Abstract：
OBJECTIVE: To investigate the positive rate of late-onset gestational diabetes mellitus (GDM) by additional fasting blood glucose (FBG) screening at 32-34 gestational weeks (GW) and analyse the perinatal outcomes of late-onset GDM after standard treatment.
METHODS: An Prospective cohort study.
METHODS: Single centre in China.
METHODS: 1130 singleton pregnancies with negative GDM screening in their first and second trimester.
METHODS: Additional FBG testing was performed at 32-34 GW. Pregnancies with FBG ≥5.1 mmol/L were diagnosed as GDM and received standardized treatment. Perinatal outcomes were collected and compared.
METHODS: Diagnosis of late-onset GDM, obstetric and neonatal outcomes.
RESULTS: 6.3% (71/1130) of participants had FBG values ≥5.1 mmol/L and were diagnosed with late-onset GDM. Sixty-five (91.5%) were treated by dietary therapy and 6 (8.5%) by insulin therapy. The perinatal outcomes of full-term delivery were compared. The incidence of macrosomia (22.7% vs. 5.1%, adjusted odds ratio (aOR) 5.51, 95% confidence interval (CI) 1.83-16.61, p = 0.002) and NICU transferring (18.3% vs. 10.1%, aOR 1.94, 95% CI 1.01-3.74, p = 0.046) was significantly higher in late-onset GDM group than that in FBG <5.1 mmol/L group. Elevated FBG was associated with overweight or obesity during pregnancy (54.9% vs. 34.9%, OR 2.27, 95% CI 1.40-3.68, p = 0.001).
CONCLUSIONS: 6.3% of singleton pregnancies with normal GDM screening results in the first and second trimester were found to have late-onset GDM by additional FBG screening at 32-34 GW, and their risk of macrosomia during a full-term pregnancy remains significantly higher after standard treatment.
METHODS: An Prospective cohort study.
METHODS: Single centre in China.
METHODS: 1130 singleton pregnancies with negative GDM screening in their first and second trimester.
METHODS: Additional FBG testing was performed at 32-34 GW. Pregnancies with FBG ≥5.1 mmol/L were diagnosed as GDM and received standardized treatment. Perinatal outcomes were collected and compared.
METHODS: Diagnosis of late-onset GDM, obstetric and neonatal outcomes.
RESULTS: 6.3% (71/1130) of participants had FBG values ≥5.1 mmol/L and were diagnosed with late-onset GDM. Sixty-five (91.5%) were treated by dietary therapy and 6 (8.5%) by insulin therapy. The perinatal outcomes of full-term delivery were compared. The incidence of macrosomia (22.7% vs. 5.1%, adjusted odds ratio (aOR) 5.51, 95% confidence interval (CI) 1.83-16.61, p = 0.002) and NICU transferring (18.3% vs. 10.1%, aOR 1.94, 95% CI 1.01-3.74, p = 0.046) was significantly higher in late-onset GDM group than that in FBG <5.1 mmol/L group. Elevated FBG was associated with overweight or obesity during pregnancy (54.9% vs. 34.9%, OR 2.27, 95% CI 1.40-3.68, p = 0.001).
CONCLUSIONS: 6.3% of singleton pregnancies with normal GDM screening results in the first and second trimester were found to have late-onset GDM by additional FBG screening at 32-34 GW, and their risk of macrosomia during a full-term pregnancy remains significantly higher after standard treatment.
摘要：
目的：通过32～34孕周（GW）额外空腹血糖（FBG）筛查，了解晚发性妊娠期糖尿病（GDM）的阳性率，并分析标准治疗后晚发性GDM的围生期结局。
方法：前瞻性队列研究。
方法：中国单一中心。
方法：1130例妊娠早期和中期GDM筛查阴性的单胎妊娠。
方法：在32-34GW下进行额外的FBG测试。FBG≥5.1mmol/L的孕妇被诊断为GDM，并接受标准化治疗。收集并比较围产期结局。
方法：晚发性GDM的诊断，产科和新生儿结局。
结果：6.3%(71/1130)的参与者FBG值≥5.1mmol/L，并被诊断为迟发性GDM。饮食治疗65例（91.5％），胰岛素治疗6例（8.5％）。比较足月分娩的围产期结局。巨大儿的发病率(22.7%vs.5.1%,调整后的比值比（aOR）5.51，95%置信区间（CI）1.83-16.61，p=0.002）和NICU转移（18.3%vs.10.1%,aOR1.94，95％CI1.01-3.74，p=0.046）晚发性GDM组明显高于FBG<5.1mmol/L组。妊娠期FBG升高与超重或肥胖相关（54.9%vs.34.9%,OR2.27，95%CI1.40-3.68，p=0.001）。
结论：6.3%的妊娠早期和中期GDM筛查结果正常的单胎妊娠通过32-34GW的额外FBG筛查发现有迟发性GDM，在标准治疗后，他们在足月妊娠期间发生巨大儿的风险仍然明显更高。
方法：前瞻性队列研究。
方法：中国单一中心。
方法：1130例妊娠早期和中期GDM筛查阴性的单胎妊娠。
方法：在32-34GW下进行额外的FBG测试。FBG≥5.1mmol/L的孕妇被诊断为GDM，并接受标准化治疗。收集并比较围产期结局。
方法：晚发性GDM的诊断，产科和新生儿结局。
结果：6.3%(71/1130)的参与者FBG值≥5.1mmol/L，并被诊断为迟发性GDM。饮食治疗65例（91.5％），胰岛素治疗6例（8.5％）。比较足月分娩的围产期结局。巨大儿的发病率(22.7%vs.5.1%,调整后的比值比（aOR）5.51，95%置信区间（CI）1.83-16.61，p=0.002）和NICU转移（18.3%vs.10.1%,aOR1.94，95％CI1.01-3.74，p=0.046）晚发性GDM组明显高于FBG<5.1mmol/L组。妊娠期FBG升高与超重或肥胖相关（54.9%vs.34.9%,OR2.27，95%CI1.40-3.68，p=0.001）。
结论：6.3%的妊娠早期和中期GDM筛查结果正常的单胎妊娠通过32-34GW的额外FBG筛查发现有迟发性GDM，在标准治疗后，他们在足月妊娠期间发生巨大儿的风险仍然明显更高。
