Li Yuan, Zhu Yumin, Zheng Wenjun, Gao Yumei, Huang Ruili, Yang Tingting, Chen Ying
Department of Gynaecology and Obstetrics, The First People's Hospital of Shangqiu, Clinical College of Xuzhou Medical University, Shang Qiu, Henan, China.
Front Endocrinol (Lausanne). 2025 May 29;16:1587306. doi: 10.3389/fendo.2025.1587306. eCollection 2025.
Gestational diabetes mellitus (GDM) is a prevalent condition during pregnancy, and macrosomia is a recognized risk associated with it. However, the specific relationship between fasting blood glucose (FBG) levels and the risk of macrosomia in GDM, particularly any potential thresholds for this relationship, remains unclear.
This retrospective cohort study analyzed data from 7,957 pregnant women who underwent antenatal care and delivered at The First People's Hospital of Shangqiu between February 1, 2018, and December 30, 2022. Participants were stratified into three groups based on FBG levels: <5.1 mmol/L, 5.1-7 mmol/L, and ≥7 mmol/L. Multivariable logistic regression analyses were performed to assess the association between FBG levels and the risk of macrosomia. Two-piecewise regression models were applied to identify a threshold for the FBG-macrosomia relationship.
The prevalence of macrosomia increased substantially with increasing FBG levels (P < 0.001). The adjusted multivariable logistic regression analyses revealed that compared to women with FBG levels <5.1 mmol/L, those with FBG levels of 5.1-7 mmol/L and ≥7 mmol/L had 4.69 (95% CI: 4.06-5.42) and 8.65 (95% CI: 7.31-10.23) times higher risk of macrosomia, respectively (both P < 0.001). Two-piecewise regression models identified a threshold of 8.037 mmol/L. Below this threshold, each unit increase in FBG was associated with a 1.93-fold increase in the odds of macrosomia (95% CI: 1.83-2.04, P < 0.001). Above this threshold, the association was no longer statistically significant (OR = 1.04, 95% CI: 0.90-1.21, P = 0.587). Furthermore, the stratified analysis also showed a positive association between FBG level and macrosomia.
There is a nonlinear relationship between FBG levels during pregnancy and the risk of macrosomia in GDM women, with a potential threshold effect at 8.037 mmol/L. Below the threshold, macrosomia prevalence markedly rises with elevated FBG levels, whereas above it, the association loses significance, implying a potential saturation at very high glucose levels.
妊娠期糖尿病（GDM）是孕期常见的病症，巨大儿是与之相关的一种公认风险。然而，空腹血糖（FBG）水平与GDM患者巨大儿风险之间的具体关系，尤其是这种关系的任何潜在阈值，仍不明确。
这项回顾性队列研究分析了2018年2月1日至2022年12月30日期间在商丘市第一人民医院接受产前检查并分娩的7957名孕妇的数据。参与者根据FBG水平分为三组：<5.1 mmol/L、5.1 - 7 mmol/L和≥7 mmol/L。进行多变量逻辑回归分析以评估FBG水平与巨大儿风险之间的关联。应用两段式回归模型确定FBG与巨大儿关系的阈值。
巨大儿的患病率随着FBG水平的升高而显著增加（P < 0.001）。调整后的多变量逻辑回归分析显示，与FBG水平<5.1 mmol/L的女性相比，FBG水平为5.1 - 7 mmol/L和≥7 mmol/L的女性发生巨大儿的风险分别高4.69倍（95% CI：4.06 - 5.42）和8.65倍（95% CI：7.31 - 10.23）（均P < 0.001）。两段式回归模型确定的阈值为8.037 mmol/L。低于该阈值时，FBG每升高一个单位，巨大儿的几率增加1.93倍（95% CI：1.83 - 2.04，P < 0.001）。高于该阈值时，这种关联不再具有统计学意义（OR = 1.04，95% CI：0.90 - 1.21，P = 0.587）。此外，分层分析也显示FBG水平与巨大儿之间存在正相关。
孕期FBG水平与GDM女性巨大儿风险之间存在非线性关系，在8.037 mmol/L处存在潜在的阈值效应。低于该阈值时，巨大儿患病率随FBG水平升高而显著上升，而高于该阈值时，这种关联失去意义，这意味着在非常高的血糖水平可能存在饱和现象。
