Abstract：
OBJECTIVE: To monitor fetal size and identify predictors for birthweight in women with gestational diabetes (GDM) and normal glucose tolerance (NGT).
METHODS: Cohort study of 1843 women universally screened for GDM, with routine ultrasounds each trimester. Women with GDM and NGT were categorized in subgroups by birthweight centile.
RESULTS: Of the total cohort, 231 (12.5%) women were diagnosed with GDM. Fetal size, incidence of large-for-gestational age (LGA: 12.3% of GDM vs. 12.9% of NGT, p = 0.822) and small-for-gestational age (SGA) neonates (4.8% of GDM vs. 5.1% of NGT, p = 0.886) were similar between GDM and NGT. GDM women with LGA neonates were more insulin resistant at baseline and had more often estimated fetal weight (EFW) ≥ P90 on the 28-33 weeks ultrasound (p = 0.033) than those with AGA (appropriate-for-gestational age) neonates. Compared to NGT women with AGA neonates, those with LGA neonates were more often obese and multiparous, had higher fasting glycemia, a worse lipid profile, and higher insulin resistance between 24 -28 weeks, with more often excessive gestational weight gain. On the 28-33 weeks ultrasound, abdominal circumference ≥ P95 had a high positive predictive value for LGA neonates in GDM (100%), whereas, in both GDM and NGT, EFW ≥ P90 and ≤ P10 had a high negative predictive value for LGA and SGA neonates (> 88%), respectively.
CONCLUSIONS: There were no differences in fetal size throughout pregnancy nor in LGA incidence between GDM and NGT women. EFW centile at 28-33 weeks correlated well with birthweight. This indicates that GDM treatment is effective and targeted ultrasound follow-up is useful. TRIAL REGISTRATION CLINICALTRIALS.GOV: NCT02036619. Registration date: January 15, 2014. https://clinicaltrials.gov/ct2/show/NCT02036619 .
METHODS: Cohort study of 1843 women universally screened for GDM, with routine ultrasounds each trimester. Women with GDM and NGT were categorized in subgroups by birthweight centile.
RESULTS: Of the total cohort, 231 (12.5%) women were diagnosed with GDM. Fetal size, incidence of large-for-gestational age (LGA: 12.3% of GDM vs. 12.9% of NGT, p = 0.822) and small-for-gestational age (SGA) neonates (4.8% of GDM vs. 5.1% of NGT, p = 0.886) were similar between GDM and NGT. GDM women with LGA neonates were more insulin resistant at baseline and had more often estimated fetal weight (EFW) ≥ P90 on the 28-33 weeks ultrasound (p = 0.033) than those with AGA (appropriate-for-gestational age) neonates. Compared to NGT women with AGA neonates, those with LGA neonates were more often obese and multiparous, had higher fasting glycemia, a worse lipid profile, and higher insulin resistance between 24 -28 weeks, with more often excessive gestational weight gain. On the 28-33 weeks ultrasound, abdominal circumference ≥ P95 had a high positive predictive value for LGA neonates in GDM (100%), whereas, in both GDM and NGT, EFW ≥ P90 and ≤ P10 had a high negative predictive value for LGA and SGA neonates (> 88%), respectively.
CONCLUSIONS: There were no differences in fetal size throughout pregnancy nor in LGA incidence between GDM and NGT women. EFW centile at 28-33 weeks correlated well with birthweight. This indicates that GDM treatment is effective and targeted ultrasound follow-up is useful. TRIAL REGISTRATION CLINICALTRIALS.GOV: NCT02036619. Registration date: January 15, 2014. https://clinicaltrials.gov/ct2/show/NCT02036619 .
摘要：
目的：监测妊娠糖尿病（GDM）和糖耐量正常（NGT）妇女的胎儿大小并确定出生体重的预测因素。
方法：队列研究对1843名女性进行了GDM筛查，每三个月进行常规超声检查。GDM和NGT的女性按出生体重百分位分为亚组。
结果：在总队列中，231名（12.5%）女性被诊断为GDM。胎儿大小,胎龄较大的发生率(LGA：GDM的12.3%与12.9%的NGT，p=0.822）和小于胎龄儿（SGA）新生儿（GDM的4.8％与5.1%的NGT，p=0.886）在GDM和NGT之间相似。患有LGA新生儿的GDM妇女在基线时更胰岛素抵抗，并且在28-33周超声检查中（p=0.033）的估计胎儿体重（EFW）≥P90的频率高于AGA（适合胎龄）新生儿。与NGT女性AGA新生儿相比，那些患有LGA的新生儿更经常肥胖和多胎，空腹血糖较高，更坏的血脂，和更高的胰岛素抵抗之间24-28周，更常见的是妊娠期体重增加过多。在28-33周的超声检查中，腹围≥P95对GDM中LGA新生儿有较高的阳性预测值(100%)，然而,在GDM和NGT中，EFW≥P90和≤P10对LGA和SGA新生儿有较高的阴性预测值(>88%)，分别。
结论：GDM和NGT妇女在整个妊娠期间胎儿大小和LGA发生率均无差异。28-33周时的EFW百分位数与出生体重密切相关。这表明GDM治疗是有效的并且靶向超声随访是有用的。审判注册临床试验。GOV：NCT02036619。报名日期：2014年1月15日。https://clinicaltrials.gov/ct2/show/NCT02036619.
方法：队列研究对1843名女性进行了GDM筛查，每三个月进行常规超声检查。GDM和NGT的女性按出生体重百分位分为亚组。
结果：在总队列中，231名（12.5%）女性被诊断为GDM。胎儿大小,胎龄较大的发生率(LGA：GDM的12.3%与12.9%的NGT，p=0.822）和小于胎龄儿（SGA）新生儿（GDM的4.8％与5.1%的NGT，p=0.886）在GDM和NGT之间相似。患有LGA新生儿的GDM妇女在基线时更胰岛素抵抗，并且在28-33周超声检查中（p=0.033）的估计胎儿体重（EFW）≥P90的频率高于AGA（适合胎龄）新生儿。与NGT女性AGA新生儿相比，那些患有LGA的新生儿更经常肥胖和多胎，空腹血糖较高，更坏的血脂，和更高的胰岛素抵抗之间24-28周，更常见的是妊娠期体重增加过多。在28-33周的超声检查中，腹围≥P95对GDM中LGA新生儿有较高的阳性预测值(100%)，然而,在GDM和NGT中，EFW≥P90和≤P10对LGA和SGA新生儿有较高的阴性预测值(>88%)，分别。
结论：GDM和NGT妇女在整个妊娠期间胎儿大小和LGA发生率均无差异。28-33周时的EFW百分位数与出生体重密切相关。这表明GDM治疗是有效的并且靶向超声随访是有用的。审判注册临床试验。GOV：NCT02036619。报名日期：2014年1月15日。https://clinicaltrials.gov/ct2/show/NCT02036619.
