Song Geng, Wei Yumei, Juan Juan, Su Rina, Yan Jianying, Xiao Mei, Zhao Xianlan, Zhang Meihua, Ma Yuyan, Liu Haiwei, Sun Jingxia, Hu Kejia, Yang Huixia
Department of Obstetrics and Gynecology, Peking University First Hospital, Beijing 100034, China.
Beijing Key Laboratory of Maternal Fetal Medicine of Gestational Diabetes Mellitus, Beijing 100034, China.
Matern Fetal Med. 2022 Aug 9;5(1):9-15. doi: 10.1097/FM9.0000000000000150. eCollection 2023 Jan.
This study aimed to determine the likelihood of gestational diabetes mellitus (GDM) in subsequent pregnancy among women without GDM history and to identify risk factors for GDM in subsequent pregnancy.
This retrospective cohort study involved participants who delivered twice in same hospital of 18 research centers when delivered the second baby from January 2018 to December 2018. Finally 6204 women were enrolled and 5180 women without GDM history were analyzed further. Women were categorized as non-GDM or GDM based on the blood glucose values of the subsequent pregnancy, and the characteristics and GDM risk of these groups were compared. A univariate analysis of potential risk factors was performed using the Chi-squared test and/or -test for qualitative or quantitative variables, respectively. Associations with values <0.1 were chosen to be included in the multivariate binary logistic regression model.
In primary analysis of 6204 women, the incidence of GDM in subsequent pregnancy is 48.9% (490/1002) in women with GDM history and 16.1% (835/5202) in women without GDM history. In a further analysis for 5180 women without GDM at index pregnancy, compared with the non-GDM group, the GDM group had a significantly higher age, prepregnancy body mass index, and blood glucose value at each oral glucose tolerance test (OGTT) timepoint (fasting, 1 h and 2 h) during the index and subsequent pregnancies, as well as higher weight retention during the interval between the two pregnancies (<0.001). Age above 35 years in subsequent pregnancy (odds ratio ()=1.540, 95% confidence interval () = 1.257-1.886, <0.001), macrosomia in index pregnancy (=1.749, 95% =1.277-2.395, =0.001), OGTT blood glucose values in index pregnancy (fasting, =2.487, 95% =1.883-3.285, <0.001; 1 h, =1.142, 95% =1.051-1.241, =0.002; 2 h, =1.290, 95% =1.162-1.432, <0.001) and weight retention (=1.052, 95% =1.035-1.068, <0.001) were independent risk factors for GDM in subsequent pregnancy.
For women without GDM history, GDM risk factors including age, macrosomia history, OGTT value, and weight retention, these can be evaluated before a subsequent pregnancy. Early warning and interventions are needed for women at high risk.
本研究旨在确定既往无妊娠期糖尿病（GDM）病史的女性在后续妊娠中患GDM的可能性，并确定后续妊娠中GDM的危险因素。
这项回顾性队列研究纳入了2018年1月至2018年12月在18个研究中心的同一家医院分娩两次的参与者。最终纳入6204名女性，其中5180名无GDM病史的女性被进一步分析。根据后续妊娠的血糖值将女性分为非GDM组或GDM组，并比较这些组的特征和GDM风险。分别使用卡方检验和/或t检验对定性或定量变量进行潜在危险因素的单因素分析。将P值<0.1的关联因素纳入多因素二元逻辑回归模型。
在对6204名女性的初步分析中，有GDM病史的女性后续妊娠中GDM的发生率为48.9%（490/1002），无GDM病史的女性为16.1%（835/5202）。在对5180名首次妊娠无GDM的女性进行的进一步分析中，与非GDM组相比，GDM组在首次妊娠和后续妊娠期间的年龄、孕前体重指数以及每次口服葡萄糖耐量试验（OGTT）时间点（空腹、1小时和2小时）的血糖值均显著更高，并且两次妊娠间隔期间的体重增加也更多（P<0.001）。后续妊娠年龄>35岁（比值比（OR）=1.540，95%置信区间（CI）=1.257 - 1.886，P<0.001）、首次妊娠巨大儿（OR=1.749，95%CI=1.277 - 2.395，P=0.001）、首次妊娠OGTT血糖值（空腹，OR=2.487，95%CI=1.883 - 3.285，P<0.001；1小时，OR=1.142，95%CI=1.051 - 1.241，P=0.002；2小时，OR=1.290，95%CI=1.162 - 1.432，P<0.001）以及体重增加（OR=1.052，95%CI=1.035 - 1.068，P<0.001）是后续妊娠中GDM的独立危险因素。
对于无GDM病史的女性，包括年龄、巨大儿病史、OGTT值和体重增加等GDM危险因素可在后续妊娠前进行评估。对高危女性需要进行早期预警和干预。
