, but there was no difference between early and late-onset GDM concerning neonatal adverse outcomes.
关于妊娠期糖尿病（GDM）的诊断和术语，相关文献一直在不断发展以实现标准化。有证据表明，在妊娠24周或更早被诊断出高血糖的女性发生产后糖尿病前期的风险更高，这凸显了孕期高血糖诊断时机的重要性，但其与新生儿不良结局的关联仍存在争议。我们旨在研究早发型GDM与新生儿及婴儿不良结局之间的关联，并将其与晚发型GDM模型进行比较。
这是一项在巴西圣保罗州阿西斯市围产期糖尿病研究中心开展的回顾性队列研究，该中心隶属于巴西圣保罗州立大学博图卡图医学院。分组情况如下：早发型参与者在妊娠20周前空腹血糖水平≥92mg/dL且<126mg/dL，而晚发型参与者孕早期筛查结果为阴性，在孕24 - 28周时75g口服葡萄糖耐量试验（OGTT）结果为阳性。对于早发型GDM，空腹血糖水平≥92mg/dL是公认的与不良妊娠结局风险增加相关的阈值，而<126mg/dL可排除显性糖尿病。晚发型GDM的诊断标准为初始筛查阴性且在24 - 28周时OGTT阳性，这与因胎盘激素分泌导致胰岛素抵抗通常达到峰值的标准诊断时间框架一致。母亲的基线特征包括孕前体重指数（BMI；kg/m²）和孕期体重增加量（kg），孕期体重增加量计算为最终孕期体重（妊娠36周或更晚）与孕前母亲体重之差，并根据孕前BMI进行分类。此外，本研究评估的围产期结局包括出生时的孕周（GA）、根据GA分类为适当、巨大或小样的出生体重（BW）以及第1分钟和第5分钟的阿氏评分。
共选取880名孕妇，其中203名（23.07%）患有GDM且符合2016年12月至2021年12月期间的研究条件。根据GDM的发病时间，89名（43.8%）属于早发型组，114名（56.2%）属于晚发型组。早发型组孕早期空腹血糖值更高。晚发型组75g OGTT值更高。早发型组最终BMI更高。进行单因素线性回归以确定晚发型与母亲和新生儿结局之间的关系；然而，未检测到显著关系。
早发型GDM孕妇孕期BMI更高，但早发型和晚发型GDM在新生儿不良结局方面无差异。
