Abstract：
Gestational diabetes mellitus (GDM) has a rapidly increasing prevalence, which poses challenges to obstetric care and service provision, with known serious long-term impacts on the metabolic health of the mother and the affected offspring. The aim of this study was to evaluate the association between glucose levels on the 75 g oral glucose tolerance test and GDM treatment and outcomes. We performed a retrospective cohort study of women with GDM attending a tertiary Australian hospital obstetric clinic between 2013 and 2017, investigating the relationship between the 75 g oral glucose tolerance test (OGTT) glucose values, and obstetric (timing of delivery, caesarean section, preterm birth, preeclampsia), and neonatal (hypoglycaemia, jaundice, respiratory distress and NICU admission) outcomes. This time frame encompassed a change in diagnostic criteria for gestational diabetes, due to changes in international consensus guidelines. Our results showed that, based on the diagnostic 75 g OGTT, fasting hyperglycaemia, either alone or in combination with elevated 1 or 2 h glucose levels, was associated with the need for pharmacotherapy with either metformin and/or insulin (p < 0.0001; HR 4.02, 95% CI 2.88-5.61), as compared to women with isolated hyperglycaemia at the 1 or 2 h post-glucose load timepoints. Fasting hyperglycaemia on the OGTT was more likely in women with higher BMI (p < 0.0001). There was an increased risk of early term birth in women with mixed fasting and post-glucose hyperglycaemia (adjusted HR 1.72, 95% CI 1.09-2.71). There were no significant differences in rates of neonatal complications such as macrosomia or NICU admission. Fasting hyperglycaemia, either alone or in combination with post-glucose elevations on the OGTT, is a strong indicator of the need for pharmacotherapy in pregnant women with GDM, with significant ramifications for obstetric interventions and their timing.
摘要：
妊娠期糖尿病(GDM)患病率迅速增加,这对产科护理和服务提供构成了挑战，已知对母亲和受影响后代的代谢健康有严重的长期影响。这项研究的目的是评估75g口服葡萄糖耐量试验的葡萄糖水平与GDM治疗和结局之间的关系。我们对2013年至2017年在澳大利亚三级医院产科诊所就诊的GDM妇女进行了一项回顾性队列研究，调查了75g口服葡萄糖耐量试验（OGTT）葡萄糖值之间的关系。和产科(分娩时间，剖腹产,早产,先兆子痫)，和新生儿（低血糖，黄疸,呼吸窘迫和NICU入院)结果。这个时间框架包括妊娠期糖尿病诊断标准的变化。由于国际共识准则的变化。我们的研究结果表明,基于诊断75克OGTT，空腹高血糖症，单独或与升高的1或2小时葡萄糖水平组合，与二甲双胍和/或胰岛素药物治疗的需要相关(p<0.0001;HR4.02,95%CI2.88-5.61),与在葡萄糖负荷后1或2小时患有单纯高血糖的女性相比。OGTT的空腹高血糖在BMI较高的女性中更有可能（p<0.0001）。患有混合空腹和血糖升高后高血糖的女性早期分娩风险增加（调整后HR1.72，95％CI1.09-2.71）。新生儿并发症的发生率没有显着差异，例如巨大儿或NICU入院。空腹高血糖症,单独或与OGTT上的葡萄糖后升高相结合，是GDM孕妇需要药物治疗的有力指标，对产科干预及其时机有重大影响。
