Hosier Hillary, Lundsberg Lisbet S, Culhane Jennifer, Partridge Caitlin, Son Moeun
Department of Obstetrics, Gynecology and Reproductive Sciences, Yale School of Medicine, 333 Cedar St, New Haven, CT, 06510, USA.
Department of Maternal-Fetal Medicine, Weill-Cornell Medicine, New York, NY, 10021, USA.
BMC Pregnancy Childbirth. 2025 Feb 11;25(1):145. doi: 10.1186/s12884-025-07214-x.
The objective of this study was to investigate whether an isolated abnormal 1-hour glucose challenge test (GCT) among patients without gestational diabetes (GDM) is associated with adverse outcomes.
This is a retrospective cohort study of patients who underwent GDM screening at ≥ 24 weeks' gestation with a 1-hour GCT and delivered a singleton fetus at > 35 weeks' gestation at an urban tertiary hospital from 1/2013 to 10/2021. Data were extracted from an electronic medical record data warehouse using standardized billing/diagnosis codes. Individuals were categorized into 3 groups: normal screening (1-hour GCT value < 140 mg/dL), intermediate screening (1-hour GCT value ≥ 140 and < 200 but normal 3-hour glucose tolerance test (GTT)), and GDM (1-hour GCT ≥ 200 mg/dL or abnormal 3-hour GTT). The primary composite perinatal morbidity outcome included any of the following: large for gestational age (LGA) birthweight, birth injury, hypoglycemia with neonatal intensive care unit (NICU) admission, respiratory distress syndrome, transient tachypnea of the newborn, apnea, NICU admission, or perinatal death. Multiple secondary outcomes were also evaluated. Bivariable analyses and multivariable logistic regression modeling were performed.
Of 37,277 eligible patients, 29,698 (79.7%) had normal screening results, 5092 (13.7%) had intermediate screening results, and 2487 (6.6%) were diagnosed with GDM. There were significant differences in baseline characteristics between the three groups, including age, parity, race and ethnicity, payer-type, obesity, and pre-pregnancy metformin use. Compared to normal screening, intermediate screening was associated with an increased risk for the composite perinatal morbidity outcome (OR 1.23, 95% CI 1.15-1.32), cesarean (OR 1.37, 95% CI 1.28-1.46), and hypertensive disorders of pregnancy (OR 1.30, 95% CI 1.20-1.40). Associations for these outcomes were further pronounced in those with GDM compared to normal screening (OR 1.86, 95% CI 1.70-2.03; OR 1.69, 95% CI 1.56-1.84; and OR 1.57, 95% CI 1.42-1.74, respectively). After adjusting for potential confounders, increased risks for the composite perinatal morbidity outcome persisted for those with intermediate screening (aOR 1.18, 95% CI 1.10-1.26).
In addition to patients with GDM, individuals an isolated abnormal 1-hour GCT without GDM were also at increased risks for adverse pregnancy outcomes. Further investigation is needed to understand if patients with mild dysregulation may still benefit from other interventions.
本研究的目的是调查无妊娠期糖尿病（GDM）的患者中孤立的1小时葡萄糖耐量试验（GCT）异常是否与不良结局相关。
这是一项回顾性队列研究，研究对象为2013年1月至2021年10月在一家城市三级医院接受≥24周妊娠GDM筛查且1小时GCT检查，并在>35周妊娠时分娩单胎胎儿的患者。数据从电子病历数据仓库中使用标准化计费/诊断代码提取。个体被分为3组：正常筛查（1小时GCT值<140mg/dL）、中间筛查（1小时GCT值≥140且<200但3小时葡萄糖耐量试验（GTT）正常）和GDM（1小时GCT≥200mg/dL或3小时GTT异常）。主要围产期发病复合结局包括以下任何一种：大于胎龄（LGA）出生体重、出生损伤、因新生儿重症监护病房（NICU）入院的低血糖、呼吸窘迫综合征、新生儿短暂性呼吸急促、呼吸暂停、NICU入院或围产期死亡。还评估了多个次要结局。进行了双变量分析和多变量逻辑回归建模。
在37277名符合条件的患者中，29698名（79.7%）筛查结果正常，5092名（13.7%）筛查结果为中间值，2487名（6.6%）被诊断为GDM。三组之间的基线特征存在显著差异，包括年龄、产次、种族和民族、付款人类型、肥胖和孕前二甲双胍使用情况。与正常筛查相比，中间筛查与围产期发病复合结局风险增加相关（比值比1.23，95%置信区间1.15 - 1.32）、剖宫产（比值比1.37，95%置信区间1.28 - 1.46）和妊娠高血压疾病（比值比1.30，95%置信区间1.20 - 1.40）。与正常筛查相比，GDM患者这些结局的相关性更显著（分别为比值比1.86，95%置信区间1.70 - 2.03；比值比1.69，95%置信区间1.56 - 1.84；比值比1.57，95%置信区间1.42 - 1.74）。在调整潜在混杂因素后，中间筛查患者围产期发病复合结局风险仍然增加（校正后比值比1.18，95%置信区间1.10 - 1.26）。
除GDM患者外，无GDM但1小时GCT孤立异常的个体不良妊娠结局风险也增加。需要进一步研究以了解轻度调节异常的患者是否仍可从其他干预措施中获益。
