Dutta Deep, Kumar Manoj, Jindal Radhika, Joshi Ameya, Kamrul-Hasan Abul B M, Bhattacharya Saptarshi
Department of Endocrinology, Center for Endocrinology Diabetes Arthritis and Rheumatism (CEDAR) Superspeciality Healthcare, Dwarka, New Delhi, India.
Department of Endocrinology, Maharishi Markandeshwar Institute of Medical Sciences, Ambala, Haryana, India.
Indian J Endocrinol Metab. 2025 Jul-Aug;29(4):381-393. doi: 10.4103/ijem.ijem_140_25. Epub 2025 Jul 11.
The significance of hypoglycaemia during oral glucose tolerance tests (OGTT) in pregnancy is uncertain. This systematic review and meta-analysis (SRM) evaluated if hypoglycaemia during OGTT predicts feto-maternal outcomes. Electronic databases were searched for studies in pregnancy where an OGTT at 24-28 weeks was done and feto-maternal outcomes were documented. Hypoglycaemia during OGTT (reactive hypoglycaemia) was defined as blood glucose < 90 mg/dl or less than the fasting-glucose value. Primary outcomes were the occurrence of small-for-gestational-age (SGA) and neonatal intensive-care unit (NICU) admission. Secondary outcomes were birthweight, macrosomia, large-for-gestational-age (LGA), gestational age at delivery (GA), 5-minute Apgar score (5AS), caesarean section (CS), and pregnancy-induced hypertension (PIH). Association of hypoglycaemia with pre-pregnancy maternal weight, maternal weight gain during pregnancy, and maternal age was noted. PRISMA guidelines were followed, and the preestablished protocol was registered on PROSPERO (CRD42025644556). From initially screened 448 articles, data from 13 articles involving 30,462 women were analysed. Compared to normoglycemia, hypoglycaemia during OGTT was associated with significantly higher SGA [OR1.81;95%CI1.31-2.50; = .0003], higher NICU admission [OR 1.44; 95% CI 1.17-1.76; < .001; I = 0%], lower birthweight [MD-68.38g; 95%CI -126.25- -10.52; = .020], lower macrosomia [OR 0.60;95%CI 0.42-0.86; < .005], higher 5AS <8 [OR2.53;95%CI1.37-4.68; = .003], lower CS [OR 0.82;95%CI0.75-0.90; < .0001], lower maternal pre-pregnancy weight [MD -4.90 kg; 95%CI 9.17-0.62; = .02; = 75%] and higher gestational-hypertension [OR 1.31; 95%CI 1.03 -1.66; = .030]. The rates of SGA, LGA, 5AS <8, and maternal age were similar in women with hypoglycaemia and gestational diabetes. Hypoglycaemia during OGTT is associated with gestational hypertension, lower birthweight, increased SGA, higher NICU admission, and higher 5AS <8. Lower maternal pre-pregnancy weight was a predictor of hypoglycaemia during OGTT.
孕期口服葡萄糖耐量试验（OGTT）期间低血糖的意义尚不确定。本系统评价和荟萃分析（SRM）评估了OGTT期间的低血糖是否能预测母婴结局。通过电子数据库检索孕期进行24 - 28周OGTT并记录母婴结局的研究。OGTT期间的低血糖（反应性低血糖）定义为血糖<90mg/dl或低于空腹血糖值。主要结局是小于胎龄儿（SGA）的发生和新生儿重症监护病房（NICU）收治情况。次要结局包括出生体重、巨大儿、大于胎龄儿（LGA）、分娩孕周（GA）、5分钟阿氏评分（5AS）、剖宫产（CS）和妊娠期高血压（PIH）。记录低血糖与孕前母体体重、孕期母体体重增加以及母体年龄的关联。遵循PRISMA指南，并在PROSPERO（CRD42025644556）上注册了预先制定的方案。从最初筛选的448篇文章中，分析了13篇文章中30462名女性的数据。与血糖正常相比，OGTT期间的低血糖与显著更高的SGA[比值比（OR）1.81；95%置信区间（CI）1.31 - 2.50；P = 0.0003]、更高的NICU收治率[OR 1.44；95%CI 1.17 - 1.76；P < 0.001；异质性指数（I²） = 0%]、更低的出生体重[平均差（MD）- 68.38g；95%CI - 126.25 - - 10.52；P = 0.020]、更低的巨大儿发生率[OR 0.60；95%CI 0.42 - 0.86；P < 0.005]、更高的5AS<8发生率[OR 2.53；95%CI 1.37 - 4.68；P = 0.003]、更低的CS发生率[OR 0.82；95%CI 0.75 - 0.90；P < 0.0001]、更低的孕前母体体重[MD - 4.90kg；95%CI - 9.17 - - 0.62；P = 0.02；I² = 75%]以及更高的妊娠期高血压发生率[OR 1.31；95%CI 1.03 - 1.66；P = 0.030]相关。低血糖和妊娠期糖尿病女性的SGA、LGA、5AS<8发生率以及母体年龄相似。OGTT期间的低血糖与妊娠期高血压、更低的出生体重、SGA增加、更高的NICU收治率以及更高的5AS<8发生率相关。孕前母体体重较低是OGTT期间低血糖的一个预测因素。
