Jotic Aleksandra Z, Stoiljkovic Milica M, Milicic Tanja J, Lalic Katarina S, Lukic Ljiljana Z, Macesic Marija V, Gajovic Jelena N Stanarcic, Milovancevic Mina M, Obradovic Marko H, Gojnic Miroslava G, Rafailovic Djurdja P, Lalic Nebojsa M
Clinic for Endocrinology, Diabetes and Metabolic Diseases, University Clinical Center of Serbia, Dr Subotica 13, 11000, Belgrade, Serbia.
Faculty of Medicine, University of Belgrade, Dr Subotica 8, 11000, Belgrade, Serbia.
Diabetes Ther. 2025 May;16(5):1049-1062. doi: 10.1007/s13300-025-01713-y. Epub 2025 Mar 19.
The most common form of pregestational diabetes in pregnancy is type 2 diabetes, requiring strict metabolic monitoring owing to the risk of adverse pregnancy outcomes. Our study aimed to identify predictors of composite maternal outcome (CMO) and fetal outcome (CFO) separately in pregnant women with early-onset type 2 diabetes (PwEOT2D).
The cross-sectional pilot study included 60 PwEOT2D by recording age, socioeconomic determinants, preconception body mass index (pBMI), preconception (pHbA1c) and trimester-specific glycated hemoglobin (HbA1c), gestational weight gain (GWG), and pregnancy outcomes. We defined CMO as at least one of the following: gestational hypertension, preeclampsia, eclampsia, preterm delivery, or emergency section. CFO included at least one of the following: small or large for gestational age, macrosomia, neonatal hypoglycemia, or admission to the neonatal intensive care unit.
CMO was detected in 55% and CFO in 35% of PwEOT2D. The majority of PwEOT2D with CMO lived in suburban areas (73.1%), while those without CMO mostly lived in rural areas (51.9%, p = 0.014). Moreover, PwEOT2D with CMO had comparable pBMI to those without CMO (31.45 ± 6.27 versus 28.99 ± 6.28 kg/m, p = 0.136). However, PwEOT2D with CMO had higher pHbA1c (7.28 ± 0.95 versus 6.46 ± 0.96%, p = 0.002) and first trimester HbA1c (7.24 ± 1.08 versus 6.42 ± 0.97%, p = 0.003). Similarly, PwEOT2D with CFO had higher pHbA1c (7.84 ± 0.95 versus 6.41 ± 0.67%, p < 0.001) and first trimester (7.29 ± 1.07 versus 6.65 ± 1.07%, p = 0.032) and second trimester HbA1c (6.45 ± 0.87 versus 5.96 ± 0.82%, p = 0.038). Additionally, GWG was higher in the second (4.38 ± 2.01 versus 3.33 ± 1.61 kg, p = 0.032) and third trimester (5.66 ± 2.93 versus 3.89 ± 2.61 kg, p = 0.002) compared with those without CMO. Regression analysis identified pHbAc, first trimester of pregnancy, and community type as predictors of CMO, while pHbA1c and the occurrence of CMO were predictors of CFO.
Our results imply that preconception and first trimester of pregnancy HbAc, as well as community disparities, are predictors of CMO, while the predictors of CFO were only preconception HbA1c and the occurrence of CMO in pregnant women with EOT2D. Therefore, tailoring preventive strategies, followed by achieving and sustaining trimester-specific metabolic control, might improve pregnancy outcomes in women with EOT2D.
妊娠前糖尿病最常见的形式是2型糖尿病，由于存在不良妊娠结局的风险，需要进行严格的代谢监测。我们的研究旨在分别确定早发型2型糖尿病孕妇（PwEOT2D）的孕产妇综合结局（CMO）和胎儿结局（CFO）的预测因素。
这项横断面试点研究纳入了60例PwEOT2D患者，记录了她们的年龄、社会经济决定因素、孕前体重指数（pBMI）、孕前糖化血红蛋白（pHbA1c）和孕期各阶段的糖化血红蛋白（HbA1c）、孕期体重增加（GWG）以及妊娠结局。我们将CMO定义为以下至少一项：妊娠期高血压、子痫前期、子痫、早产或急诊剖宫产。CFO包括以下至少一项：小于或大于胎龄、巨大儿、新生儿低血糖或入住新生儿重症监护病房。
55%的PwEOT2D患者出现CMO，35%出现CFO。大多数出现CMO的PwEOT2D患者居住在郊区（73.1%），而未出现CMO的患者大多居住在农村地区（51.9%，p = 0.014）。此外，出现CMO的PwEOT2D患者的pBMI与未出现CMO的患者相当（31.45±6.27 vs 28.99±6.28 kg/m²，p = 0.136）。然而，出现CMO的PwEOT2D患者的pHbA1c较高（7.28±0.95 vs 6.46±0.96%，p = 0.002），孕早期HbA1c也较高（7.24±1.08 vs 6.42±0.97%，p = 0.003）。同样，出现CFO的PwEOT2D患者的pHbA1c较高（7.84±0.95 vs 6.41±0.67%，p < 0.001），孕早期（7.29±1.07 vs 6.65±1.07%，p = 0.032）和孕中期HbA1c也较高（6.45±0.87 vs 5.96±0.82%，p = 0.038）。此外，与未出现CMO的患者相比，出现CMO的患者在孕中期（4.38±2.01 vs 3.33±1.61 kg，p = 0.032）和孕晚期（5.66±2.93 vs 3.89±2.61 kg，p = 0.002）的GWG更高。回归分析确定pHbAc、孕早期和社区类型是CMO的预测因素，而pHbA1c和CMO的发生是CFO的预测因素。
我们的结果表明，孕前和孕早期的HbAc以及社区差异是CMO的预测因素，而CFO的预测因素仅为孕前HbA1c和早发型2型糖尿病孕妇CMO的发生情况。因此，制定针对性的预防策略，随后实现并维持孕期各阶段的代谢控制，可能会改善早发型2型糖尿病孕妇的妊娠结局。
